Groin Pain - what could it be?

We see a wide variety of patients who come in for groin pain. This can be pain at the crease of the hip, pain at the pubic bone, pain in the lower abdomen, pain at the inner thigh, or even at the pelvic floor. With so many different muscles, tendons, and tissues running through the general “groin” area, it can be hard to pin down which thing is actually the pain generator!

Anatomy - What stuff is even there?

-Abdominal muscles: the rectus abdominis (6 pack muscle), external oblique, conjoint tendon (internal oblique and transverse abdominis) create the pubic aponeurosis - which attaches to the pubic bone.

-Leg muscles: The inner thigh muscles adductor longus and gracilis ALSO attach to the pubic aponeurosis.

-Nerves: the iliohypogastric, ilioinguinal, and genitofemoral nerves can all refer to pain in the area often referred to as the groin. Iliohypogastric would be across the hip crease, Ilioinguinal would also be across the hip crease, and additionally over the pubic bone and down the inner thigh slightly. The genitofemoral would be down the front/inner thigh, and potentially into the genitals. L1-2 issues can also refer to that area.

-Organs: bladder is down there, so are the uterus and ovaries for those who have them.

What can cause pain?

-Muscle strain: any of the above muscles could be strained with activity and cause pain. This usually hurts when you contract it, and feels a bit improved with rest.

-Nerve irritation or entrapment: tightness around a nerve will put pressure on it, usually resulting in pain along the area the nerve goes to.

-Hip joint issue: arthritis and labrum tears or irritation can refer pain to the groin.

-Stress fractures: a stress fracture or bone stress response in the femur (hip) or pelvis (usually the pubic ramus) can refer pain to the groin.

-Hernia: a tear in the protective layer of muscle that allows organs to poke through.

-Medical issue: things like a urinary tract infection, kidney stones, or testicular torsion CAN refer pain to the groin area - generally the lower abdomen or upper thigh. This pain doesn’t really change with movements, and is fairly unrelenting, with no clear accident or injury.

What are some red flags I need to see a doctor for groin pain?

• Fever - that doesn’t happen with a musculoskeletal issue!

• Can’t walk - could be a fracture

• Pain at night - could be a sign of something more serious

• Not getting better with rest

• Not getting better with targeted PT

What should I do for groin pain?

-Identify what structure is irritated (PTs are good at this!). Imaging can also be somewhat helpful, but famously can’t pain the whole picture, and sometimes the results show issues that aren’t causing pain.

-Figure out WHY it's irritated. Generally speaking all the muscles around the lower abdomen and upper thigh need to be in a relative balance. If one is weak it can make the other ones tight. If your strategy for moving is impaired, it can put excess stress on certain muscles.

-Don’t just rest - total rest for a muscle issue usually doesn’t solve the underlying issue. Rest can be a helpful tool, but resting until it doesn’t hurt and then going back to the activity that hurt it in the first place is a recipe for hurting it again!

-Strengthen what is weak, and loosen up what is tight, make sure things are balanced! (That’s where PTs can be really helpful)