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The 5 steps to treating groin injuries

Your groin is a bit like Kings Cross station in London with several different structures crossing and attaching in that area. In this article I’ll discuss the most common causes for groin pain in runners and running sports and give you some tips on how to get it better. Remember to join the Sports Injury Group to ask questions or get more injury prevention advice.

In this article:

  • What structures can cause groin pain?

  • The 5 steps to treating groin injuries

Here's the video from the livestream I did in the Facebook Group:



What structures can cause groin pain?


The groin area is a very “busy” area with loads of bones, ligaments, muscles, tendons and nerves either attaching there or crossing over it and any of them can be the cause of your pain. I’ve decided to list only the most common causes for groin pain that I see in runners/running sports.


1. Hip joint impingement

When we run and walk our legs are meant to move in pretty much a straight line. In some people their hips may turn in too much when they run, causing the bones in the groin to press against each other. If this happens often it can cause inflammation and pain deep in the groin.


This type of injury usually causes a gradual build-up of pain over several days or weeks. The main cause for this is usually a lack of good muscle strength and pelvic stability and can easily be fixed by following the right rehab programme.


2. Muscle strains/tears

A strain or tear in any of the muscles that attach around the groin area can cause pain there. The most common ones are the hip flexors (iliopsoas, rectus femoris), adductor muscles and abdominal muscles (rectus abdominus).


You can usually tell that you’ve torn or strained something if the pain comes on very suddenly and is quite sharp. But ligament strains can feel very similar and there are specific tests that physios can help you perform to distinguish between muscle strains and ligament strains.



3. Gilmore’s groin / Sportsman’s hernia

Gilmore’s groin or Sportsman’s hernia causes pain deep in the groin area. It can start suddenly or develop slowly over time and it usually affects people who play sports that involve a lot of twisting movements e.g. football.


It’s not a true hernia and you don’t get a bulge like you would with a normal hernia. They’re not really sure about what exactly causes the pain but most athletes with this condition seem to have a tear in some of the ligaments and tendons deep inside the inguinal area.


The first line of treatment for Gilmore’s groin is to follow a carefully graded strengthening programme for at least 12 to 24 weeks. If this isn’t successful, you may benefit from surgery to fix or trim the ligaments or tendons at fault.


4. Adductor tendinopathy

Adductor tendinopathy or tendonitis as it’s sometimes called is a very common cause for groin pain in runners. This condition affects the adductor tendons close to where they attach onto your pubic bone and can be very painful.


The pain can come on gradually over a period of days/weeks or during a run. Sometimes you may only feel the pain the day after a hard training session. Initially runners find that they may be able to “run it off” but that it then hurts again after the run. As the injury gets worse it may stop them from running altogether.


You can develop adductor tendinopathy or tendinitis for several reasons but the main ones I see in clinic include if your hip/pelvic stability is poor or if you push your training too much, not allowing enough recovery time or suddenly do a lot of downhill running.



5. Osteitis pubis

Osteitis pubis is another type of over-use injury in the groin. It’s caused by a lack of stability in the core, pelvis and hip which causes the tendons and even the pubic bone to take too much strain. This injury usually develops gradually over several weeks and typically in a runner who has been ignoring his groin pain and has been trying to train through it.


MRI scans usually show bone oedema (swelling in the bone) over the pubic area and the abdominal and adductor tendons are often also affected.


The 5 steps to treating groin injuries


Step 1: Identify the cause of your pain

Getting your injury diagnosed and understanding what exactly caused the injury in the first place will stop you from wasting time on treatments and exercises that aren’t appropriate.


I’m afraid that you cannot get an accurate diagnosis from Google! A sports physio is a good person to consult about this as they can:

  1. Determine what is wrong by listening to how your injury developed, analysing your training schedule and getting you to perform certain test movements. When I see my patients via Skype, I get them to perform a full battery of tests in front of the camera to check their muscle strength and movement patterns. I often also get them to film themselves running on a treadmill so that I can play it back in slow motion and identify factors that could have contributed to their injury.

  2. A physio will also provide you with a treatment plan that addresses all the aspects including how you should adjust your training and what you need to do to strengthen your body and allow your injury to recover.


Step 2: Relative rest

Yes, your injury will likely require a bit of rest to recover BUT you don’t always have to use complete rest. I’m a firm believer in relative rest which means that a person continues all exercise that does not trigger their pain. For instance, if you can run 3 miles slowly without pain during or after the run, then that is fine to do. But if it does cause your pain to increase, it may be a better option to stick to cycling or swimming for a while.


There’s really no recipe for this. I tend to sit with my patients and have a thorough discussion about when they feel pain and what happens with every type of exercise they do and then come up with a plan. This plan is also not set in stone – I try and teach my patients how to decide for themselves what is good vs. what should be avoided.


Relative rest can be a very effective way to maintain your fitness and sanity while actually strengthening your injury!



Step 3: Build strength and flexibility

Some injuries e.g. hip flexor strains can be caused by not being flexible enough while others e.g. adductor tendinopathy and osteitis pubis are usually caused by a lack of muscle strength/control around the pelvis and trunk.


You can see how understanding your injury and its causes plays a key part in deciding what exercises you should do. That said, most groin injuries can usually benefit from improving core and glute strength.


The level of strength training that you start with is also important. Some injuries will allow you to immediately do heavy or strong core workouts while others will flare up if you’re not careful. The exercises that you choose to do should not cause any increase in your symptoms during or after doing them.


Step 4: Your exercises should be progressed over time

Your injury won’t get back to its full strength if you just do the same exercises all the time. Your strength training programme should be progressed over time as you recover and grow stronger.


I usually set my patients clear targets to hit so that they know when they’re ready to move on to the next step. For instance, if you can hop 20 times with good form and no pain you’re usually ready to trial a short run/walk session.


Step 5: Slow return to running

This is where most people get it wrong so please be careful when you go back to running. Your first few runs should be run/walks where you alternate short periods of running and walking.


A run/walk session has 2 benefits:

  1. If you do aggravate your injury, you usually just annoy it rather than piss it off properly which means that it settles down again within a few days. If on the other hand you’ve gone and done a proper run, you may end up flaring it up for a week or more.

  2. A run/walk session is a great way to strengthen your leg and most of my patients find that they can progress to a continuous 20 minute run within 2 or 3 weeks.

You can download an example of a run/walk programme here.



Let me know if you have any questions! You are also welcome to consult me via Skype for a diagnosis of you injury and a bespoke treatment programme.

Best wishes

Maryke


About the Author

Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Masters Degree in Sports Injury Management. Follow her on LinkedIn or ReasearchGate

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