Groin Strains
What is a groin strain?
Groin strain is a broad term describing a tear or stretch injury to one or more of the muscles and tendons in the groin region — the area where the inner thigh meets the pelvis. The most commonly injured structure is the adductor longus, the large muscle on the inner thigh that draws the leg toward the midline, though hip flexor strains involving the iliopsoas or rectus femoris, and injuries at the pubic symphysis and surrounding structures, are all grouped under the groin strain umbrella.
This matters clinically because "groin strain" can mean several quite different things — and the management for a grade 2 adductor longus tear is quite different to that for iliopsoas tendinopathy or osteitis pubis. Getting an accurate diagnosis of which structure is actually injured is the first and most important step in effective management.
For a detailed breakdown of adductor-specific injuries — the most common type of groin strain — our dedicated hip adductor strain page covers this in depth.
What causes groin strains?
Groin strains occur when the muscles or tendons of the groin region are loaded beyond their capacity — either from a sudden explosive effort or from cumulative overuse over time. Acute groin strains are common in sports involving sudden changes of direction, kicking, jumping and rapid acceleration — football codes, soccer, hockey, basketball, sprinting and martial arts are the sports most frequently associated. The injury typically occurs during a powerful hip adduction or hip flexion effort — kicking a ball, pushing off hard in a change of direction, or attempting a tackle.
Chronic groin pain — where symptoms develop gradually rather than from a single event — is particularly common in high-volume running and kicking athletes, and is often related to adductor tendinopathy at the pubic attachment, osteitis pubis (stress reaction at the pubic symphysis), or a combination of both. This presentation requires a substantially different management approach to an acute muscle tear and is one of the most challenging conditions in sports physiotherapy to manage effectively.
Risk factors for groin strain include previous groin injury (the single most significant predictor of future injury), weak adductors relative to abductors, reduced hip range of motion, fatigue, inadequate preparation for the demands of the sport, and rapid increases in training load.
Groin pain — what else could it be?
Accurate diagnosis is particularly important with groin pain because several other conditions produce similar symptoms and require quite different management. Femoroacetabular impingement (FAI) and hip labral tears both produce deep groin pain, particularly with hip flexion and rotation. Inguinal hernias can present with groin discomfort in active people. Hip osteoarthritis characteristically refers pain to the groin. Sacroiliac joint dysfunction and lumbar nerve root irritation can also refer pain to the groin and inner thigh. A thorough clinical assessment — not just imaging — is essential to distinguish between these.
What are the symptoms?
Acute groin strain produces sudden onset pain in the inner thigh or groin, typically during a specific movement. Tenderness, swelling and bruising develop in the hours following significant tears. Walking is usually possible but painful, and kicking, sprinting and side-stepping are significantly aggravating.
Chronic groin pain tends to be more insidious — a gradual onset of stiffness and discomfort that worsens with activity and improves with rest in the early stages, progressing to persistent pain during and after activity if not addressed.
How is it diagnosed?
Clinical assessment involves palpation of the adductor muscles and pubic region, strength testing of hip adduction and flexion, specific provocation tests including the squeeze test and FABER test, and assessment of hip range of motion. The pattern of tenderness — whether at the muscle belly, at the pubic attachment, or deeper in the hip joint — guides the diagnosis significantly.
Ultrasound is the most accessible imaging for acute muscle tears and tendon pathology. MRI provides the most comprehensive assessment of complex groin pain, particularly where pubic bone stress reaction or labral pathology is suspected.
How can physiotherapy help?
In the acute phase, physiotherapy focuses on protecting the healing tissue, managing pain and swelling, and maintaining pain-free movement. Progressive rehabilitation then follows the same principles as other muscle injuries — early isometric loading for pain management and early tendon stimulus, progressing through isotonic strengthening to the eccentric and sport-specific loading that is required before return to sport.
Hip abductor and gluteal strengthening is as important as adductor rehabilitation — the force couple between these muscle groups governs lateral hip stability, and restoring balance between them is central to preventing recurrence. Dry needling assists with pain management in the acute and subacute phases. Real time ultrasound monitors healing and guides loading progression. Clinical Pilates provides a controlled environment for hip strengthening during the period when full sport training is not appropriate.
For chronic adductor tendinopathy and osteitis pubis, a structured progressive loading program — typically the Copenhagen adductor protocol — over eight to twelve weeks or more is the evidence-based approach. This is a condition where patience and program consistency matter enormously.
Return to sport is guided by objective criteria — pain-free adductor and abductor strength testing, squeeze test findings, and sport-specific movement performance — rather than a fixed number of weeks from injury.
Our physiotherapists Eliane Machado and Bethany Kippen and Exercise Physiologist Ash O'Regan all have experience in groin and hip injury management and are members of the Australian Physiotherapy Association.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
Groin strain is a broad term describing a tear or stretch injury to one or more of the muscles and tendons in the groin region — the area where the inner thigh meets the pelvis. The most commonly injured structure is the adductor longus, the large muscle on the inner thigh that draws the leg toward the midline, though hip flexor strains involving the iliopsoas or rectus femoris, and injuries at the pubic symphysis and surrounding structures, are all grouped under the groin strain umbrella.
This matters clinically because "groin strain" can mean several quite different things — and the management for a grade 2 adductor longus tear is quite different to that for iliopsoas tendinopathy or osteitis pubis. Getting an accurate diagnosis of which structure is actually injured is the first and most important step in effective management.
For a detailed breakdown of adductor-specific injuries — the most common type of groin strain — our dedicated hip adductor strain page covers this in depth.
What causes groin strains?
Groin strains occur when the muscles or tendons of the groin region are loaded beyond their capacity — either from a sudden explosive effort or from cumulative overuse over time. Acute groin strains are common in sports involving sudden changes of direction, kicking, jumping and rapid acceleration — football codes, soccer, hockey, basketball, sprinting and martial arts are the sports most frequently associated. The injury typically occurs during a powerful hip adduction or hip flexion effort — kicking a ball, pushing off hard in a change of direction, or attempting a tackle.
Chronic groin pain — where symptoms develop gradually rather than from a single event — is particularly common in high-volume running and kicking athletes, and is often related to adductor tendinopathy at the pubic attachment, osteitis pubis (stress reaction at the pubic symphysis), or a combination of both. This presentation requires a substantially different management approach to an acute muscle tear and is one of the most challenging conditions in sports physiotherapy to manage effectively.
Risk factors for groin strain include previous groin injury (the single most significant predictor of future injury), weak adductors relative to abductors, reduced hip range of motion, fatigue, inadequate preparation for the demands of the sport, and rapid increases in training load.
Groin pain — what else could it be?
Accurate diagnosis is particularly important with groin pain because several other conditions produce similar symptoms and require quite different management. Femoroacetabular impingement (FAI) and hip labral tears both produce deep groin pain, particularly with hip flexion and rotation. Inguinal hernias can present with groin discomfort in active people. Hip osteoarthritis characteristically refers pain to the groin. Sacroiliac joint dysfunction and lumbar nerve root irritation can also refer pain to the groin and inner thigh. A thorough clinical assessment — not just imaging — is essential to distinguish between these.
What are the symptoms?
Acute groin strain produces sudden onset pain in the inner thigh or groin, typically during a specific movement. Tenderness, swelling and bruising develop in the hours following significant tears. Walking is usually possible but painful, and kicking, sprinting and side-stepping are significantly aggravating.
Chronic groin pain tends to be more insidious — a gradual onset of stiffness and discomfort that worsens with activity and improves with rest in the early stages, progressing to persistent pain during and after activity if not addressed.
How is it diagnosed?
Clinical assessment involves palpation of the adductor muscles and pubic region, strength testing of hip adduction and flexion, specific provocation tests including the squeeze test and FABER test, and assessment of hip range of motion. The pattern of tenderness — whether at the muscle belly, at the pubic attachment, or deeper in the hip joint — guides the diagnosis significantly.
Ultrasound is the most accessible imaging for acute muscle tears and tendon pathology. MRI provides the most comprehensive assessment of complex groin pain, particularly where pubic bone stress reaction or labral pathology is suspected.
How can physiotherapy help?
In the acute phase, physiotherapy focuses on protecting the healing tissue, managing pain and swelling, and maintaining pain-free movement. Progressive rehabilitation then follows the same principles as other muscle injuries — early isometric loading for pain management and early tendon stimulus, progressing through isotonic strengthening to the eccentric and sport-specific loading that is required before return to sport.
Hip abductor and gluteal strengthening is as important as adductor rehabilitation — the force couple between these muscle groups governs lateral hip stability, and restoring balance between them is central to preventing recurrence. Dry needling assists with pain management in the acute and subacute phases. Real time ultrasound monitors healing and guides loading progression. Clinical Pilates provides a controlled environment for hip strengthening during the period when full sport training is not appropriate.
For chronic adductor tendinopathy and osteitis pubis, a structured progressive loading program — typically the Copenhagen adductor protocol — over eight to twelve weeks or more is the evidence-based approach. This is a condition where patience and program consistency matter enormously.
Return to sport is guided by objective criteria — pain-free adductor and abductor strength testing, squeeze test findings, and sport-specific movement performance — rather than a fixed number of weeks from injury.
Our physiotherapists Eliane Machado and Bethany Kippen and Exercise Physiologist Ash O'Regan all have experience in groin and hip injury management and are members of the Australian Physiotherapy Association.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
