Let’s get one thing straight from the start, groin pain can be a confusing problem for patients, and it’s often a very confusing problem for their therapists too. There a few good reasons why it seems a particularly difficult task to unravel. Firstly, when we examine people with groin pain, the area that is painful or tender, isn’t necessarily the area that is causing the problem. In other words, there may be pain referring from other structures, or areas creating biomechanical ‘mischief’ which ‘overloads’ other tissues, making them secondarily sore. Secondly, there is often more than one ‘pathology’ at play, and finally, there is huge amount of confusion about those ‘pathologies’.
So where to start? Firstly, let’s bust a myth about the term ‘Sportsman’s Hernia’. A hernia implies a lump, but actually in the case of the sportsman’s groin, it’s actually a disruption of soft tissue structures – and there is no lump. There are of course true hernias, such as an inguinal hernia, that typically occurs in an older population, as an obvious swelling in the groin, and it doesn’t typically hurt unless a loop of bowel becomes nipped in it. Sportsman’s groin problems are typically over diagnosed, and tend to occur mostly in elite level, professional male footballers. It became a diagnosis known in the popular press and so it tends to be the first conclusion people jump to. No matter how nifty you may be in a game of five-a-side, chances are that your groin pain isn’t a sportsman’s hernia. Chances are, you might have a hip condition called femoroacetabular impingement (F.A.I.) and /or a condition that overloads the bony and soft-tissue structures at the front of the pelvis called ‘osteitis pubis’ (O.P.). Osteitis Pubis is a slightly old fashioned term, and is now increasing known by a better term – pubic overload.
So how might you know if you have F.A.I .or O.P.? There are a few symptoms that are fairly classic for these two, and they regularly occur together. F.A.I. is a hip condition that will often give you pain deep in your groin (not the outside part of the hip- the trochanter- which you feel as a bony area near your trouser leg seam), and it’s typically made achy after sport, . You might also feel a pinching sensation in your groin, and it can be uncomfortable getting up from a seat, or swinging your leg out of a car. O.P. tends to give you a more central ache, in the bony part of the pelvis near your bladder, and it may make your adductors on the inside of your thighs feel tight or irritable. If you were to position your fist between your knees and squeeze, chances are you’ll know about it if you have O.P.
The good news is, F.A.I. and O.P. problems can be detected and sorted out with the correct assessment, high resolution imaging, and can often be managed without surgery. Then you can get back to being a sportsman; or sportswoman!