Hip and groin pain is common in athletes and active people, especially in sports that involve sprinting, sudden stops and quick changes of direction. It can affect everything from daily activities to training and performance.
But groin pain isn’t always caused by one injured muscle or joint. The region contains many structures, and pain can come from several sources at once, or be referred from elsewhere in the body.
Many possible sources of pain
In 2015, the Doha agreement set out a standard way to classify groin pain in athletes, using three main categories [1]:
- Defined clinical entities: adductor-related, iliopsoas-related, inguinal-related and pubic-related groin pain
- Hip-related groin pain
- Other causes of groin pain in athletes
The more recent ESSKA–EHPA–ESMA consensus (2026) built on this. It stresses systematic clinical assessment, appropriate use of imaging, and recognising that more than one condition can be present at the same time [2].
The message from both: where it hurts doesn’t tell you why it hurts. One person may have adductor-related pain alongside hip joint symptoms. Another may have groin pain influenced by the lower back, pelvis or nervous system. Finding one contributor doesn’t necessarily explain the whole picture.
Looking beyond muscles and joints
In some cases, the pelvic floor is worth considering. These muscles and connective tissues support the pelvis and help control bladder, bowel and sexual function.
Cooke and colleagues describe the pelvic floor as a potentially overlooked factor in athletes with hip and groin pain [3]. A scoping review by Giagio and colleagues also identified pelvic floor dysfunction in athletes, while noting gaps in the evidence, particularly for male athletes and pelvic pain [4].
Relevant symptoms may include pelvic discomfort, changes in bladder or bowel function, pain with sexual activity, or discomfort when sitting for long periods. These don’t automatically mean pelvic floor dysfunction, but they may warrant further assessment or referral to a pelvic health physiotherapist.
Nerves can play a role too. Pudendal neuralgia, for example, can cause pain, burning or altered sensation in the perineal or genital region, sometimes made worse by sitting [5]. Groin pain alone isn’t enough to diagnose it. It’s one possibility to consider when the overall symptom pattern supports further investigation.
Why a thorough assessment matters
If symptoms persist or don’t respond to treatment as expected, it may be time to revisit the original explanation. A thorough assessment considers your history, how your symptoms behave, a physical examination, relevant medical history and how you’ve responded to previous treatment.
Imaging can help when clinically indicated, but findings must be interpreted alongside your symptoms and examination. Structural changes can show up in people with no pain at all, and no single test can reliably explain every presentation.
Screening for concerning features is also essential. Severe or rapidly worsening pain, significant trauma, fever, inability to bear weight or other worrying symptoms shouldn’t be assumed to be a routine musculoskeletal injury. These may need medical assessment, further investigation or referral.
What this means for treatment
Treatment should target the factors most relevant to you, rather than focusing only on the structure that hurts. Depending on the findings, it may include progressive strengthening, adjusting training loads, building tolerance to sport-specific activities, or coordinating care with other health professionals.
If progress is slower than expected, reassessment can show whether the plan needs to change or whether other contributors need investigating.
The key takeaway
Hip and groin pain can have overlapping causes, and a single diagnosis may not explain every symptom. A systematic assessment, appropriate screening and an individualised plan help guide your recovery and a safe return to the activities that matter to you.
If hip or groin pain is affecting your daily life or your sport, a physiotherapy assessment can help identify what’s contributing and set out the right plan for you.
References
- Weir A, Brukner P, Delahunt E, et al. Doha agreement meeting on terminology and definitions in groin pain in athletes. British Journal of Sports Medicine. 2015;49:768–774. https://doi.org/10.1136/bjsports-2015-094869
- Hölmich P, Weir A, Papadopoulou T, et al. Hip and groin pain in physically active adults with a focus on terminology, clinical examination and imaging: A formal ESSKA–EHPA–ESMA Consensus. Knee Surgery, Sports Traumatology, Arthroscopy. 2026. https://doi.org/10.1002/ksa.70565
- Cooke R, Papadopoulou T, Weir A, Donnelly GM. Hiding in plain sight: the pelvic floor in hip and groin pain. British Journal of Sports Medicine. https://doi.org/10.1136/bjsports-2025-110028
- Giagio S, Salvioli S, Pillastrini P, Innocenti T. Sport and pelvic floor dysfunction in male and female athletes: A scoping review. Neurourology and Urodynamics. 2021. https://doi.org/10.1002/nau.24564
- Labat JJ, Riant T, Robert R, et al. Diagnostic criteria for pudendal neuralgia by pudendal nerve entrapment (Nantes criteria). Neurourology and Urodynamics. 2008;27:306–310. https://doi.org/10.1002/nau.20505