Groin pain syndrome is a term used to describe groin pain without clinical evidence of hernia or hip pathology. Though the condition is thought to affect between 2% and 20% of athletes, there is not a lot of conclusive research on its cause or the best way to treat it. Most of the published research on those with groin pain without hernia or hip joint pathology are case studies (primarily of professional male athletes), making it difficult to establish agreed upon treatment guidelines, as these types of studies are considered to be of low quality and do not apply to the general population.
Understanding the anatomy of the trunk and pelvis helps us appreciate why physical activity applies tremendous strain to this region. First, the pubic joint is in the front/midline of the pelvis, the sacrum or “tail bone” is in the back, and ilium (or “wings” of the pelvis) make up the sacroiliac joints. These joints only partially move as we walk, run, twist, jump, etc. while the hip joints move freely. The muscles arising from the legs connect to multiple places on the pelvis and spine.
With groin pain syndrome, there is a significant amount of tension directed at the pubic joint by the muscles, tendons, and ligaments (collectively called “soft tissues”) during intense athletic activities (and sometimes regular daily life). These soft tissues also provide shock absorption and add structural support to the pubic joint.
Researchers speculate that groin pain syndrome is caused by the significant difference in strength of the opposing muscle forces from above (abdominal muscles) and below (adductors) leading to strain/sprain and eventually pubic joint pathology (osteoarthritis). Because of this high level of force, injury to the labrum that lines the rim of the hip joint may occur simultaneously resulting in two separate injuries or pain generators, making it easy to overlook the often more subtle, less known groin pain syndrome. Degeneration or joint arthritis can result in both the pubic joint and hip joint, again, adding to the confusion and differential diagnosis.
One case study that involved three soccer players with groin pain syndrome reported that all three athletes experienced satisfactory outcomes after an eight-week course of conservative treatment that included manual joint and soft tissue manipulation. Another study that looked at outcomes from NFL players who underwent either conservative or surgical treatment for groin pain syndrome found no difference in performance between the two groups, though the data suggests that players who underwent surgery for groin pain syndrome may have had shorter careers than those in the non-surgical group.
Doctors of chiropractic are trained to identify all potential causes for a patient’s musculoskeletal condition and to offer conservative treatment options to reduce pain and restore function so the patient can resume their normal activities.
