Groin pain in men most often comes from the musculoskeletal structures around the hip — the adductor (inner-thigh) tendons, the hip joint, the iliopsoas, or the abdominal/inguinal wall ("sports hernia") — and is common in pivoting and kicking sports. But the groin is also where some non-musculoskeletal problems are felt, including hernias and testicular or urological issues, which need a doctor rather than a physiotherapist.
This guide covers the musculoskeletal causes a hip specialist treats and, importantly, the red flags that mean you should seek medical care first.
Sudden severe testicular pain — emergency
Sudden severe testicular pain and swelling can indicate testicular torsion, which is a time-critical emergency. Go to A&E or seek emergency care immediately — this is not a condition a physiotherapist assesses or manages.
Common musculoskeletal causes in men
When a musculoskeletal cause is the likely driver, the most common structures involved are:
Adductor-related groin pain
Inner-thightendon and muscle injury — the most common sporting cause of male groin pain. Often follows a sprint, kick, twist or sudden change of direction. Usually presents as tenderness on the inner thigh, with pain on resisted adduction.
→ Groin strain: grades, healing time, and how to treat it →Inguinal or "sports hernia" (athletic pubalgia)
A disruption of the abdominal / inguinal wall — distinct from a true inguinal hernia (no visible bulge). Common in kicking, pivoting and change-of-direction sports. Often felt at the lower abdomen / inner groin junction, sometimes worse with coughing or sit-ups.
Hip-joint problems (FAI, labral tear, osteoarthritis)
The hip joint itself can present as deep groin pain. FAI and labral tears are most common in active 20–50 year olds; osteoarthritis tends to present later. Catching, pinching and pain with deep flexion or sitting are common features.
→ FAI and labral tears explained →Iliopsoas-related pain
Overload or irritation of the deep hip flexor. Pain is often higher and deeper than an adductor problem, sometimes with a click or snap on hip flexion/extension. Common in dancers, runners, martial artists and strength training.
Referred pain from the lower back
The lumbar spine can refer pain into the groin — particularly when there's nerve involvement or referred pain patterns that don't fit a clear local source. Usually picked up on examination of the back alongside the hip.
The full picture — including the differential, the assessment approach, and the rehabilitation pathway — is covered on the broader groin pain pillar page.
What the location can suggest
Location is one of the most useful starting clues, though it's not a diagnosis on its own:
Most often adductor-related — the inner-thigh muscle or tendon. Pain is usually worse with squeezing the legs together or stretching them apart.
Often hip-joint related (FAI, labral tear, OA). The "C-sign" — cupping the side of the hip — is a classic presentation. Worse with sitting and deep flexion.
Suggests inguinal wall / "sports hernia". Often worse with coughing, sneezing, or sit-ups. A visible or palpable bulge would push the picture toward a true inguinal hernia — needs medical assessment.
Raises the possibility of referred pain from the lower back, sometimes with nerve involvement (pins and needles, numbness, pain extending into the leg).
Unilateral groin pain is common and not inherently more concerning than bilateral. Many musculoskeletal causes (adductor strain, FAI, inguinal wall) are typically one-sided. Persistent one-sided pain is still worth assessing.
Red flags — see a doctor, not a physio
Groin pain in men sometimes points to a non-musculoskeletal cause. The following features are reasons to seek prompt medical assessment before (or instead of) physiotherapy:
See a doctor promptly if you have:
- A lump or bulge in the groin or scrotum (possible hernia) — needs examination by a doctor, often surgical opinion.
- Testicular pain or swelling — sudden severe pain is an emergency (testicular torsion); persistent pain or swelling needs medical review.
- Fever, feeling unwell, or urinary symptoms (burning, frequency, blood in urine) — suggests infection or other medical cause.
- Severe or sudden pain, or pain after significant trauma.
- Unexplained weight loss or night sweats alongside groin pain.
These features point away from routine musculoskeletal causes. A physiotherapist isn't the right first port of call — a medical assessment is.
How a specialist assesses musculoskeletal groin pain
Where the picture clearly fits a musculoskeletal cause, a hip and groin specialist assessment typically combines:
History and pattern recognition
Where the pain sits, what brings it on, what sport or activity, what makes it better or worse, and any history of previous strains or surgery. This often points strongly toward the structure involved before any hands-on testing.
Resisted testing and joint provocation
Resisted adduction, hip impingement tests, iliopsoas provocation, lumbar and abdominal-wall screening — to localise the source across the structures that commonly present as groin pain.
Selective imaging, never in isolation
Imaging is interpreted alongside the clinical picture, not on its own — and where a non-musculoskeletal cause is suspected, onward referral for medical assessment is the priority.
Why it keeps coming back
Recurrent male groin pain usually reflects one of two patterns: returning to sport before adductor capacity has been rebuilt, or the real source being the hip joint, the abdominal wall, or the iliopsoas — not the muscle originally blamed. The groin strain guide covers this recurrence pattern in detail.
When to see a specialist
If groin pain is persistent or recurring and a musculoskeletal cause is likely, a specialist hip and groin assessment can identify the source and plan treatment. Where features suggest a non-musculoskeletal cause, the right first step is a medical assessment — not physiotherapy.
Persistent or recurring groin pain?
John Gravenall offers specialist hip and groin assessments in London, the Midlands, and online.
Book a specialist hip assessment →Frequently Asked Questions
What causes groin pain in men?
Most often adductor-related groin pain (inner-thigh tendons), but also inguinal or 'sports hernia' problems, hip-joint issues (FAI, labral tear, osteoarthritis), iliopsoas-related pain, and referred pain from the lower back. Non-musculoskeletal causes (hernias, testicular or urological issues) need to be ruled out first by a doctor when features suggest them.
When should a man worry about groin pain?
Seek prompt medical assessment if groin pain comes with a lump or bulge in the groin or scrotum, testicular pain or swelling (especially sudden severe pain), fever or urinary symptoms, or severe/sudden pain. These point away from routine musculoskeletal causes and need medical assessment, not physiotherapy.
Is my groin pain a muscle or a hernia?
Both can feel similar. A visible or palpable bulge, or pain that worsens with coughing or straining, points toward a hernia and warrants examination by a doctor. A true inguinal hernia usually needs surgical opinion; a 'sports hernia' (athletic pubalgia) is different and can be managed conservatively in many cases.
Why does my groin pain keep returning?
Usually because full sport is resumed before adductor capacity has been rebuilt, or because the real source is the hip joint, the abdominal wall, or the iliopsoas — not the adductor muscle. A specialist assessment helps identify the actual source rather than treating the most obvious one.