The BEST Groin Pain Treatment (Causes, Exercises & 3 Free Programs)

Do you have pain in your groin when playing sport, squatting, or other day-to-day activities? In this article, we’ll look at the best groin pain treatment.

According to the current scientific evidence, there are 5 possible causes.

First, I’ll show you how to identify what’s causing your pain.

Next, we’ll touch on whether you should get imaging or not. After that, you will discover the best treatment approach (including exercises).

And finally, to make the implementation as easy as possible, I’ll give you 3 sample programs. One for the early stage, one for the mid-stage, and one for the late stage of your rehab.

By the end of this article, you’ll have everything you need to start an effective rehab immediately.

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The Big Problem

Does this look familiar to you?

Groin Pain Treatment - Boom-Bust-Cycle

Your pain increases after activity. It gets to a point where it doesn’t feel right anymore. So you take a break from sports.

I mean you don’t want to make things worse, right?

The break leads to an improvement in your symptoms. Yay! Yet as soon as you’re more active again, your pain comes back until you have to take another break. And so the cycle continues.

The reason for this is actually very simple. And we’ll get to that when we cover the treatment approach.

For now, I need you to understand that this approach doesn’t work (obviously). And that you have to change something about that.

Now we have to talk about the 5 potential causes of your pain.

The 5 Potential Causes of Your Groin Pain

According to the Doha Agreement, we have these potential causes (Thorborg et al. 2018):

  1. Adductor-related pain
  2. Pubic-related pain
  3. Inguinal-related pain
  4. Iliopsoas-related pain
  5. Hip-related pain

Here is some advice that will guide you in the right direction:

First of all: research recommends that palpation can help identify the tissue. That means – apply light pressure to the sensitive area.

Here are the pressure points described in research:

Groin Pain Treatment - Palpation

This manual testing raises our suspicion and moves us closer to one affected area.

Now I want to get into more detail about each source of pain.

  • Pain around the insertion of the adductor longus tendon at the pubic bone. Pain may radiate distally along the medial thigh.
  • Pain on adductor stretching & contraction.

Groin Pain Treatment - Anatomy
  • Pain in the anterior part of the thigh, more outward than adductor-related groin pain.
  • Pain with resisted hip flexion or hip flexor stretching.
  • Pain reproduced with resisted abdominal muscle testing.

  • Pain in the inguinal region that worsens with activity.
  • If pain is severe, often inguinal pain occurs when coughing or sneezing or sitting up in bed.

  • Pain in the region of the symphysis joint and the immediately adjacent bone.
  • More likely if pain is reproduced by resisted abdominal and hip adductor testing.

  • Mechanical symptoms present, such as catching, locking, clicking, or giving way. Catching means that you feel a sudden resistance when moving the hip. Locking means that the hip may feel as if it is stuck in a position. Clicking means that you hear a pop or click as you move your hip in certain directions. Giving way describes a feeling of instability. Your hip seems to lose strength or support during movement.
  • Motion- or position-related pain in the hip or groin. Pain may also be felt in the back, buttock, or thigh.
  • Limited range of hip motion (typically restricted internal rotation).
  • Evidence of labral and/or chondral damage on imaging.

Should You Get Imaging or Not?

So what kind of imaging is most useful for which source of pain?

Groin pain treatment - clinical examination

Adductor and Pubic related pain → Ultrasound / MRI

Inguinal or Iliopsoas related pain → Ultrasonography

Hip related → X-Ray / MRI

One important side note here:

Inappropriate or excessive imaging can be a problem. Because imaging findings alone do NOT equate to pathology. Imaging results can cause fear and increase pain.

Why? Because findings are very common. But that’s only part of the truth. Many findings don’t correlate with pain!

About 7 out of 10 people will have abnormalities in their hip WITHOUT pain (Register at al. 2012)

„The vast majority of hip and groin pain can be treated without any imaging whatsoever.“ – Dr. John Snyder

So: no imaging early in the process. Unless medical professionals suspect a serious pathology that needs immediate clarification.

Otherwise: go for 1-2 months of conservative treatment first. If your symptoms aren’t improving or are worsening consider imaging.

The Best Groin Pain Treatment Approach

Surgery or Not?

Research suggests, that non-surgical treatment should be the way to go. Because surgery doesn’t lead to better results and has a much higher risk of adverse events (King et al. 2015).

Rehab principle

As I discuss in chapter 2 of my book “Pain Free Athlete“, load management is absolutely critical in rehab. This also applies to groin pain.

The activities you are performing at the moment are too strenuous for your groin. That’s why it’s useful to take a step back from the pain-provoking activities.

At the same time, you don’t want to stop and wait until the pain subsides and then return to your previous activities. This often leads to the boom-bust-cycle that we’ve covered before.

Instead, you want to build up the load tolerance of the tissue. And you achieve that by performing specific exercises.

Very important: Start with a low intensity that your body tolerates well. And then increase the load gradually. Many make the mistake of doing waaaay too much.

By the way: I have more info on how to create a successful pain rehab program in my free pain guide. To receive it, simply enter your name and email into the form.



Okay now that we have a solid foundation of knowledge, let’s talk about exercises.

Exercises

It goes without saying that you want to specifically address the muscles in your groin. These are mainly your adductors.

Groin Pain Treatment - Leg Muscles

But you also want to train your abductors and your abs. This will set you up for an optimal, comprehensive rehab.

Adductors:

  • Copenhagen Plank Progression
Groin Pain Treatment - Copenhagen Plank Progression
  • Do the Copenhagen Plank isometrically then dynamically if they work well

Groin Pain Treatment - Seated & Standing Abduction

Abductors:

Groin Pain Treatment - Side Plank Progression
Groin Pain Treatment - Seated & Standing Abduction

Abs:

Groin Pain Treatment - Plank Progression
Groin Pain Treatment - Leg Raise Progression

How many steps and reps should you do per exercise? Aim for 3 Sets of 10-20 repetitions for the dynamic exercises. And 3 Sets of 30-60s hold times for the isometric exercises.

Perform the exercises 2-3 times per week with at least one rest day between.

Those exercises are getting too easy for you? Great! Then make sure you progress into more complex movements again. We’re talking:

Groin Pain Treatment - Complex Movements

Go for 3 Sets of 8-15 reps per exercise here.

Perform them 2x per week with at least 2 rest days between.

Start with a slow tempo here and get more explosive over time.

And finally – if you take part in a sport that requires cutting, jumping, etc. prepare for that stuff! Helpful exercises would be:

  • Hops (2 legs, 1 leg)

Groin Pain Treatment - Hops
  • Landings (2 legs, 1 leg)

Groin Pain Treatment - Landings
  • Jumps (Countermovement, Drop Jump)

Groin Pain Treatment - Jumps

Go for 3 sets of 30s for the hops. And 3 sets of 4-10 reps work well for the landings and jumps.

Start with lower reps and increase them over time. Perform these jumpy exercises 2x per week with at least 2 rest days between.

Of course, you shouldn’t do all the exercises at once. Let’s take a look at the sample programs that I prepared for you.

Sample Programs

Conclusion & Next Steps

  • There are 5 different sources of groin pain:
  1. Adductor-related
  2. Pubic-related
  3. Inguinal-related
  4. Iliopsoas-related
  5. Hip-related

  • Avoid excessive and early imaging.
  • Non-surgical treatment is the way to go.
  • Treatment looks more or less the same for all mentioned types of groin pain:
  • Reduce aggravating activities at first.
  • Work specifically on the affected tissue.
  • Address the abductors and abs as well.
  • Build up your load tolerance over time by doing a progressive exercise program.

Now take one of the sample sessions and get started today. You can always adjust along the way if something is too easy or too hard.

If you’re not progressing the way you want to, you can always apply for an online pain coaching with me and my team. To get more information, click here.

Don’t forget to grab your copy my the free pain e-book I mentioned earlier. This will help you avoid massive ups and downs in your rehab. And it’ll help you stay on track.



And if you want to know the unknown truth about deep core muscle training, continue with this article.


Literature

  • King, E., Ward, J., Small, L., Falvey, E., & Franklyn-Miller, A. (2015). Athletic groin pain: a systematic review and meta-analysis of surgical versus physical therapy rehabilitation outcomes. British journal of sports medicine49(22), 1447–1451. https://doi.org/10.1136/bjsports-2014-093715
  • Schöberl, M., Prantl, L., Loose, O., Zellner, J., Angele, P., Zeman, F., Spreitzer, M., Nerlich, M., & Krutsch, W. (2017). Non-surgical treatment of pubic overload and groin pain in amateur football players: a prospective double-blinded randomised controlled study. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA25(6), 1958–1966. https://doi.org/10.1007/s00167-017-4423-z
  • Register, B., Pennock, A. T., Ho, C. P., Strickland, C. D., Lawand, A., & Philippon, M. J. (2012). Prevalence of abnormal hip findings in asymptomatic participants: a prospective, blinded study. The American journal of sports medicine40(12), 2720–2724. https://doi.org/10.1177/0363546512462124
  • Thorborg, K., Reiman, M. P., Weir, A., Kemp, J. L., Serner, A., Mosler, A. B., & HÖlmich, P. (2018). Clinical Examination, Diagnostic Imaging, and Testing of Athletes With Groin Pain: An Evidence-Based Approach to Effective Management. The Journal of orthopaedic and sports physical therapy48(4), 239–249. https://doi.org/10.2519/jospt.2018.7850
  • Weir, A., Jansen, J. A., van de Port, I. G., Van de Sande, H. B., Tol, J. L., & Backx, F. J. (2011). Manual or exercise therapy for long-standing adductor-related groin pain: a randomised controlled clinical trial. Manual therapy16(2), 148–154. https://doi.org/10.1016/j.math.2010.09.001

Gino Lazzaro

Gino has a Master's degree in sports physiotherapy. In his company Pain Physio, he offers highly individualized 1:1 Pain Coaching for athletes who have been dealing with pain for more than three months. You can apply here.

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