Etiology — what causes it

Multifactorial. Adductor-related pain follows training error, abrupt return to load, and reduced eccentric capacity. Inguinal and pubic-related pain involves the posterior inguinal wall and pubic symphysis. Hip-related pain may overlap with FAI.

Epidemiology — who gets it

Groin pain accounts for 12–16% of injuries in football (soccer) and ice hockey (Werner et al., BJSM). Peak in 18–30 year old male athletes in pivoting sports.

Clinical signs

The Doha consensus emphasizes pattern recognition — adductor tenderness and pain on resisted adduction (adductor-related); pain on resisted abdominal contraction and palpation of the inguinal canal (inguinal-related); pain over pubic symphysis (pubic-related); hip pain with FADIR (hip-related). Crossover is common.

Symptoms

Groin pain with kicking, cutting, accelerating, and changing direction. Often progressive after a training spike. Pain may radiate to lower abdomen, perineum, or medial thigh.

Best evidence for chiropractic treatment

The Hölmich protocol (Hölmich et al., Lancet) — active strengthening including isometric, concentric, and eccentric adductor work — outperformed passive treatment for adductor-related groin pain. The Copenhagen Adductor Strengthening program reduces groin injury risk in football (Harøy et al., Br J Sports Med). Treatment is subtype-specific per the Doha consensus.

Subtypes

  • Adductor-related. Most common; Hölmich protocol is the standard.
  • Iliopsoas-related. Anterior hip flexor pain; activity modification and graded loading.
  • Inguinal-related. Posterior inguinal wall; surgical consultation in selected refractory cases.
  • Pubic-related. Pubic symphysis tenderness; load management and core control.
  • Hip-related. Overlap with FAI; managed accordingly.

When to seek emergency care

Some symptoms need urgent medical attention — not a chiropractic visit. Call 911 or go to the nearest emergency department for: progressive limb weakness, loss of bowel or bladder control, saddle anesthesia (numbness in the groin/inner thighs), severe unrelenting pain unrelieved by position, signs of fracture after significant trauma, chest pain, stroke-like symptoms (face drooping, arm weakness, speech changes), or any rapidly worsening or unusual symptom.

Bottom line

Groin pain in athletes has many subtypes — accurate categorization (per Doha) drives the right targeted approach. Most respond to progressive loading.