Conditions We Treat
Groin Strain
At a glance
A groin strain usually means adductor-related groin pain, the most common type of groin injury in footballers. Under the 2015 Doha agreement it is defined by tenderness of the adductor muscles on the inside of the thigh together with pain when you squeeze your legs together against resistance. Most cases are managed without surgery through assessment, hands-on care and progressive strengthening, and a single exercise, the Copenhagen adduction, has been shown to lower the risk of groin problems in footballers by 41%.
You lunge for a wide ball on the padel court or plant your foot to change direction on the rugby field, and feel a sharp pull high on the inside of your thigh. Sometimes there is no single moment at all, just a groin that aches after every hockey match, feels stiff the next morning and catches when you climb out of the car.
Groin pain in athletes used to come with a confusing list of labels. In 2015, 24 international experts agreed a simpler system known as the Doha agreement. It groups groin pain into adductor-related, iliopsoas-related, inguinal-related and pubic-related groin pain, with hip-related groin pain and other causes as separate categories (Weir et al., 2015). Adductor-related groin pain is defined by tenderness of the adductor muscles and pain when you squeeze your legs together against resistance. It is what most people mean by a groin strain, and in a season-long study of 998 male footballers it was the most common presentation, with age and a previous groin injury both identified as risk factors (Hölmich et al., 2014).
The adductors work hard whenever you kick, accelerate or push off sideways. That is why we see groin strains so often in footballers, rugby players and hockey players, and in padel players, where long lateral lunges load the inside of the thigh at full stretch. Our article on common padel injuries covers that side of things in more detail.
Acute strains generally recover well with a structured, criteria-based programme. In a study of 81 male athletes with acute adductor injuries, those with mild to moderate injuries returned to full team training after a median of 18 days, while complete tears took a median of 78 days. Athletes who reached a clinically pain-free stage during rehab re-injured far less often, 5% compared with 21% (Serner et al., 2020). Rather than picking a return date in advance, we use clear milestones of strength and pain-free movement to decide when you are ready to step up.
Long-standing groin pain behaves differently. It tends to creep up over weeks or months and flare with every match. A 2021 systematic review of conservative treatment for long-standing adductor-related groin pain identified manual therapy combined with strengthening exercise among the better-supported options (Bisciotti et al., 2021). That is the core of our approach: soft tissue work and joint mobilisation through the hip, pelvis and lower back where they are stiff, alongside a graded adductor and hip strengthening programme and sensible adjustments to training load through the season.
Prevention has particularly clear evidence behind it. In a cluster-randomised trial of 35 semi-professional Norwegian football teams, players who did a programme built around one exercise, the Copenhagen adduction, three times a week in preseason and once a week during the season had a 41% lower risk of groin problems than those who trained as normal (Harøy et al., 2019). We teach the progressions so you or your team can keep it going long after the pain has settled.
Not all groin pain is a strain. Pain that sits higher, in the inguinal canal region, and is worse when you cough or sneeze points towards inguinal-related groin pain (Weir et al., 2015). Deep pain at the front of the hip with clicking or catching may be coming from the joint itself, which our hip pain page covers. Groin pain can also come from the lower back, the sacroiliac joint, the abdomen or the pelvis, and international consensus stresses that more serious causes should not be missed (Hölmich et al., 2026). See your GP if you notice a lump in the groin or testicular pain or swelling, and also if you feel generally unwell with your groin pain. As primary contact practitioners, we can refer you directly for imaging or to a specialist when the picture calls for it.
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Book OnlineCommon symptoms of a groin strain
- Pain on the inside of the upper thigh or in the groin
- A sharp pull at the moment of injury while kicking, lunging or changing direction
- Pain when squeezing your knees together
- Tenderness along the adductor muscles
- Pain with sprinting, kicking or side-to-side movement
- Stiffness in the groin the morning after training or a match
- Discomfort getting in and out of a car
- Weakness or a lack of power when pushing off sideways
- Groin pain that warms up during play and returns afterwards
- Pain that keeps returning at the same point in the season
Groin strains respond best to early, structured rehab. If your groin is sore after sport or keeps flaring, getting assessed early helps you start the right programme before it becomes a long-standing problem.
Located on Rivonia Road in Morningside, we treat patients from Sandton, Bryanston, Rivonia, Fourways and across Johannesburg.
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Frequently Asked Questions
Most acute groin strains recover within a few weeks. In a study of 81 male athletes following a criteria-based rehab programme, those with mild to moderate adductor injuries returned to full team training after a median of 18 days. Complete tears took longer, with a median of 78 days. Long-standing groin pain that has built up over months usually needs a longer, structured strengthening programme.
It is the term agreed by international experts in the 2015 Doha agreement for what most people call a groin strain. It is defined by tenderness of the adductor muscles on the inside of the thigh together with pain when you squeeze your legs together against resistance. It is the most common type of groin pain in footballers.
A groin strain is usually tender on the inside of the upper thigh and hurts when you squeeze your knees together. Pain that sits higher, in the region of the inguinal canal, and is worse when you cough or sneeze points more towards inguinal-related groin pain. A visible or palpable lump in the groin should be checked by your GP. Part of our assessment is working out which structure is involved and referring you on if needed.
Strengthening the adductors is a practical place to start. In a trial of 35 semi-professional football teams, a programme built around a single exercise, the Copenhagen adduction, lowered the risk of groin problems by 41%. It was done three times a week in preseason and once a week during the season, so it fits easily into training.
Playing through a groin that is getting worse each week tends to drag the problem out. You do not always need complete rest, but training load usually needs adjusting while strength is rebuilt. In one study, athletes who reached a clinically pain-free stage during rehab before going back re-injured far less often than those who did not.
Yes. The hip joint is a common source of groin pain, and the Doha agreement lists hip-related groin pain as its own category. Deep pain in the front of the hip, clicking or catching and pain when the hip is bent and turned inwards are clues. We examine the hip as part of every groin assessment.
References
- Weir A, Brukner P, Delahunt E, et al. Doha agreement meeting on terminology and definitions in groin pain in athletes. British Journal of Sports Medicine. 2015;49(12):768-774.
- Hölmich P, Thorborg K, Dehlendorff C, Krogsgaard K, Gluud C. Incidence and clinical presentation of groin injuries in sub-elite male soccer. British Journal of Sports Medicine. 2014;48(16):1245-1250.
- Serner A, Weir A, Tol JL, et al. Return to sport after criteria-based rehabilitation of acute adductor injuries in male athletes: a prospective cohort study. Orthopaedic Journal of Sports Medicine. 2020;8(1):2325967119897247.
- Bisciotti GN, Chamari K, Cena E, et al. The conservative treatment of longstanding adductor-related groin pain syndrome: a critical and systematic review. Biology of Sport. 2021;38(1):45-63.
- Hölmich P, Weir A, Papadopoulou T, et al. Hip and groin pain in physically active adults with a focus on terminology, clinical examination and imaging: a formal ESSKA-EHPA-ESMA consensus. Knee Surgery, Sports Traumatology, Arthroscopy. 2026;34(10):3844-3855.
- Harøy J, Clarsen B, Wiger EG, et al. The Adductor Strengthening Programme prevents groin problems among male football players: a cluster-randomised controlled trial. British Journal of Sports Medicine. 2019;53(3):150-157.