What to Know About Groin Pain: Causes, Treatment and Prevention

Groin pain can suddenly sideline people of all ages and fitness levels — whether you’re a young athlete in peak condition, a middle-aged office worker who isn’t very active or a retired fitness buff who works out regularly.

“A strain, pull or tear to one or more muscles in this area can result in groin pain,” says Warren Young, MD, a primary sports medicine physician at HSS Westchester. “But groin pain can be a symptom of other conditions, so it shouldn’t be ignored.”

Groin Anatomy 101

The groin is located in the inner part of the hip between the thighs and the abdomen. It contains several muscles including: 

• Hip flexors: These muscles toward the front of the hip help you move your leg and knee up toward your body. The iliopsoas muscle is the primary flexor of the hip joint and is important for standing, walking and running. 
• Hip adductors: These muscles on your inner thighs extend between the thighbones and the pelvis. They help you bring your legs together. 
• Core muscles: Your core includes your abdominal muscles, plus more in your back and pelvis. The rectus abdominis, also known as the “six pack” muscles, attach to the pelvis and aid in core stability and movement.

Causes of Groin Pain  

Pain in the groin is often caused by chronic overuse of the hip flexors or adductors. Possible causes of groin pain include: 

• A pull of one of these muscle groups, also known as groin strain. 
• Extreme bending or repetitive motions that occur during a sports activity or physical labor. These movements can strain or tear muscles and connective tissues or cause a sports hernia or inguinal hernia (the most common type of hernia, which occurs in the groin).
• Inflammation of the joint between the pubic bones. Overusing the hips, pelvis and groin can lead to this condition, also known as osteitis pubis.
• Stress fractures of the hip or pelvis or a tear of the labrum (cartilage that lines the rim of the hip socket). These injuries could be caused by running or jumping too much and not allowing enough time for the body to rest and heal.

Groin pain can also be caused by an acute or traumatic injury, including a forceful impact. “You might see bruising with an acute muscle injury or tear, whereas someone with a hernia may notice a soft mass or bump in that area,” explains Dr. Young. 

Certain conditions or even infection can also lead to groin pain. For example:  

• Congenital conditions such as hip dysplasia, an instability of the hip that occurs when the socket of the hip joint doesn’t fully support the ball of the joint due to abnormal bone development. This can increase your risk of dislocating the hip.
• Femoroacetabular impingement, also known as hip impingement, which happens when the bones of the hip joint don't fit together properly and rub against each other. This condition can cause wear and tear on the hip joint and increase risk for hip pain, osteoarthritis and labrum tears.
• Orthopedic conditions such as osteoarthritis of the hip.
• Testicular torsion (when the cord that provides blood flow to the testicle twists and cuts off that blood flow, causing sudden pain and swelling).
• Infection of the epididymis, a structure associated with testes. 

When to See a Doctor for Groin Pain

According to Dr. Young, groin pain should not be ignored for long.  “A mild strain will go away and resolve in two to six weeks, while other injuries like a stress fracture will worsen as you continue or increase your activity,” he says. “I recommend getting groin pain evaluated after a sudden onset of severe pain or pain that persists and limits your activity.”

Dr. Young suggests that patients contact their primary care doctor to discuss their symptoms, but they should request to see a sports medicine physician if their symptoms point to anything beyond a strain. The physician should do a complete evaluation, including a physical exam in the office, as well as an in-depth medical history to identify any predisposing factors that may make a certain diagnosis more likely.

An X-ray may be done as a first step. “If there are additional concerns regarding a possible stress fracture, labrum tear, or significant muscle tear, an MRI would be helpful to assess the area more thoroughly,” adds Dr. Young.  

Treatment Options for Groin Pain

Initial treatment of groin pain includes icing the area, getting lots of rest and avoiding activities that cause pain such as running and jumping. If the pain lasts more than two weeks, Dr. Young recommends that patients be evaluated.

Different treatments are recommended depending on the cause of the groin pain:

• Muscle and tendon strains can be alleviated with rest, ice, pain medicines and physical therapy.
• Stress fractures and labrum tears require an extended period of complete rest from running and jumping, use of crutches and physical therapy. Hip fractures and labrum tears may need surgery.
• Treatment for hip impingement includes an extended period of complete rest from running and jumping, use of crutches and physical therapy. Surgery is sometimes required. 
• Osteoarthritis is often treated with rest, anti-inflammatory medicines, physical therapy, cortisone injections and eventually hip replacement surgery.
• Sports hernia is initially treated with rest, anti-inflammatories, and physical therapy.  Surgery is sometimes required. 
• Testicular torsion requires surgery right away to save the testicle.

Preventing Groin Pain

According to Dr. Young, hip and core muscle strengthening and stretching exercises can be helpful to prevent muscle injuries, including muscle and tendon strains. 

He also suggests that people maintain a healthy weight or lose excess weight to help decrease the risk of hip arthritis. 

Groin pain can be a symptom of a problem that gets worse without treatment, so early intervention is key to preventing that from happening. 

“In general, it’s important that people not put off seeing a doctor to evaluate any sudden and severe groin pain, or pain that persists,” emphasizes Dr. Young. “Delayed diagnosis of a stress fracture can lead to long-term injury of the hip joint, and non-orthopedic causes of groin pain need to be identified early on in order to address them as soon as possible.”