Diagnosing Groin Pain

Physiotherapists use the client’s history, symptoms, signs, any imaging, and a thorough physical examination to diagnose musculoskeltal conditions. There are several anatomical structures in the groin and hip region, which may each present with their own unique pattern with respect to the aforementioned.

The Doha agreement (Weir et al., 2016) is a consensus statement on groin pain in athletes, aiming to standardise terminology and definitions in this area. It classifies groin pain into different entities and emphasises a comprehensive clinical assessment to accurately diagnose and manage the condition. The following describes the six pain classifications.

  1. Pubic Pain: (The pubic bones create the centre rim of the pelvic girdle, atop the groin and genitals). The agreement recognises pubic pain as a common manifestation of groin pain in athletes. It is often associated with underlying issues such as pubic bone stress injuries or osteitis pubis.
  2. Inguinal Pain: Inguinal pain is localised to the inguinal canal region (atop the pubic rim). It can be caused by inguinal canal posterior wall deficiency, commonly referred to as “sports hernia.”
  3. Adductor Pain: This type of groin pain is related to the adductor muscles and tendons. Adductor-related groin pain is often seen in athletes involved in sports with rapid changes of direction and kicking movements.
  4. Iliopsoas Pain: Pain in the region of the iliopsoas tendon (a hip flexor) or its bursa is considered as iliopsoas-related groin pain. Inflammation or injury to these structures can lead to this condition.
  5. Hip Pain: The agreement highlights the importance of considering the hip joint (ball and socket) as a possible source of groin pain. Hip-related issues such as labral tears or femoroacetabular impingement can present with similar symptoms.
  6. Lumbar Pain: The Doha agreement also emphasises the need to consider the lumbar spine (lower back) as a potential source of referred pain to the groin region. Lumbar spine pathologies can mimic groin pain and should be ruled out during the assessment.

To diagnose and classify groin pain accurately, the Doha agreement recommends a thorough medical history, comprehensive physical examination, and at times, appropriate imaging techniques. The goal is to differentiate between the various entities and identify the primary cause of the pain to provide targeted treatment.

If you have pain in this region, we offer a Free Assessment by a registered Physiotherapist. If you agree that the diagnosis sounds reasonable, and you’d like to proceed with the treatment, only then do you pay.


Reference: Weir, A., Brukner, P., Delahunt, E., Ekstrand, J., Griffin, D., Khan, K. M., … & Paterno, M. V. (2015). Doha agreement meeting on terminology and definitions in groin pain in athletes. British Journal of Sports Medicine, 50(12), 768-774. doi:10.1136/bjsports-2015-095623