Subscribe for unlimited access to DynaMed content, CME/CE & MOC credit, and email alerts on content you follow.

Already subscribed? Sign in now

Learn more about CME

Sports-related Groin Pain


General Information


  • groin pain in athletes due to sports-related activities involving kicking, rapid accelerations and decelerations, sudden changes in direction, and overuse1,5
  • many patients presenting with sports-related groin pain will have injuries with multiple components (or coexisting injuries), potentially complicating the diagnosis1

Also called

  • sportsman's groin
  • inguinal disruption
  • sports hernia
  • athletic pubalgia
  • core muscle injury


  • tendinopathy defined as activity-related pain, focal tendon tenderness, and changes on intratendinous imaging

Classification of groin pain

  • classification system derived from the Doha agreement meeting on terminology and definitions in groin pain in athletes
    • defined clinical entities for groin pain
      • adductor-related groin pain
        • adductor tenderness
        • pain on resisted adduction testing
      • iliopsoas-related groin pain
        • iliopsoas tenderness
        • if pain on resisted hip flexion and/or pain on hip flexor stretching, iliopsoas-related groin pain is more likely
      • inguinal-related groin pain
        • pain in inguinal canal region and tenderness of inguinal canal
        • if pain is aggravated with abdominal resistance or Valsalva/cough/sneeze, inguinal-related groin pain is more likely
        • no palpable inguinal hernia is present
      • pubic-related groin pain
        • local tenderness of pubic symphysis and immediately adjacent bone
        • no particular resistance test can specifically provoke symptoms related to pubic-related groin pain that can be used in conjunction with palpation
    • hip-related groin pain
      • always consider pain from hip as possible cause of groin pain
      • history should focus on description of pain (onset, nature and location) and mechanical symptoms such as catching, locking, clicking or giving way
      • physical exam should include passive range of motion and hip special tests (flexion, abduction, and external rotation [FABER] and flexion, adduction, and internal rotation [FADIR] test)
      • if clinical suspicion of hip-related groin pain (through history and/or clinical exam), investigate and treat appropriately
    • other causes of groin pain
      • primary categories are orthopedic, neurological, rheumatological, urological, gastrointestinal, dermatological, oncological and surgical causes
      • identifying other possible causes is done through careful history and physical exam (encompassing more than musculoskeletal system), and appropriate additional investigations or referrals
    • Reference - Br J Sports Med 2015 Jun;49(12):768OpenInNewfull-textOpenInNew
  • terms to avoid using based on the Doha agreement meeting on terminology and definitions in groin pain in athletes
    • adductor and iliopsoas tendinitis or tendinopathy
    • athletic groin pain
    • athletic pubalgia
    • biomechanical groin overload
    • Gilmore’s groin
    • groin disruption
    • Hockey-goalie syndrome
    • Hockey groin
    • osteitis pubis
    • sports groin
    • sportsman’s groin
    • sports hernia
    • sportsman’s hernia
    • Reference - Br J Sports Med 2015 Jun;49(12):768OpenInNewfull-textOpenInNew


General references used

  1. Tammareddi K, Morelli V, Reyes M Jr. The athlete's hip and groin. Prim Care. 2013 Jun;40(2):313-33OpenInNew
  2. Suarez JC, Ely EE, Mutnal AB, et al. Comprehensive approach to the evaluation of groin pain. J Am Acad Orthop Surg. 2013 Sep;21(9):558-70OpenInNew
  3. Hackney RG. (iv) Groin pain in athletes. Orthopaedics and Trauma. 2012 Feb;26(1): 25-32OpenInNew
  4. Sheen AJ, Stephenson BM, Lloyd DM, et al. 'Treatment of the sportsman's groin': British Hernia Society's 2014 position statement based on the Manchester Consensus Conference. Br J Sports Med. 2014 Jul;48(14):1079-87OpenInNewfull-textOpenInNew
  5. Crockett M, Aherne E, O'Reilly M, Sugrue G, Cashman J, Kavanagh E. Groin Pain in Athletes: A Review of Diagnosis and Management. Surg Technol Int. 2015 May;26:275-82OpenInNew

Recommendation grading systems used

  • American College of Rheumatology (ACR) grading system for recommendations
    • strength of recommendations
      • Strong - most informed patients would choose the recommended management and clinicians can structure their interactions with patients accordingly
      • Conditional - majority of informed patients would choose the recommended management but many would not so clinicians must ensure that patients' care is in keeping with their values and expectations
    • Reference - ACR recommendation on use of nonpharmacologic and pharmacologic therapies of the hand, hip, and knee (22563589Arthritis Care Res (Hoboken) 2012 Apr;64(4):465OpenInNew), commentary can be found in Arthritis Care Res (Hoboken) 2013 Feb;65(2):324OpenInNew
  • Osteoarthritis Research Society International (OARSI) grading system for recommendations
    • levels of evidence
      • Level Ia - meta-analysis of randomized controlled trials
      • Level Ib - at least 1 randomized controlled trial
      • Level IIa - at least 1 well-designed controlled study, but without randomization
      • Level IIb - at least 1 well-designed quasi-experimental study
      • Level III - at least 1 nonexperimental descriptive study (for example, comparative, correlation or case-controlled study)
      • Level IV - expert committee reports, opinions, and/or experience of respected authorities
    • Reference - OARSI recommendation on management of hip and knee osteoarthritis (18279766Osteoarthritis Cartilage 2008 Feb;16(2):137OpenInNewfull-textOpenInNew), commentary can be found in 18515155Osteoarthritis Cartilage 2008 Dec;16(12):1585OpenInNew
  • American Academy of Orthopaedic Surgeons (AAOS) grading system for recommendations
    • strength of recommendation
      • Strong - evidence from ≥ 2 high-quality studies with consistent findings for recommending for or against intervention
      • Moderate - evidence from ≥ 2 moderate-quality studies with consistent findings OR evidence from 1 high-quality study for recommending for or against intervention
      • Limited - evidence from ≥ 2 low-quality studies with consistent findings OR evidence from a 1 moderate-quality study recommending for against intervention or diagnostic OR evidence is insufficient or conflicting and does not allow a recommendation for or against intervention
      • Consensus - no supporting evidence, recommendation based on clinical opinion
    • Reference - AAOS evidence-based clinical practice guideline on management of osteoarthritis of the hip (AAOS 2017 Mar 13 PDF)PictureAsPdf

Synthesized Recommendation Grading System for DynaMed

  • DynaMed systematically monitors clinical evidence to continuously provide a synthesis of the most valid relevant evidence to support clinical decision-making (see 7-Step Evidence-Based MethodologyOpenInNew).
  • Guideline recommendations summarized in the body of a DynaMed topic are provided with the recommendation grading system used in the original guideline(s), and allow DynaMed users to quickly see where guidelines agree and where guidelines differ from each other and from the current evidence.
  • In DynaMed (DM), we synthesize the current evidence, current guidelines from leading authorities, and clinical expertise to provide recommendations to support clinical decision-making in the Overview & Recommendations section.
  • We use the Grading of Recommendations Assessment, Development and Evaluation (GRADE)OpenInNew to classify synthesized recommendations as Strong or Weak.
    • Strong recommendations are used when, based on the available evidence, clinicians (without conflicts of interest) consistently have a high degree of confidence that the desirable consequences (health benefits, decreased costs and burdens) outweigh the undesirable consequences (harms, costs, burdens).
    • Weak recommendations are used when, based on the available evidence, clinicians believe that desirable and undesirable consequences are finely balanced, or appreciable uncertainty exists about the magnitude of expected consequences (benefits and harms). Weak recommendations are used when clinicians disagree in judgments of relative benefit and harm, or have limited confidence in their judgments. Weak recommendations are also used when the range of patient values and preferences suggests that informed patients are likely to make different choices.
  • DynaMed (DM) synthesized recommendations (in the Overview & Recommendations section) are determined with a systematic methodology:
    • Recommendations are initially drafted by clinical editors (including ≥ 1 with methodological expertise and ≥ 1 with content domain expertise) aware of the best current evidence for benefits and harms, and the recommendations from guidelines.
    • Recommendations are phrased to match the strength of recommendation. Strong recommendations use "should do" phrasing, or phrasing implying an expectation to perform the recommended action for most patients. Weak recommendations use "consider" or "suggested" phrasing.
    • Recommendations are explicitly labeled as Strong recommendations or Weak recommendations when a qualified group has explicitly deliberated on making such a recommendation. Group deliberation may occur during guideline development. When group deliberation occurs through DynaMed-initiated groups:
      • Clinical questions will be formulated using the PICO (Population, Intervention, Comparison, Outcome) framework for all outcomes of interest specific to the recommendation to be developed.
      • Systematic searches will be conducted for any clinical questions where systematic searches were not already completed through DynaMed content development.
      • Evidence will be summarized for recommendation panel review including for each outcome, the relative importance of the outcome, the estimated effects comparing intervention and comparison, the sample size, and the overall quality rating for the body of evidence.
      • Recommendation panel members will be selected to include at least 3 members that together have sufficient clinical expertise for the subject(s) pertinent to the recommendation, methodological expertise for the evidence being considered, and experience with guideline development.
      • All recommendation panel members must disclose any potential conflicts of interest (professional, intellectual, and financial), and will not be included for the specific panel if a significant conflict exists for the recommendation in question.
      • Panel members will make Strong recommendations if and only if there is consistent agreement in a high confidence in the likelihood that desirable consequences outweigh undesirable consequences across the majority of expected patient values and preferences. Panel members will make Weak recommendations if there is limited confidence (or inconsistent assessment or dissenting opinions) that desirable consequences outweigh undesirable consequences across the majority of expected patient values and preferences. No recommendation will be made if there is insufficient confidence to make a recommendation.
      • All steps in this process (including evidence summaries which were shared with the panel, and identification of panel members) will be transparent and accessible in support of the recommendation.
    • Recommendations are verified by ≥ 1 editor with methodological expertise, not involved in recommendation drafting or development, with explicit confirmation that Strong recommendations are adequately supported.
    • Recommendations are published only after consensus is established with agreement in phrasing and strength of recommendation by all editors.
    • If consensus cannot be reached then the recommendation can be published with a notation of "dissenting commentary" and the dissenting commentary is included in the topic details.
    • If recommendations are questioned during peer review or post publication by a qualified individual, or reevaluation is warranted based on new information detected through systematic literature surveillance, the recommendation is subject to additional internal review.

DynaMed Editorial Process

Special acknowledgements

  • DynaMed topics are written and edited through the collaborative efforts of the above individuals. Deputy Editors, Section Editors, and Topic Editors are active in clinical or academic medical practice. Recommendations Editors are actively involved in development and/or evaluation of guidelines.
  • Editorial Team role definitions
    Topic Editors define the scope and focus of each topic by formulating a set of clinical questions and suggesting important guidelines, clinical trials, and other data to be addressed within each topic. Topic Editors also serve as consultants for the internal DynaMed Editorial Team during the writing and editing process, and review the final topic drafts prior to publication.
    Section Editors have similar responsibilities to Topic Editors but have a broader role that includes the review of multiple topics, oversight of Topic Editors, and systematic surveillance of the medical literature.
    Recommendations Editors provide explicit review of DynaMed Overview and Recommendations sections to ensure that all recommendations are sound, supported, and evidence-based. This process is described in "Synthesized Recommendation Grading."
    Deputy Editors are employees of DynaMed and oversee DynaMed internal publishing groups. Each is responsible for all content published within that group, including supervising topic development at all stages of the writing and editing process, final review of all topics prior to publication, and direction of an internal team.

How to cite

National Library of Medicine, or "Vancouver style" (International Committee of Medical Journal Editors):

  • DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T115701, Sports-related Groin Pain; [updated 2018 Dec 03, cited place cited date here]. Available from Registration and login required.


Subscribe for unlimited access to DynaMed content.
Already subscribed? Sign in