Athlete’s groin refers to a complex of symptoms that has many names among medical professionals. Synonyms include “soft groin” or “pubic inguinal pain syndrome” (PIPS). High-performance athletes are particularly affected by this condition. It is caused by excessive strain on the groin due to repeated, abrupt movements. These symptoms occur, for example, in soccer players and tennis players.
Groin pain is a common problem among athletes and can have serious consequences for professional athletes. @ Jo Panuwat D / AdobeStock
Over time, this intense strain leads to a weakening of the posterior wall of the inguinal canal. However, a sports hernia is not a hernia! It is not a hernia (an opening or tear) through which abdominal organs can protrude.
In the case of a sports groin strain, the posterior wall of the inguinal canal bulges outward. This can also occur when intra-abdominal pressure is high, such as when coughing or straining. The bulging of the inguinal fascia presses on adjacent nerve bundles, causing pain.
Other causes include a spermatic cord lipoma in men and a Nuck’s cyst in women. The spermatic cord lipoma, in particular, is more common among young athletes. The exact causes are not yet fully understood, but mechanical irritation from rapid movements may also be a trigger. A lipoma is a benign tumor composed of fatty tissue in the inguinal canal. It can grow in size and thereby displace other nearby structures. This causes pain radiating toward the abdomen or testicles.
If structures near the groin are diseased, they can also cause pain in the groin. For example:
- Hip and hip joints
- Pubic bone
- Spine
- Surrounding muscle groups (back and abdominal muscles, adductors)
- Nerve bundles
- Lymph nodes
- Intra-abdominal organs
Although the causes of groin pain are varied, a sports groin strain is usually accompanied by a typical set of symptoms:
- A pulling or burning pain in the groin, abdomen, or back, as well as in the scrotum and thighs: Doctors refer to this as nerve compression pain, which results from pressure on the nerve pathways. This pain can radiate from the groin to various areas.
- Pain in the pubic region: In the case of a soft groin, the inguinal canal is widened (due to overstretching). This allows for the displacement of tendinous structures that anchor the abdominal muscles to the bone. The result is altered stress on the pubic bone, which can also lead to pain.
The pain often subsides at rest or during a period of rest. However, it usually returns during physical activity.
In the case of a sports hernia, complex forces act on the abdominal wall and the inguinal canal, especially during abrupt changes in direction or explosive movements. Repeated compression in the area of the genitofemoral nerve and its genital branch causes typical radiating pain extending into the inner thigh.
Although this functional disorder is not classified as a classic hernia, it behaves similarly because the muscular and fascial structures are overloaded. Athlete’s groins therefore occur more frequently, especially in athletes whose muscles are subjected to high levels of stress.
Diagnosis and Evaluation of Athlete’s Groin and Pain in the Groin Region
If you are experiencing symptoms that appear to be those of an athlete’s hernia, you should consult an experienced specialist for a diagnosis. For competitive athletes, this is usually their team physician.
The diagnosis is made in several steps:
- Medical history interview: The doctor will first conduct a comprehensive medical history interview (doctor-patient consultation) with you. During this conversation, you will describe the intensity of your athletic activities as well as the location and severity of your pain. Your medical history will also be reviewed during this discussion.
- Physical examination: During the physical examination, the doctor will palpate the groin area to diagnose a hernia, if present.
- Dynamic ultrasound examination (sonography): A definitive diagnosis is provided by a dynamic ultrasound examination (sonography). This procedure clearly visualizes changes in tissue structure. Combined with typical symptoms, this allows for a diagnosis.
- Further Tests: If the diagnosis is still unclear, additional tests such as X-rays or magnetic resonance imaging (MRI) may be performed.
Sports Groin: How Can a Sports Groin Be Treated?
There are various treatment options for a sports hernia. Your specialist will recommend the appropriate procedure. When deciding on a treatment plan, the doctor will consider the following factors:
- Cause of the groin pain
- Type of pain (acute, chronic, nature of the pain, and severity)
- Importance to the athlete (for example, a quick return to competitive sports)
If acute groin pain remains untreated, chronic conditions may develop. Elite athletes, in particular, should act quickly if they suspect a sports groin injury to prevent the condition from worsening. This also helps reduce the risk of a hernia.
If the pain is mild, you can start with conservative treatment: This involves taking it easy for a while to avoid further irritation. Afterward, you can perform targeted stability and strengthening exercises with the help of physical therapy.
If the symptoms do not improve—despite rest and physical therapy—surgery is recommended. Various techniques may be considered. The type of surgical technique depends on the nature of the pain and the affected tissue:
- Nerve compression: In this case, pain relief can be achieved by making an incision through the nerve or by removing the damaged section of the nerve.
- Repositioning of the muscular support structure: Surgical division followed by reattachment is a treatment option here.
- Spermatic cord lipoma: This must be surgically removed either via laparoscopic surgery (keyhole surgery) or through a small incision.
All procedures are primarily aimed at achieving pain relief. In most cases, doctors also combine these methods with surgical reinforcement of the posterior wall of the inguinal canal. This stabilizes the soft inguinal region using a synthetic mesh (prosthesis). For young athletes without a severe inguinal hernia, biodegradable synthetic meshes are also used. These are very stable but are completely broken down by the body after 15–18 months and replaced by the body’s own connective tissue.
The surgical techniques for treating a sports hernia are minimally invasive. Patients receive local anesthesia and can resume light exercise two days after the procedure. The success rate for treating a sports hernia is high. About 80 percent of those affected can resume their athletic activities pain-free and to their full capacity two weeks after the procedure.
If you are experiencing pain that may indicate a sports hernia or a hernia, consult your primary care physician. They will refer you to the appropriate specialist. These are often experienced orthopedic surgeons, hernia surgeons, or specialists in sports medicine, sports surgery, or sports orthopedics.
You can find specialists, for example, in group practices, medical centers, or at your local hospital. You can also obtain information or recommendations from the relevant professional association.
To prevent long-term or permanent damage, early evaluation by specialized physicians is crucial—especially for symptoms in the pubic bone area, where a clear distinction must be made between athlete’s groin, inguinal hernia, and other anatomically related causes of pain.
Sports involving rapid changes in direction, such as ice hockey and field hockey, are frequent triggers of a specific condition known as “soft groin” among professional athletes. Depending on the findings, treatment may include not only stabilizing measures but also neurolysis or neurectomy to provide lasting relief from symptoms.
The so-called “soft groin” is a typical finding in sports groin injuries and describes a functional weakness without a classic hernia. Many affected individuals report pain in the groin and a diffuse ache in the groin region, which occurs primarily during physical exertion. To treat an athlete’s groin, a precise diagnosis is crucial, as the complex of symptoms is often multifaceted.
Especially among elite and professional athletes, activity-related groin pain is common, resulting from imbalances and increased tension in the muscles, such as the adductors. In addition to pain in the groin area, symptoms of a sports hernia include chronic groin pain that intensifies with sudden movements. The diagnosis is made through a clinical examination as well as supplementary procedures to evaluate groin pain. In this context, athlete’s groin is generally considered a diagnosis of exclusion, even though it is not a diagnosis of exclusion in the strict sense but is increasingly defined as a distinct condition.
Defining athlete’s groin as a weakness of the posterior wall of the inguinal canal helps to better understand the causes of groin pain. In this context, athlete’s groin is viewed as a weakness of the posterior wall of the inguinal canal. Conditions such as pubalgia or pubalgia athletica, as well as osteitis pubis, must be taken into account during differential diagnosis. Treatment for athlete’s groin depends on the severity of symptoms and ranges from conservative measures to surgical intervention by a specialist in general surgery.
Centers such as the Muschaweck Hernia Center in Munich specialize in sports hernias and offer targeted treatment approaches. Overall, this professional article on the topic of sports hernias shows that the so-called sports hernia is a common cause of groin pain and should be treated early to prevent chronic pain.
How can you recognize the typical pain of a sports hernia?
The typical pain manifests as a burning or pulling sensation in the groin that intensifies with physical activity and may subside at rest. It often radiates along the inguinal canal to the lower abdomen, pubic bone, or thigh.
How does a doctor assess a sports groin strain during a clinical examination?
The examination focuses on tenderness, pain with exertion, and the stability of the posterior wall of the inguinal canal. This helps distinguish whether the condition is a sports groin strain or caused by another factor.
How does a sports hernia differ from a true hernia?
In a sports hernia, there is no opening through which tissue protrudes. It causes functional symptoms and pain from overexertion, whereas a true hernia involves a hernial orifice with possible protrusion of tissue or organs.
What treatment is appropriate, and when is surgery necessary?
Treatment usually begins with rest, physical therapy, and targeted exercises. If the pain persists or the ability to bear weight is limited, surgery may be necessary to stabilize the groin area.
