Groin pain in athletes: clarification of sports hernia

Backache. Pain in the lower back
Lower back pain could be an indication of a groin injury. (istockphoto.com)

“Sports hernia” is a term that sports fans are pretty familiar with. It seems every week another player is having surgery for it. But what is it really? That is the age old question. The sports medicine community recently published a consensus paper in the British Journal of Sports Medicine, June 2015, entitled “Doha agreement meeting on terminology and definitions in groin pain in athletes.” What the authors attempted to do was to change the terminology used for “sports hernia” in order to provide specific and precise definitions to the different categories of groin pain in athletes.

Sports hernia, along with athletic pubalgia, Gilmore’s groin, Hockey-goalie syndrome, Hockey groin, osteitis pubis, and sportsman’s hernia, were some of the many terms that were used interchangeably but were incorrect in their definition of the problem. Groin pain in athletes is the new general term agreed upon as an umbrella term without an implied specific diagnosis. 

The consensus group broke down groin pain in athletes into 7 different categories: adductor-related groin pain, iliopsoas-related groin pain, inguinal-related groin pain, pubic-related groin pain, hip-related groin pain, other musculoskeletal cause (inguinal hernia, referred low back pain, fracture, etc), and non-musculoskeletal pain (gynecological conditions, tumors, etc).  These sub-groups help to better define the true diagnoses and in turn the most appropriate treatment.

Adductor-related groin pain involves the structures that bring the leg across one’s body (adduct). They defined it as “adductor tenderness AND pain on resisted adduction testing.”  Iliopsoas-related groin pain is defined as “iliopsoas tenderness” and “is more likely if there is pain on resisted hip flexion AND/OR pain on stretching the hip flexors.”  Inguinal-related groin pain is defined as “pain location in the inguinal canal region AND tenderness of the inguinal canal.”  Pubic-related groin pain is defined as “local tenderness of the pubic symphysis and the immediately adjacent bone” and “no particular resistance test that specifically provoked symptoms related to pubic-related groin pain that could be used in conjunction with palpation.” These definitions help to narrow down which structure/structures are directly involved in order to most effectively treat the problem.

This article helps to clarify a complex problem with confusing terminology. With more specific and precise terminology, future research should be able to more accurately define the specific problem and it’s underlying structure, enable comparison of research studies instead of comparing “apples to oranges,” and ultimately improve non-operative and post-operative treatment for athletes with groin pain.


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