Adductor and groin pain in runners and footballers

Groin pain in athletes includes multiple distinct presentations that require different management. The most common: adductor-related groin pain (adductor muscle or tendon), inguinal-related groin pain (inguinal ligament area, sometimes called sports hernia or athletic pubalgia), pubic-related groin pain (symphysis pubis stress), and hip-flexor related groin pain.

Treating all groin pain as "adductor strain" produces poor outcomes for most presentations. Clinical differentiation, based on palpation, provocation testing, and loading assessment, is the starting point.

Medial thigh and groin pain that is provoked by adductor loading (resisted adduction, single-leg stance, kicking, change of direction) and palpation of the adductor muscle belly or its proximal tendon. Common in footballers, hockey players, and runners with high lateral movement demands.

Management: the Copenhagen adductor programme has strong evidence for both treatment and prevention. Progressive adductor loading (side-lying adduction, Copenhagen plank, lateral squat variations) is the primary intervention. Soft tissue work reduces acute tissue reactivity and maintains quality through the loading programme.

Athletic pubalgia involves disruption of the posterior inguinal wall or conjoint tendon at the pubic symphysis. It produces deep groin and pubic pain that radiates to the adductor region, is worse with explosive effort (sprinting, kicking), and does not clearly respond to adductor loading.

This distinction matters because athletic pubalgia frequently requires surgical repair for athletes who want to return to high-level sport, the loading protocol that works for adductor strain does not address the structural disruption.

For adductor-related presentations, manual work to the adductor group reduces acute reactivity and allows earlier entry into the loading programme. MFR to the adductor origin and proximal tendon is particularly useful in chronic presentations where tissue quality has deteriorated.

The most important clinical question: what is the correct diagnosis? A clinical assessment is the appropriate starting point for any groin pain that has not resolved within 3 weeks of rest and light loading.