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 cases of groin pain are due to tears in the hamstring or adductor muscles, most cases are unrelated to muscle injury. To treat your injury correctly, finding the cause of groin pain in runners is essential. 

Why is My Groin Sore after Running? Common Causes

groin pain

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 lead to pain in the groin area. Patients often report groin pain that occurs with running or other sports and radiates into the adductor or abdominal muscles. As a result, the 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 for runners than for other sportspeople. Osteitis pubis rehabilitation involves reducing running load and exercises to strengthen the pelvis and improve pelvic flexibility. An osteitis pubis injection is sometimes needed to help rehab, but it 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 with age, leading to hip arthritis. As arthritis progresses, hip joint movement becomes stiff and painful. Finally, a hip stress fracture can cause groin pain. A stress fracture in the hip bone occurs in endurance runners, military recruits, and young females. Those with bone weakness (also known as osteoporosis) are at increased risk.

It is essential to determine whether groin pain is hip-related, as treatments differ for hip-related versus non-hip-related causes. Often, the clinical assessment reveals signs of hip joint stiffness. Imaging, such as an X-ray or MRI, is also needed to confirm that the hip is the source of groin pain.

Sports Hernia as a cause of groin pain in runners

Sports hernia vs. hernia

A hernia is a hole in the abdominal wall that typically develops with age. As the hole enlarges, abdominal contents, such as fat or bowel, pass through it, causing a visible lump and groin pain. Typically, hernia pain is exacerbated by coughing or straining. Frequently, pain may mimic other causes, such as pubic overload, which can be missed during the initial assessment. True hernias that cause a lump or pain need fixation with a mesh – either open or via keyhole surgery.

Conversely, the term “sports hernia” is controversial and refers 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 recommend that the person discontinue or modify sporting activities while undergoing a rehabilitation program to strengthen the pelvis.

Can a sports hernia heal without surgery?

Yes is the simple answer. There is a consensus that surgery for a sports hernia should be avoided in almost all cases. In addition, sports hernia strengthening exercises can improve symptoms and, in most cases, obviate the need for bypass surgery.

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 sports.

Can Pelvic Problems cause Groin Pain in Runners?

Of course. Sportspeople also suffer from common pelvic conditions. For example, gynaecological 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 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 Determine the Cause?

In general, we can diagnose most of the conditions listed above through 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 determine the cause. Generally, the clinical examination involves a step-by-step analysis of the hip and groin, including the hip joint, the lower spine, the buttocks, and the pubic symphysis. Additionally, Dr Masci will assess whether you have features of a hernia or a sports hernia. Finally, he uses a diagnostic ultrasound in his office to determine 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 developed a specialised groin MRI protocol. Rather than multiple investigations such as X-rays, ultrasound, and MRIs, the experts at Onewelbeck use a one-stop groin scan that detects most causes, including osteitis pubis, hip joint problems, hernias, and gynaecological and urological conditions. Additionally, in some cases, we use ultrasound in conjunction with MRI to determine the cause of your groin pain. Finally, we may use other tests, such as nerve studies, to identify a trapped nerve.

Final Word from Sportdoctorlondon about Groin Pain in Runners:

Hip and groin pain are complex. Pain can originate from multiple sites, including the hip, pubic symphysis, hernia, and pelvis. You should see a doctor who is an expert in diagnosing hip and groin pain.

Other relation conditions for groin pain in runners: