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Health condition · Clinically reviewed

Groin pain, from adductor strain to hernia, hip and beyond.

Groin pain is a symptom, not a diagnosis. A structured history, targeted examination and the right imaging turn a vague ache into a plan.

A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE, BOA, BAUS, RCOG and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice across musculoskeletal, urology, gynaecology and sports medicine.

Key facts

Groin pain at a glance.

The essentials, in plain English - what it is, which systems can cause it and how the workup is shaped in the UK.

  • What it is

    Pain felt in the crease between the lower abdomen and thigh. A hub symptom with musculoskeletal, urological, gynaecological, nerve, spinal and vascular causes.

  • Most common cause

    Musculoskeletal - adductor tendinopathy, iliopsoas tendinopathy, hip joint pathology and athletic pubalgia lead the list, especially in kicking sports.

  • Hernia to consider

    Inguinal, femoral and sports hernia all present as groin pain. A palpable lump on cough or strain is a clue but not always present.

  • Emergencies

    Testicular torsion, septic arthritis, ectopic pregnancy, cauda equina and iliofemoral DVT all present with groin or hip pain and need same-day care.

  • Assessment

    Structured history plus examination of hip, spine, abdomen, inguinal region and genitalia - then targeted imaging and labs.

  • Treatment

    Treat the underlying diagnosis. Musculoskeletal groin pain responds to specialist physio, load management and, where indicated, injection or surgery.

Why this guide matters

A hub symptom that needs a system-by-system approach.

Groin pain is a crossroads. The three points below shape the way it should be worked up in modern UK practice.

  • Nine systems can produce it

    Musculoskeletal, hernia, urological, gynaecological, nerve, spinal, vascular, tumour and infection - a good history narrows it fast.

  • Some causes are emergencies

    Torsion, ectopic pregnancy, cauda equina, septic arthritis and iliofemoral DVT can hide inside vague groin pain - and need same-day care.

  • Musculoskeletal wins on volume

    Adductor tendinopathy, iliopsoas problems, hip pathology and athletic pubalgia dominate, especially in kicking sports - and respond well to targeted rehab.

How the diagnosis is made

From vague ache to a working diagnosis.

The steps a UK GP or specialist will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    History and pain map

    Onset, activity link, character, radiation, night pain, urinary or bowel change, cycle and sexual health - each points to a system.

  2. 02

    Assessing

    Hip and spine examination

    Range of motion, FADIR and FABER for hip and labral irritation, Ober for iliotibial band, Thomas for iliopsoas, Trendelenburg for abductors.

  3. 03

    Assessing

    Adductor and pubic exam

    Adductor squeeze test, palpation of adductor origin, pubic symphysis and rectus abdominis - the athletic pubalgia cluster.

  4. 04

    Assessing

    Abdomen, hernia and genital exam

    Inguinal and femoral canals with cough and Valsalva, testicular exam, per-vaginal assessment where relevant and inguinal lymph node check.

  5. 05

    Confirming

    Targeted imaging

    X-ray for bone and joint, ultrasound for hernia and tendon, MRI for labrum, adductor and pubic bone stress - chosen from the exam.

  6. 06

    Confirming

    Labs and screens

    Urinalysis, STI screen, inflammatory markers, pregnancy test and prostate-specific testing where clinically appropriate.

  7. 07

    Referral

    Specialist referral

    Musculoskeletal, urology, gynaecology, vascular or spinal - matched to the leading diagnosis after first-line workup.

Typical timeline: a first visit to a working diagnosis in one to three weeks.

Symptoms

The patterns that point to a cause.

Groin pain rarely arrives on its own. The features around it - how it starts, where it radiates and what makes it worse - guide the diagnosis.

  • Activity-related groin pain

    Kicking, sprinting, cutting or twisting reproduces it - classic for adductor or iliopsoas tendinopathy and athletic pubalgia.

  • Deep anterior hip pain

    A C-sign around the hip with catching or clicking - suspicious for femoroacetabular impingement and labral pathology.

  • Lump on cough or strain

    A bulge in the inguinal or femoral region that appears on Valsalva - hernia until proven otherwise.

  • Testicular or scrotal pain

    Radiation into testis or scrotum - consider epididymitis, torsion, urolithiasis or referred pain from the ureter.

  • Cyclical pelvic pain

    Pain linked to the menstrual cycle, dyspareunia or heavy periods - think endometriosis, adenomyosis and ovarian pathology.

  • Burning or numb thigh

    Burning over the outer thigh suggests meralgia paraesthetica; groin numbness after surgery points to ilioinguinal or genitofemoral neuropathy.

  • Back and buttock pain with groin ache

    Referred pain from the L1 to L3 nerve roots, facet joints or discs - the spine is a frequent hidden source.

  • Red flag - sudden severe pain

    Sudden, severe or systemically unwell presentations - torsion, ectopic pregnancy, DVT, septic arthritis or cauda equina need urgent care.

Treatment

How groin pain is treated in the UK.

Every plan starts with an accurate diagnosis. Most cases settle with targeted rehab and time; some need injection, hernia repair, arthroscopy or system-specific care.

  • Treat the underlying diagnosis

    The whole plan turns on what is driving the pain - musculoskeletal, urological, gynaecological, nerve, spinal or vascular.

  • Specialist physiotherapy

    For adductor, iliopsoas, athletic pubalgia and hip pathology - eccentric loading, motor control and staged return to sport.

  • Activity modification and NSAIDs

    Short-term load reduction, topical or oral anti-inflammatories and simple analgesia while the tissue settles.

  • Image-guided injection

    Ultrasound or fluoroscopy-guided cortisone or PRP for adductor origin, iliopsoas bursa, hip joint or pubic symphysis in selected cases.

  • Hip arthroscopy for FAI and labrum

    For confirmed femoroacetabular impingement or labral tear that fails conservative care - specialist hip surgeon-led.

  • Hernia repair

    Inguinal, femoral or sports hernia repair - open or laparoscopic, depending on the anatomy and surgeon.

  • Urological and gynaecological care

    Antibiotics for infection, stone management, hormonal treatment or laparoscopy for endometriosis - matched to the diagnosis.

  • Spinal and nerve care

    Facet or nerve-root injections for referred pain, and targeted neuromodulation or release for ilioinguinal, genitofemoral or lateral femoral cutaneous neuropathy.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or specialist knows your history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE Clinical Knowledge Summaries. Groin pain, hip pain, testicular pain and pelvic pain.

  • British Orthopaedic Association. Guidance on hip and groin pathology and athletic pubalgia.

  • BAUS. Guidance on epididymo-orchitis, testicular torsion and urolithiasis.

  • RCOG. Green-top guidelines on chronic pelvic pain, endometriosis and ectopic pregnancy.

  • Doha Agreement (2015) on terminology and definitions in groin pain in athletes.

Red flags

When groin pain is an emergency.

Most groin pain is treatable in primary care. These are the situations where waiting is not safe - and where same-day assessment matters.

  • Testicular torsion

    Sudden severe testicular or groin pain, often with nausea and a high-riding testis - a same-day surgical emergency.

  • Ectopic pregnancy

    Pelvic or groin pain with a positive pregnancy test, missed period or bleeding - urgent early pregnancy assessment.

  • Cauda equina syndrome

    Bilateral leg pain, saddle numbness, bladder or bowel change - emergency spinal assessment and MRI.

  • Septic arthritis of the hip

    Hot, painful hip with fever and inability to weight-bear - urgent joint aspiration and IV antibiotics.

  • Iliofemoral DVT

    Unilateral leg swelling, groin heaviness and calf pain, especially after surgery, flight or immobility - urgent imaging.

  • Femoral neck stress fracture

    Deep groin pain in runners, worse on weight-bearing, night pain - a missed diagnosis that can progress to a full fracture.

  • Cancer red flags

    Unexplained weight loss, night pain, palpable mass or history of malignancy - imaging and rapid referral where indicated.

  • Systemic infection

    Fever, rigors, sweats with groin or pelvic pain - consider abscess, pyelonephritis or PID.

  • Aneurysm or vascular emergency

    Pulsatile groin mass, sudden severe pain or ischaemic limb - immediate vascular assessment.

Living with it

A treatable problem, with a clear ladder.

Four things that make the biggest difference day to day - respecting the tissue, rebuilding strength, staging return to sport and knowing when to escalate.

A quiet reminder

Progress needs review, not just rest.

If groin pain has not settled after six to eight weeks of good rehab, that is a signal to reassess, not to wait longer.

  1. 01 Load

    Respect the tissue

    For musculoskeletal groin pain, back off aggravating loads for two to four weeks while you rebuild strength - not indefinite rest.

  2. 02 Rebuild

    Eccentric and hip strength work

    Copenhagen adductor exercises, hip abductor strengthening and core control are the backbone of recovery.

  3. 03 Return

    Return-to-sport staging

    Graded return through running, change of direction, sport-specific drills and match play - not straight back in.

  4. 04 Escalate

    Know when to escalate

    Persistent pain beyond six to eight weeks of good rehab, mechanical hip symptoms or any red flag warrants specialist review.

Frequently asked

Everything we get asked about groin pain.

Quick answers on causes, emergencies, workup and recovery.

  • What causes groin pain?

    Many things - musculoskeletal problems like adductor or iliopsoas tendinopathy, hip joint pathology, athletic pubalgia and hernias account for most sports-related cases. Urological, gynaecological, nerve, spinal and vascular causes are all possible and need to be considered based on your history.

  • When is groin pain an emergency?

    Sudden severe testicular pain, pain with a positive pregnancy test and bleeding, hot and swollen hip with fever, sudden leg swelling suggesting DVT, or back and groin pain with saddle numbness or bladder change - all need same-day assessment.

  • How do doctors work out what is causing groin pain?

    A structured history, examination of the hip, spine, abdomen, inguinal region and genitalia, and targeted imaging and blood tests. Specific tests like the adductor squeeze, FADIR, FABER and Valsalva help point to the source.

  • What is a sports hernia?

    A tear or weakness in the muscles and tendons of the lower abdomen and groin - often the rectus abdominis and adductor complex - without a true hernia sac. It causes activity-related groin pain that fails to settle with simple rest and needs specialist management.

  • Do I need an MRI for groin pain?

    Not always. Many cases settle with a clinical diagnosis and a course of specialist physio. MRI is helpful when a labral tear, femoroacetabular impingement, adductor tear, pubic bone stress or hernia is suspected and treatment depends on imaging.

  • How long does groin strain take to heal?

    A mild adductor strain often settles in two to four weeks with graded rehab. Athletic pubalgia, tendinopathy and hip labral problems can take three to six months and sometimes surgery. Progress needs regular review, not just time off.

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