Chronic groin pain in athletes

Introduction

Groin pain is often viewed as a difficult condition to manage. This diagnosis makes up 5% of all athletic injuries and is common in direction-change sports such as soccer and AFL, making up 25% of injuries in soccer. Groin pain should be considered in two main diagnostic groups, described as ‘pubalgic’ and ‘non-pubalgic’. 

The pubalgic group includes the entities of adductor tendinopathy, osteitis pubis, posterior inguinal wall weakness (or ‘sports hernia’) and iliopsoas tendinopathy. In 30–40% of cases, there may be more than one of these entities causing pain concurrently. 

Non-pubalgic pain is dominated by the hip joint, where diagnoses such as osteoarthritis, stress fracture, avascular necrosis and femoroacetabular impingement need to be considered. 

Aetiology

The aetiology of ‘pubalgic’ groin pain is multifactorial. It may be a consequence of

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