Groin pain is felt in the crease where the lower abdomen meets the thigh, and it has many possible sources — the hip joint, the adductor (inner-thigh) tendons, the iliopsoas, the abdominal/inguinal wall, the pubic bone, or pain referred from the back. Because several different problems produce pain in the same small area, groin pain is one of the most frequently misdiagnosed complaints — and that's the usual reason it keeps coming back.
Resolving it depends less on generic treatment and more on identifying which structure is actually driving it. Get that wrong and the treatment might feel helpful for a week — then the pain returns.
The many causes of groin pain
Clinicians often group groin pain using the Doha agreement categories — a consensus framework for classifying groin problems in sport:
Adductor-related
The inner-thigh tendons. The most common cause in athletes — particularly in pivoting sports like football, hockey and rugby.
Iliopsoas-related
The deep hip flexor muscle/tendon. Often aggravated by high-volume running, cycling, or sit-ups.
Inguinal / abdominal-wall related
Sometimes called "sports hernia" or inguinal disruption. More common in men, especially in explosive twisting sports.
Pubic-related
The pubic bone and symphysis. Often called osteitis pubis. Can coexist with adductor problems.
Hip joint
FAI, a labral tear, or osteoarthritis presenting as groin pain — often missed when treatment focuses only on the soft tissue.
Referred
From the lumbar spine, sacroiliac joint, or elsewhere. Back pain commonly refers into the groin crease.
One person can have more than one source at once. This is exactly why single-mechanism treatment often only half-works — you might be treating the adductor when the hip joint is also contributing.
→ When groin pain is a hip-joint problem (FAI & labral tears)
Why groin pain keeps coming back after rest
Rest settles irritable tissue but doesn't change two things: the capacity of the tendon or muscle, and the load you return to. So pain eases, you resume activity — and it flares again. The classic rest-and-flare cycle.
Persistent groin pain usually needs progressive loading of the right structure plus a graded return, not repeated rest-and-flare loops. The tissue needs to be rebuilt, not just quieted down.
Groin pain in men vs women — key differences
Men
- More commonly seen with adductor-related and inguinal/"sports hernia" groin pain
- Often in pivoting sports — football, rugby, hockey, athletics
- Hip-joint causes (FAI, labral tears) are frequently missed and mislabelled as a muscle strain
- Higher rates of athletic groin injury overall
Women
- Additional considerations including referred pain from the menstrual cycle or pregnancy (e.g. round-ligament pain)
- Pelvic-floor contributions need ruling in or out
- Hip-joint causes (FAI, labral, OA) are also easily missed in women
- Endometriosis and gynaecological sources should be considered in persistent cases
Across both sexes: hip-joint causes (FAI, labral tear, osteoarthritis) are easily missed and mislabelled as a muscle strain. If treatment targeting the adductor or abdominal wall isn't working, the hip joint needs to be on the list.
When groin pain is actually a hip problem
A crucial diagnostic split: is the pain coming from the soft tissue (adductor/iliopsoas/abdominal wall) or from inside the hip joint (FAI, labral tear, OA)? Getting this split right changes the entire plan — and it's the part generic treatment most often gets wrong.
Joint-based groin pain typically shows:
The "C-sign" — cupping the side of the hip instead of pointing to the groin crease. Pain worse with deep flexion, prolonged sitting and twisting. May catch or click. These are the markers that point toward the joint rather than the soft tissue.
How persistent groin pain is properly assessed
A thorough assessment is the difference between generic treatment that suppresses symptoms and a plan that actually fixes the problem:
History
Sport and activity profile, onset mechanism, exact location of pain, what aggravates and eases it, sitting tolerance — the pattern tells you where to look.
Palpation and resisted tests
To localise adductor, iliopsoas or abdominal-wall involvement — which structures are tender under load, not just pressure.
Hip-joint testing
Impingement tests (FADIR), full range of motion, and screening for FAI, labral tears, or osteoarthritis presenting as groin pain.
Lumbar screen
To exclude referred pain from the back — a common and easily overlooked source of persistent groin pain.
Imaging selectively
To confirm a specific structure when it will change management — not as a first resort, but when the clinical picture suggests it.
You should leave with a named diagnosis (or the leading two), and a plan with a timeline — not just another generic exercise sheet.
When to see a specialist
Consider a specialist hip and groin assessment if groin pain:
Has lasted more than a few weeks or keeps recurring despite rest or generic physio
Limits sport, running or training — especially if you're having to modify or stop what you love
Came with catching/clicking or deep-flexion pain — a possible sign the hip joint is involved
You've been treated for a "strain" repeatedly without lasting improvement
Stop the rest-and-flare cycle
Get a precise diagnosis and a structured plan. John Gravenall offers specialist hip and groin assessment in London, the Midlands, and online.
Book a specialist assessment →Frequently Asked Questions
What causes persistent groin pain?
Most often adductor (inner-thigh) tendon problems, but also iliopsoas, inguinal/"sports hernia," pubic-related, hip-joint (FAI/labral/OA), or referred pain — sometimes more than one at once. The Doha agreement classifies groin pain into six categories for this reason.
Why does my groin pain keep coming back?
Rest calms the tissue but doesn't rebuild its capacity or change the load you return to — recurring pain usually needs progressive loading of the right structure and a graded return, not repeated rest-and-flare loops.
How do I know if my groin pain is from my hip?
Hip-joint groin pain often shows the "C-sign" (cupping the side of the hip), worsens with deep sitting and twisting, and may catch or click. These features distinguish joint-based groin pain from soft-tissue causes — a specialist can confirm with examination.
When should I worry about groin pain?
Pain that's severe, persistent, follows trauma, or comes with fever, a lump, or testicular pain warrants prompt medical assessment. These are not typical of musculoskeletal groin pain and need ruling out.
Is groin pain a muscle or a hernia?
Both are possible — an inguinal/"sports hernia" and an adductor strain can feel similar in the same location. Which one it is changes the treatment entirely, which is why examination by someone who sees these regularly matters.
