Groin Pain: Not Always a Pulled Muscle or Hip Flexor

Groin pain and pain in the groin: rarely one fixed spot

Groin pain is pain in the groin area: the region between your abdomen and your thigh, on the inside of the leg. The complaint rarely comes from one fixed spot. Researchers therefore group groin pain by structure: pain around the adductors (the muscles on the inside of the leg), around the iliopsoas (the large hip flexor), around the inguinal canal, around the pubic bone, and pain that comes from the hip joint. Anything left over falls into a group of other causes. That grouping says one thing above all: where you feel the pain does not yet tell us which structure is causing it.

You come to Embody Health Chiropractie without a referral; your first visit costs €39. During that intake and examination you hear straight away whether chiropractic care fits your complaint. Most Dutch health insurers (partially) reimburse chiropractic care from the supplementary package, without touching your deductible.

Symptoms: where pain in the groin sits and what you notice

The most common form of groin pain is a strain of the muscles on the inside of the thigh, sometimes with the lower abdomen involved. You get it mainly in sports where you twist, turn and kick, such as football, or in any sport with quick changes in direction. Groin strains are common in exactly those sports. The adductor longus, one of the muscles on the inside of the thigh, is involved most often. Pressing on the spot often tells you which structure is taking part: with a strain you feel exactly where it hurts.

What do you notice with a groin injury?

• pain on the inside of the thigh, in the groin area
• pain when you squeeze your knees together
• pain when you bend your knee
• some minor swelling or bruising
• discomfort when coughing or sneezing, when the lower abdominal muscles are involved

Causes of groin pain: often more than one at once

In sports medicine there is often more than one cause. In athletes with hip and groin pain it regularly turns out that several structures are involved at once: the groin muscles, an overloaded tendon and an irritated joint. If you look only at the painful spot, you miss part of the story. That is why we look at the whole chain of pelvis, hip and thigh, and at the way you move.

Pain that comes from the hip itself is regularly missed in chronic groin complaints. A different shape of the hip joint (hip impingement) or a labral tear (a tear in the labrum, the cartilage rim around the hip socket) can cause sharp pain in the groin during certain hip movements, in exactly the same place as a muscle strain. In chronic pain this is easy to overlook.

From the hip, or from the muscles?

Deep in the groin, at the front of the hip, with a hip that moves less freely, more often belongs to the joint. On the inside of the thigh, with pain on squeezing, more often belongs to the muscles and tendons. Because the two can feed each other, we always examine both during your first visit. Sometimes groin pain starts suddenly after one movement; sometimes it creeps in and stays as a nagging pain.

Inguinal hernia: a cause that never goes away on its own

A hernia is a cause we always weigh up. With a hernia, part of an internal organ, such as your bowel, pushes through a gap or weak area in the muscle that keeps your organs in place. Most hernias develop in the abdomen or the groin. You usually see a bulge, which gets bigger when you cough, sneeze or strain and smaller when you lie down. In men the bulge can move down towards the scrotum, around the testicle. The bulge can hurt or give a sharp or burning feeling, but it does not have to: some people only notice a dragging feeling, or no pain at all. Unlike a muscle strain, a hernia never goes away on its own. The treatment is surgery, and when that is needed depends on your complaints.

Is it serious? Four signals we rule out first

Every first consultation at Embody Health starts by going through the signals that need medical assessment. By far the most groin pain is harmless and treatable. Those few exceptions are exactly what we do not want to overlook.

Examination and diagnosis: how do we find the cause?

During your first visit we take a medical history: we ask where the pain started, which movements provoke it and how the complaints developed over the following days. Then we feel exactly where the groin or hip area is tender and test how the joint and the pelvis move. We ask you to squeeze your knees together, bend your knee and stand on one leg. If the hip moves less freely than expected, we look at the joint and the muscles around it separately. An ultrasound or other imaging is sometimes needed to rule out a hernia or a joint problem; we then refer you to your GP or a specialist.

Treating groin pain: what does the research say?

What does research show? Researchers found that a conservative approach to iliopsoas-related groin pain achieved success rates between 77 and 100 per cent in people without previous hip surgery. That matches what we see in practice. In our treatment we look at the mobility of the hip joint and the pelvis, at the tension in the muscles on the inside of the thigh, and at the way you stand and walk, and we set out a treatment plan around adjusting the load and strengthening exercises, with manual therapy where it is needed. With gentle, precise corrections we work on the movement of the joint and of the muscles around it, so that stairs, sport and daily activities become smoother again. The aim is a return to normal physical activity.

Groin complaints often ask for more than one approach. We work on how the joint and the pelvis move, while physical therapy adds strength, condition and a gradual build-up of load. When exercise therapy runs alongside our treatment, we align it with your physical therapist, so you are not following two separate tracks.

Your first visit costs €39; a single follow-up treatment costs €65 and a consult in a recovery package €55. See what your health insurer covers and the fees.

What you can do yourself for groin pain

In the first 48 hours after a strain, rest, ice and compression help. Keep the groin calm and avoid what clearly makes the pain worse. Apply an ice pack for 15 to 20 minutes, wrapped in a damp towel so it does not touch your skin directly. That gives pain relief in the first days. If the pain improves after that, you can start gentle exercises and build the load up: three sets of ten repetitions, building up to three sets of twenty, with one to two minutes of rest in between, around four times a week. If the pain clearly increases as you exercise, stop and have it assessed. How long it takes differs: minor strains settle in weeks, severe ones can take months, but with physiotherapy most people return to their previous level within six months. Build your return to sport up step by step, with preventing groin pain in mind.

Want to read more? See the page on hip complaints and hip pain, pain in the buttock or pelvic complaints. Book a first visit. Together we will look at what suits your situation and what the best route is for you.