Groin pain manifests as pain in the pubic, groin, or inner thigh area. We discussed this condition in the ninth episode of the Sky Sport Doctor segment, which airs every Saturday morning with our scientific consultation on Sky Sport. The guest of this episode was the Director of our Turin clinic, Dr. Fabrizio Tencone.
What exactly is groin pain?
Groin pain is a very generic expression; it means “pain in the pubic area,” referring to discomfort in the groin and pubic region. It is a chronic and complex condition with numerous possible causes, not limited to those of “sports origin.” A recent Italian scientific study revealed that there are at least 66 potential causes of groin pain!
Do all athletes risk developing groin pain?
Groin pain does not affect all athletes, but it is common among those who practice sports requiring abrupt movements of the lower limbs, rapid changes in direction, sprints, and intense efforts that put significant strain on the groin and pubic area.
Football is certainly among the sports with the highest risk of groin pain, but it’s not the only one!
Another sport at risk of groin pain is tennis, with its rapid lateral movements and sudden changes in direction.
Similarly, in rugby, intense physical contact and rapid accelerations place significant strain on the muscular area around the pubic region.
What are the symptoms?
The main symptoms are pain in the groin area, which can radiate downward toward the inner thigh or upward toward the pubic bone and abdomen.
Initially, the pain is present only during sports activity, it is not sharp, and it disappears after the exertion ends. This is why it is often underestimated at first.
Athletes with groin pain have always told me, “Doc, I didn’t stop right away because I thought it would go away, but here I am, now I can’t even cough…!”
How is the diagnosis made?
The diagnosis, as with most sports-related conditions, is made through three fundamental steps:
- 1 – Hearing the athlete’s narrative;
- 2 – The medical examination, including specific tests;
- 3 – The necessary tests based on the various hypotheses.
Regarding tests, it is very important to emphasize that they are decided after the examination, not before.
Some patients tell me, “Doc, I’ll get an ultrasound or an MRI, and then I’ll come to you”. Wrong!
It could be prostatitis or cystitis, a nerve entrapment, or many other causes. Therefore, “first the examination, then the tests”.
How is groin pain treated?
The treatment is complex; groin pain is a chronic condition that usually lasts a long time and requires a lot of time to heal!
The first step is to reduce or stop the specific sports activity.
Rehabilitation treatment includes instrumental therapies, manual therapies, anti-inflammatory medications, and, in some cases, injections, but most importantly, muscle-strengthening and stretching exercises.
Surgical treatment is rare but may be necessary in the most severe cases.
Sometimes, groin pain is caused by an actual inguinal hernia or by what is known as a “sportsman’s hernia”, which is a weakness of the posterior wall of the inguinal canal.
In this case, surgical intervention is necessary!
But the real remedy for groin pain is exercise.
Since groin pain is most often caused by an imbalance or mismatch between the intensity of sports movements and the level of muscle strength in the pubic area,
- – the key to treatment is strengthening exercises;
- – groin pain is not cured on the physiotherapist’s table but by sweating in the gym;
- – the most famous exercise program is called the Copenhagen protocol.
It involves performing progressively more challenging strengthening exercises, with the difficulty increasing once the exercises at the simpler level are performed perfectly.
You start lying on a mat, lifting the injured thigh, and then progress to increasingly difficult and strenuous exercises. These exercises must be performed with the assistance of a partner who first supports the healthy (injured) leg at the knee and, during the more challenging phase, supports the healthy (injured) leg at the ankle.
If you’re able to perform exercises like these correctly, it’s very unlikely that your groin pain won’t improve or be resolved!
And how is groin pain treated for common patients?
By doing exactly what we’ve already mentioned; all these recommendations also apply to so-called regular athletes. The rules are the same.
Groin pain, as we know, is difficult to resolve, and it’s important to remember that even after recovery, it will be necessary to continue doing strengthening exercises. Treatment and prevention aren’t achieved through pleasant massages but through strenuous exercises.
Let it be clear: to heal groin pain, you need few massages and lots of sweat!
