Groin pain in runners is often called a “pulled groin” or groin strain, which suggests a muscle tear. But while some cases are adductor or hamstring tears, most groin pain in runners is unrelated to a muscle injury. Getting the right diagnosis is the key to treating it correctly. So what causes groin pain in runners?
Why is my groin sore after running? The most common cause
Most groin pain in runners and sportspeople is pubic overload, also called osteitis pubis. Excessive shearing forces across the pubic bones, tendons, and pubic joint cause pain in the groin. The pain typically comes on with running, radiates into the adductor or lower abdominal muscles, and can move from side to side. In severe cases it worsens with coughing or straining, and is sometimes mistaken for a hernia.
Reassuringly, osteitis pubis often responds better in runners than in change-of-direction athletes. Rehabilitation means reducing running load and strengthening and mobilising the pelvis; an injection is occasionally needed to support rehab, used with caution.
Can the hip joint cause groin pain in runners?
Yes. Although hip problems usually cause hip pain, some people feel only groin pain. Common hip causes include hip impingement (FAI), where bony prominences pinch as the leg moves; hip arthritis, as the cartilage thins with age; and a hip stress fracture, which occurs in endurance runners, military recruits, and younger women, and more so with low bone density.
It’s important to work out whether groin pain is hip-related, as the treatment differs. The examination often shows hip stiffness, and an X-ray or MRI confirms whether the hip is the source.
Sports hernia and hernia in runners
A true hernia is a hole in the abdominal wall that widens with age, letting abdominal contents push through to cause a lump and pain — worse with coughing or straining. True hernias causing a lump or pain need surgical repair with a mesh.
A sports hernia is different and more controversial — a weakness of the abdominal wall without a hole, thought to stretch the abdominal-wall nerves and cause pain. Most experts treat it as pubic overload, not a true hernia: modify or pause sport and strengthen the pelvis.
Can a sports hernia heal without surgery?
Usually, yes. The consensus is to avoid surgery in almost all cases — strengthening exercises improve symptoms and usually remove the need for an operation. Where pain persists despite rehab and time, a surgical repair of the posterior inguinal wall (a mesh with minimal fixation) returns most people to sport.
Can pelvic problems cause groin pain in runners?
Yes. Runners get the same pelvic conditions as anyone else. In women, gynaecological conditions such as endometriosis or ovarian cysts can refer pain to the groin. In men, prostate problems or a urinary infection can do the same. And trapped nerves in the pelvis, abdominal wall, or low back can cause unexplained groin pain.
Groin pain in female runners
Groin pain in female runners deserves a specific mention. Women are at higher risk of a pubic ramus or femoral neck stress fracture, particularly where low energy availability, irregular or absent periods, and low bone density coexist (relative energy deficiency in sport, RED-S). Gynaecological causes — endometriosis, ovarian cysts — can also present as groin pain. So in a female runner with groin pain, we assess bone health, menstrual and energy status, and pelvic causes alongside the usual musculoskeletal ones.
Groin pain in runners is complex: how is the cause found?
Most of these conditions can be diagnosed clinically. Dr Masci has particular experience in chronic hip and groin pain — listening to your symptoms and systematically examining the hip joint, lower spine, buttock, and pubic symphysis, checking for hernia or sports hernia, and using diagnostic ultrasound in clinic.
He also works at OneWelbeck’s specialised groin clinic, which has developed a one-stop groin MRI protocol — rather than separate X-rays, ultrasound, and MRIs, a single groin scan detects most causes, including osteitis pubis, hip problems, hernias, and gynaecological and urological conditions. Where a trapped nerve is suspected, nerve studies can help.
Frequently asked questions about groin pain in runners
Is groin pain in runners a pulled muscle?
Usually not. Despite the “pulled groin” label, most groin pain in runners is pubic overload (osteitis pubis), not a muscle tear. True adductor or hamstring tears do happen, but they’re the minority — which is why the right diagnosis matters before treatment.
Should I keep running with groin pain?
It depends on the cause and severity. Mild pubic overload can sometimes be managed with reduced running load, but pain that’s worsening, one that came on suddenly, or a suspected stress fracture needs assessment before you continue — running through a stress fracture risks a more serious injury.
What’s the difference between a sports hernia and a real hernia?
A real hernia is an actual hole in the abdominal wall, often with a lump, and usually needs surgery. A sports hernia is a weakness without a hole, treated like pubic overload with rehab rather than an operation in most cases.
How is the cause of groin pain in runners diagnosed?
Through a careful history and a systematic hip-and-groin examination, supported by ultrasound in clinic and, where needed, a one-stop groin MRI that screens for the main causes at once.
When should I see a doctor about running groin pain?
If the pain is persistent, worsening, came on suddenly, or comes with a lump, night pain, or urinary or testicular symptoms. These point to causes that need specific treatment rather than just load management.
Final word from Sport Doctor London about groin pain in runners
Hip and groin pain is complex, and the pain can come from several sites — the hip, pubic symphysis, a hernia, or the pelvis. See a doctor experienced in diagnosing hip and groin pain so the cause is identified and treated correctly.
To book a hip and groin assessment with Dr Masci in London, contact the team here or call +44 (0) 203 488 0350.
Hi I’ve had an ongoing problem in my groin and sometimes in front/ lateral quad pain I’m a runner but had to pull out of a couple of half marathons… not sure if it’s a tear in labrum
OA or Tendonitis..I’m self funding so would want to know upfront about MRI or just diagnosing this? I’m keen to move forward or run forward in my case 😊costs etc..
Many thanks for your email. If you wish to make an enquiry regarding an appontment, please email my admin team on admin@sportdoctorlondon.com or click on the ‘make an appointment’ button.
Lorenzo