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Health condition · Clinically reviewed

Hip and groin pain in sport, classified, imaged and rehabilitated the modern way.

Common in footballers, rugby players, runners and dancers. The Doha framework, an MRI when it counts and a Copenhagen-led rehab plan - not endless rest.

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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 sports and musculoskeletal clinician before publication.

  • 02

    Sourced from guidance

    Checked against the Doha agreement, BASEM, BJSM and peer-reviewed sports-medicine sources listed at the end.

  • 03

    Current for 2026

    Reflects modern UK practice, including the Copenhagen adduction protocol and MRI-led diagnostic pathways.

Key facts

Sports groin pain at a glance.

The essentials, in plain English - who gets it, how it is classified and how it is treated in the UK today.

  • What it is

    An umbrella for adductor, iliopsoas, inguinal, pubic and hip-joint injuries in athletes, plus non-musculoskeletal mimics.

  • Who gets it

    Common in footballers, rugby players, hockey players, runners, dancers, gymnasts and hurdlers - kicking, cutting and end-range sports.

  • Doha framework

    Groin pain is classified as adductor, iliopsoas, inguinal, pubic or hip-related - the same language used by UK sports clinicians.

  • Adductor-related

    Adductor longus tendinopathy and strain is the single most common cause in kicking sports.

  • Diagnostic imaging

    MRI is the gold standard - dynamic ultrasound is used for suspected inguinal or sports hernia.

  • Red flag

    A femoral neck stress fracture in a runner or military recruit is a specialist emergency needing urgent MRI and non-weight-bearing.

Why this guide matters

A classification, an MRI and a rehab plan.

Groin pain is a differential, not a diagnosis. The three points below shape everything else on this page.

  • The Doha framework matters

    UK sports clinicians use the Doha categories - adductor, iliopsoas, inguinal, pubic and hip-joint - to give a diagnosis and a plan.

  • MRI is the gold standard

    Musculoskeletal MRI is the single most useful test in stubborn or unclear sports groin pain, and drives targeted rehabilitation.

  • Loading beats resting

    The Copenhagen adduction protocol, gluteal and core work outperform passive rest for adductor-related groin pain.

How the diagnosis is made

From first twinge to a clear plan.

The steps a UK sports and exercise medicine team will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    Sport, load and technique history

    Volume, surface, footwear, kicking limb, cutting sports and recent changes in training all shape the differential.

  2. 02

    Assessing

    Character, onset and radiation

    Acute versus insidious, activity-related, sharp or dull, and any radiation into the abdomen, testicle or thigh.

  3. 03

    Assessing

    Red flag screen

    Night pain, weight loss, fever, urological or gynaecological symptoms and stress-fracture risk factors including RED-S and amenorrhoea.

  4. 04

    Confirming

    Focused examination

    FADIR and FABER for the hip joint, palpation of the adductors, iliopsoas and rectus, and resisted adductor squeeze (Copenhagen) testing.

  5. 05

    Confirming

    MRI - the gold standard

    Specialist musculoskeletal MRI localises the injury to adductor, iliopsoas, inguinal, pubic or intra-articular hip - see private MRI scan.

  6. 06

    Planning

    Targeted second-line imaging

    Dynamic ultrasound for suspected sports hernia, plain X-ray for pubic bone changes and stress-fracture screening where indicated.

  7. 07

    Planning

    Specialist MDT review

    Sports and exercise medicine, orthopaedic hip surgery and specialist physiotherapy shape the plan together.

Typical timeline: from first assessment to a targeted rehab plan in a week or two.

Symptoms

What sports groin pain actually feels like.

The Doha categories give a distinct clinical picture each - and there is always a short list of dangerous mimics to rule out.

  • Adductor-related pain

    Medial groin pain over the adductor longus, worse on kicking, cutting and resisted adduction (Copenhagen squeeze).

  • Iliopsoas-related pain

    Deep anterior groin or hip flexor pain with a painful or audible snap on hip flexion and rotation.

  • Inguinal-related pain

    Sports hernia, Gilmore groin and athletic pubalgia - deep inguinal pain, coughing and sit-up provocation.

  • Pubic-related pain

    Osteitis pubis and pubic bone stress reaction - central pubic tenderness, worse with sprinting and change of direction.

  • Hip-joint related pain

    FAI, labral tears, chondral injury, loose bodies and early osteoarthritis - deep C-sign pain, catching and stiffness.

  • Non-musculoskeletal mimics

    Inguinal hernia, iliopsoas abscess, urological, gynaecological and testicular causes must be considered.

  • Snapping hip

    Internal (iliopsoas over the pectineal eminence) or external (ITB over greater trochanter) snapping - painful when symptomatic.

  • Red flag - femoral neck stress fracture

    Runners, military recruits and athletes with RED-S or amenorrhoea - urgent MRI, non-weight-bearing and specialist emergency referral.

Treatment

How sports groin pain is treated in the UK.

Structured rehabilitation first, targeted injections next - and surgery for hip joint problems, sports hernia and unstable stress fractures.

  • Relative rest and load management

    Activity modification with an early return to pain-free movement - not complete rest, which prolongs recovery.

  • Copenhagen adduction protocol

    The evidence-based rehabilitation backbone for adductor-related groin pain - progressive eccentric adductor loading.

  • Specialist sports physiotherapy

    Adductor, core and gluteal strengthening, stretching, biomechanics correction and progressive return-to-play - see spinal physiotherapy.

  • NSAIDs and analgesia

    Short courses of anti-inflammatories and simple analgesia to keep rehab moving - not a substitute for loading.

  • Image-guided injections

    PRP or targeted steroid injections for tendinopathy, bursitis or resistant pubic symphysis pain - see steroid injection.

  • Hip arthroscopy

    Keyhole surgery for FAI, labral repair, chondral debridement and loose-body removal - see hip arthroscopy.

  • Sports hernia repair

    Specialist inguinal or open repair for posterior wall weakness and athletic pubalgia when conservative care fails.

  • Stress fracture management

    Non-weight-bearing for compression-side fractures and surgical fixation for tension-side femoral neck fractures - specialist commissioned.

What this guide is based on

The sources behind every claim on this page.

UK and international sports-medicine 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.

A sports and exercise medicine clinician knows your sport, load and history and can tell you which parts apply to you. If in doubt, get seen.

  • Doha agreement meeting on terminology and definitions in groin pain in athletes (BJSM).

  • British Association of Sport and Exercise Medicine (BASEM). Groin pain in athletes guidance.

  • NICE CKS. Hip pain in adults.

  • British Hip Society. Position statements on FAI and hip preservation surgery.

  • BJSM. Copenhagen adduction exercise protocol for adductor-related groin pain.

Red flags

When groin pain isn’t a sports injury.

Most groin pain in athletes is musculoskeletal and treatable. These are the situations that aren’t - and where urgent assessment is needed.

  • Femoral neck stress fracture

    Groin pain in a runner, military recruit or athlete with RED-S or amenorrhoea - needs urgent MRI, non-weight-bearing and specialist referral.

  • Tension-side stress fracture

    Superior lateral femoral neck fractures are unstable and displace - surgical fixation is often required.

  • Cauda equina symptoms

    Saddle numbness, bladder or bowel change with groin or hip pain - a same-day emergency, not a sports injury.

  • Systemic features

    Fever, night sweats or weight loss with groin pain raises concern for infection, iliopsoas abscess or malignancy.

  • Testicular or scrotal pain

    Testicular torsion and epididymo-orchitis can present as groin pain - a urological, not sports, emergency.

  • Gynaecological causes

    Ectopic pregnancy, ovarian torsion or pelvic inflammatory disease can mimic sports groin pain in women.

  • True inguinal hernia

    A palpable, reducible lump in the groin needs a general-surgical opinion, not a sports rehabilitation plan.

  • Vascular claudication

    Buttock or thigh claudication with rest relief points to iliac artery disease and needs vascular assessment.

  • RED-S and the female athlete triad

    Low energy availability, menstrual dysfunction and low bone density dramatically raise stress-fracture risk.

Living with it

A treatable injury, with a clear ladder back to sport.

Four things that make the biggest difference - loading rather than resting, patience with rehab, fixing biomechanics and knowing when to escalate.

A quiet reminder

Rehab beats rest, every time.

Structured, progressive loading returns athletes to sport faster and with fewer recurrences than passive rest.

  1. 01 Rehab

    Load, don’t just rest

    Progressive loading, especially with the Copenhagen adduction protocol, outperforms passive rest for adductor-related groin pain.

  2. 02 Patience

    Give it 8 to 12 weeks

    Most adductor and pubic-related injuries need two to three months of structured rehab - judge progress in weeks, not days.

  3. 03 Biomechanics

    Fix the cause, not the symptom

    Kicking mechanics, single-leg control, hip mobility and running form all need attention to prevent recurrence.

  4. 04 Escalate

    Know when to image or refer

    Persistent pain past six to eight weeks, night pain or stress-fracture risk factors deserve MRI and a specialist opinion.

Frequently asked

Everything we get asked about sports groin pain.

Quick answers on Doha classification, MRI, Copenhagen rehab, sports hernia and stress fractures.

  • What is groin pain in sport?

    An umbrella term for injuries around the hip and groin in athletes. The Doha agreement classifies it as adductor, iliopsoas, inguinal, pubic or hip-joint related - and clinicians also screen for non-musculoskeletal causes such as hernias, urological and gynaecological conditions.

  • Which sports cause the most groin injuries?

    Kicking and cutting sports lead the list - football, rugby, hockey, Gaelic football and Australian rules. Running, dance, gymnastics and hurdling also generate a lot of adductor, pubic and femoral neck injuries.

  • When do I need an MRI?

    MRI is the gold standard for sports groin pain. It is used when pain has not settled with a few weeks of structured rehab, when the diagnosis is unclear, when red flags are present or when a stress fracture is suspected.

  • What is the Copenhagen adduction protocol?

    A progressive eccentric adductor strengthening programme, done with a partner and a plinth, that has the best evidence for adductor-related groin pain. It is the backbone of modern rehabilitation for kicking athletes.

  • What is a sports hernia?

    Also called Gilmore groin or athletic pubalgia. It is a weakness of the posterior inguinal wall and dysfunction of the rectus abdominis and adductor common aponeurosis - not a true hernia. Treatment starts with rehab and, if that fails, specialist surgical repair.

  • When is a femoral neck stress fracture an emergency?

    Always. Groin pain in a runner, military recruit or an athlete with menstrual dysfunction or RED-S needs urgent MRI, non-weight-bearing and specialist review. A tension-side fracture can displace and cause permanent hip damage.

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