Groin pain in runners is often referred to as a pulled groin or groin strain. These terms suggest that pain is due to a muscle tear. While some causes of groin pain are due to a tear in the hamstring or adductor muscles, most cases are unrelated to muscle. To treat your injury correctly, finding the cause of groin pain in runners is essential.
Why is my groin sore after running? Common causes

Most cases of groin pain in runners and sportspeople are due to a condition called pubic overload or osteitis pubis. Excessive shearing forces on the bones, tendons, and pubic joint leads to pain in the groin area. Patients often report groin pain that comes with running or sport and moves into the adductor or abdominal muscles. As a result, pain can move from one side to the other. In severe cases, the pain worsens with coughing or straining and may be mistaken for a hernia.
Generally, osteitis pubis treatment is much easier in runners compared to sportspeople. Osteitis pubis rehabilitation reduces running load and exercises to strengthen the pelvis and improve pelvic flexibility. An osteitis pubis injection is sometimes needed to help rehab but should be used with caution.
Can the hip joint cause groin pain in runners?
The simple answer is yes. While a cartilage tear or hip stress fracture usually causes hip pain, some people with hip joint pain present with just groin pain.
There are many causes of hip joint pain. First, hip impingement occurs when a bony deformity at the socket or the ball causes pinching as you move your leg. Second, the hip’s cartilage lining can thin in older patients, leading to hip arthritis. As arthritis progresses, movement of the hip joint becomes stiff and painful. Finally, a hip stress fracture can cause groin pain. A stress fracture in hip bone occurs in endurance runners, military recruits, and young females. Those with a weakening of bones (also known as osteoporosis) are at increased risk.
It is essential to determine whether groin pain is hip-related as treatments differ from other causes. Often, the clinical assessment reveals signs of hip joint stiffness. Also, imaging such as an X-ray or MRI is needed to confirm the hip is the source of groin pain.
Sports Hernia as a cause of groin pain in runners
Sports hernia vs. hernia
Usually, a hernia is a hole in the abdominal wall that develops with age. As the hole gets bigger, contents of the abdomen such as fat or bowel pass through this hole, causing a visible lump and groin pain. Typically, pain from a hernia is worse with coughing or straining. Frequently, pain may be similar to other causes such as pubic overload and can be missed on initial assessment. True hernias that cause a lump or pain need fixation with a mesh – either open or via keyhole surgery.
Conversely, a sports hernia is a controversial term referring to a weakness of the abdominal wall without a hole. Some believe this weakness causes stretching of the nerves in the abdominal wall leading to sports hernia pain. Most experts agree that a sports hernia should be treated as pubic overload rather than a true hernia. Generally, we suggest the person stops or modifies sporting activity combined with a rehab program to strengthen the pelvis.
Can a sports hernia heal without surgery?
Yes is the simple answer. There is general agreement that we should avoid surgery for a sports hernia in almost all cases. In addition, sports hernia strengthening exercises will improve symptoms and bypass surgery in most cases.
However, in some cases of sports hernia, pain persists despite rehab and time. Therefore, we recommend a surgical repair or fixation of the posterior inguinal wall, ususally using a mesh with minimal fixation. Recent studies suggest that hernia repair successfully returns most people to sport.
Can pelvic problems cause groin pain in runners?
Of course. Sportspeople also suffer from common pelvic conditions. For example, gynecological diseases such as endometriosis or ovarian cysts can present with groin pain. Similarly, in men, problems with the prostate or urinary tract infections may refer pain to in the groin. Finally, trapped nerves in the pelvis, abdominal wall, or low back can cause unexplained groin pain.
Groin pain in runners is complex: How do we get to the bottom of the cause?
Generally, we can diagnose many of the conditions listed above through a clinical assessment.
Dr. Masci has experience in chronic hip and groin pain. By listening carefully to your symptoms and examining the hip and groin region, he can get to the bottom of the cause. Generally, the clinical examination involves a step-by-step analysis of all the parts of the hip and groin, such as the hip joint, the lower spine, the buttock, and the pubic symphysis. Also, Dr. Masci will check to see if you have features of a hernia or a sports hernia. Finally, he uses diagnostic ultrasound in his rooms to see if you have changes in your joints, tendons, or muscles that could explain your pain.
He also works at Onewelbeck’s specialised groin clinic. At Onewelbeck, we have devised a specialised groin MRI. Rather than having multiple investigations such as X-rays, ultrasound, and MRIs, the experts at Onewelbeck use a one-stop groin scan that picks up most causes, including osteitis pubis, hip joint problems, hernias, and gynecological and urological problems. Also, in some cases, we use an ultrasound together with an MRI to make sure we pick up the cause of your groin pain. Finally, we may use other tests such as nerve studies to look for a trapped nerve.
Final word from Sportdoctorlondon about groin pain in runners
Generally, hip and groin pain is complex. Pain can occur from multiple sites such as the hip, pubic symphysis, hernia, and pelvis. You should see a doctor who is an expert in diagnosing hip and groin pain.
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