Navigating Athletic Groin Pain

As a Physical Therapist in Portland, Oregon, I see a fair share of athletic groin pain.  Not surprising given the popularity of soccer, ultimate frisbee, rock climbing, and even rugby in the Pacific Northwest.

Athletic Groin Pain

Athletic groin pain is best understood as an umbrella term rather than a single diagnosis. It encompasses several overlapping conditions that can all cause pain in the same region. In the past, it’s been referred to by many names — including athletic pubalgia, sports hernia, and Gilmore’s groin. Over the last decade, the medical community has moved toward a more consistent framework.

The Doha Agreement (Weir et al., 2015) classifies groin pain into five main categories:

  • adductor-related
  • iliopsoas-related
  • inguinal-related
  • pubic-related
  • hip-related

These categories help clinicians describe where symptoms may originate, though in practice, most athletes present with a combination of these findings rather than a single isolated source.

Athletic groin pain isn’t something you get from the Xbox. It’s a condition born from activity. Reported prevalence ranges from 32% in adult sport (Mercurio et al., 2022) to 10% in youth sport (Eberbach et al., 2021), with soccer consistently showing the highest rates.

The challenge in both understanding and managing athletic groin pain is that, while it’s common, it’s often misunderstood by the medical community. What’s frequently missed is the need to synthesize the patient story, imaging, and physical findings — to filter out the noise and confidently operate within the gray zone of uncertainty.

Athletic Groin Pain and Imaging

Is imaging helpful?
Yes… and no.

Extensive comparative MRI studies, such as Banchi et al. (2015), compared soccer players with long-standing adductor-related groin pain to matched asymptomatic controls and found that 70% of asymptomatic athletes had one or more “positive” MRI findings.

This indicates that if an athlete has participated in a multi-directional sport for several years, we are very likely to find at least one structural “abnormality.” It’s similar to the early 2000s trend of labeling everyone with “hip impingement” based on imaging results — only to later learn that up to 92% of professional soccer players show hip impingement–like morphology on imaging (Falotico et al., 2019).

So, is imaging useful at all?

Yes — if interpreted correctly and communicated clearly.
MRI can be beneficial in ruling out non-musculoskeletal or non-PT-appropriate conditions. It can also identify findings with stronger correlations to symptoms, such as bone marrow edema in the pelvic region or pubic symphysis disc changes (Banchi et al., 2015). Beyond that, interpretation becomes a little gray again.

Athletic Groin Pain and Physical Assessment

Do you think physical assessment is valid?
Yes — if done well.

When assessing athletic groin pain, physical therapy tests tend to be sensitive but not specific. That means we’re good at finding pain, but less accurate at pinpointing its exact source. Pain often presents in multiple areas, reflecting the anatomical complexity and overlap of structures in the groin region.

A thorough assessment is valuable for ruling out pathology, narrowing the diagnostic field, and most importantly, developing a clinical reasoning framework — a list of plausible contributing factors.

In reality, we often can’t identify a single definitive pain generator, but we can become highly skilled at understanding why the pain is present. Once severe pathology has been excluded — through both assessment and, when appropriate, imaging — we can confidently proceed into that gray zone, focusing on the modifiable factors that keep athletes performing and progressing safely.

If you’re managing groin pain that’s limiting your sport or training, it’s worth taking a closer look. Athletic groin pain often persists not because it’s severe, but because the underlying drivers — movement strategies, strength imbalances, or loading errors — aren’t fully addressed.

My clinical focus is on athletic groin assessment and rehabilitation, shaped by my experience working within professional soccer and rugby environments. I integrate imaging interpretation, detailed movement analysis, and progressive loading strategies that reflect the unique demands of multidirectional sports such as soccer, ultimate frisbee, climbing, and rugby.

If you’re uncertain about what’s contributing to your pain or how to progress safely, this is the space where I work best — helping athletes make sense of complex presentations and return to sport with clarity and confidence.

Nathan Evans MPT. Xps. CSCS.