Anatomy: Between the deep hip flexor and the joint capsule is a large bursa (bursa iliopectinea), with the function to reduce the load on the muscle, when it slips over the hip joint. The bursa often communicates with the hip joint.

Symptoms: Pain when applying pressure on the bursa, which occasionally (but far from always) may feel swollen. Pain is agravated upon activation of the deep flexor (flexing the hip joint).

Acute treatment: Click here.

Examination: In light cases with only minimal tenderness medical examination is not necessarily required. In case of more pronounced pain or lack of progress a medical examination should be carried out to ensure that the diagnosis is correct and commence any treatment. The diagnosis is most easily and quickly made with ultrasound (which allows simultaneous treatment) (article).

Treatment: The treatment primarily comprises relief. The treatment can be supplemented with rheumatic medicine (NSAID) or injection of corticosteroid in the bursa preceded by draining of the bursa, which can advantageously be done under ultrasound guidance (article).

Complications: If progress is not smooth the correctness of the diagnosis or whether complications have arisen, should be considered:

• Degenerative arthritis in the hip joint
• Rupture of the superficial hip flexor (ruptura musculus rectus femoris)
• Rupture of the deep hip flexor (ruptura musculus iliopsoas)
• Outer snapping hip
• Inner snapping hip
• Fluid accumulation in the joint (traumatic synovitis/coxitis)
• Stress fracture of the femoral neck
• Inguinal hernia
• Inflammation of the adductor muscle of the thigh (tendinitis m adductor longus)
• Rupture of the adductor muscle of the thigh (ruptura m adductor longus)
• Rupture of the abdominal muscle fastening on the pubic bone (ruptura m rectus abdominis)
• Inflammation of the pubic bone joint (osteitis pubis)
• Nerve entrapment
• Lumbago

Special: Shock absorbing shoes or inlays will reduce the load.

Anatomy: The various muscles of the abdominal wall are penetrated by the inguinal canal, which contains nerves (N ilioinguinalis and the genital branch of N genitofemoralis) and in men the spermatic cord (funilicus spermaticus). In women the inguinal canal instead contains a small fibrous ligament. Where the inguinal canal penetrates the abdominal wall weak spots arise (anulus inguinalis superficialis and anulus inguinalis profundus).

Symptoms: Pain in the groin, aggravated when coughing. Sometimes a swelling in the groin is visible. Usually the swelling (containing intestine) can be pushed into place. If the swelling is painful and cannot be pressed into place the hernia may be strangulated (which requires acute medical assistance).

Examination: In obvious cases with visible swelling in the groin the diagnosis is easy to make. With lack of swelling in the groin the diagnosis is naturally difficult. (article 1) A normal medical examination is usually sufficient in order to make the diagnosis, however, if there is any doubt concerning the diagnosis a MRI-scan or a dynamic ultrasound scan, where weaknesses in the abdominal wall can be detected while increasing the pressure in the abdominal cavity by applying pressure can be performed (article 2) (article 3).

Treatment: With modest discomfort, you can primarily attempt training of the abdominal muscles (article). If discomfort continues, surgery is advised. If strangulated hernia is suspected you should seek acute medical assistance to evaluate the indication for acute surgery, as there is a risk of lasting damage to the intestine. With uncomplicated surgery, a relief period of approx. two months should be expected before maximal sports activity can be resumed (very dependent on the sport in question).

Complications: If progress is not smooth (even after operation) it should be considered whether the diagnosis is correct or whether complication have arisen. In particular the following should be considered:

• Inflammation of the adductor muscle of the thigh
• Rupture of the adductor muscle of the thigh
• Inflammation of the pubic joint (osteitis pubis)
• Bursitis on the front of the hip joint (bursitis iliopectinea)
• Other bursitis
• Fluid accumulation in the hip joint
• Degenerative arthritis in the hip joint
• Rupture of the superficial hip flexor (ruptura musculus rectus femoris)
• Rupture of the deep hip flexor (ruptura musculus iliopsoas)
• Outer snapping hip
• Inner snapping hip
• Stress fracture in the femoral neck
• Nerve entrapment
• Lumbago
• Piriformis syndrome

Anatomy: Numerous nerves penetrate the abdominal wall and transmit nerve branches to the area on the stomach, groin and thigh. The nerve can be entrapped where it penetrates the abdominal wall.

Symptoms: Pain in the groin region. Discomfort and sensory disturbances can often be induced if the area where the nerve is entrapped is scratched/pushed.

Examination: In the medical examination the doctor attempt to produce the discomfort symptoms by scratching or pushing the area in which the nerve is entrapped. By administering a couple of millilitres of local anaesthetic in this area the symptoms should disappear if the diagnosis is correct (otherwise the diagnosis is wrong). There is no examination (X-ray, ultrasound, MRI, scintigraphy) that can detect the nerve entrapment. The real frequency of the diagnosis is debated amongst professionals.

Treatment: Since the condition is harmless and without risk even if you continue sports activity, continuing sport is recommended in the hope that the discomfort will pass on its own. Pausing and alternative training of the abdominal muscles can be attempted. If the discomfort is long-lasting with no sign of abatement, even during summer or winter breaks, you can consider surgically severing the nerve, provided that pain abates when local anaesthesia is administered (article-1) (article-2).

Rehabilitation: If the discomfort stems from the nerve, you should be able to resume sports activity immediately following the operation.
Also read rehabilitation, general.

Complications: Since it can be difficult to make a correct diagnosis in athletes with long-term groin pain (article), it should be supplemented with, amongst other things, ultrasound scanning and consideration of x-ray scintigraphy and possibly an MRI scan. It should be considered whether the diagnosis is correct, and amongst other things consider the following:

• Inflammation of the adductor muscle of the thigh
• Rupture of the adductor muscle of the thigh
• Inflammation of the pubic bone joint (osteitis pubis)
• Inflammation of the abdominal muscle fastening on the pubic bone
• Stress fracture
• Bursitis on the front of the hip joint (bursitis iliopectinea)
• Other bursitis
• Fluid accumulation in the hip joint
• Degenerative arthritis in the hip joint
• Rupture of the superficial hip flexor (ruptura musculus rectus femoris)
• Rupture of the deep hip flexor (ruptura musculus rectus femoris)
• Outer snapping hip
• Inner snapping hip
• Lumbago
• Piriformis syndrome

Anatomy: The thigh’s adductor muscles (M adductor longus, M adductor brevis, Madduktor magnus, M gracilis and M pectineus) are all fastened in the groin on the pubic bone (tuberculum pubicum).

Symptoms: Pain upon applying pressure along the tendon with worsening upon stretching and activation of the muscle tendon (squeezing stretched legs together against resistance). In light cases a local tenderness is felt after the load (“muscle strain”, “imminent pulled muscle”). In severe cases a sudden shooting pain in the muscle is felt (partial “muscle rupture” or “pulled muscle”) and in the worst case a sudden snap is felt, rendering the muscle unusable (“total muscle rupture”). In case of total rupture a swelling can often be felt on the inside of the thigh.

Acute treatment: Click here.

Examination: In light cases medical examination in not necessarily required. Severe cases or cases not improved by treatment should be evaluated by a doctor so that a precise diagnosis can be made. A normal medical examination is usually sufficient in order to make the diagnosis, however, if there is any doubt concerning the diagnosis an ultrasound scan can be performed. Ultrasound is well suited to evaluate the tendons. If in the medical examination there is pain when applying pressure on the muscle attachment point in the groin, and aggravation at the same location upon stretching and activation of the adductor, there is hardly any doubt about the diagnosis and an ultrasound scan is not necessary. However, the diagnosis of groin pain can be particularly difficult (article).

Treatment: Relief, stretching and slowly increasing load within the pain threshold.

Complications: If progress is not smooth it should be considered whether the diagnosis is correct or whether complication have arisen. In particular the following should be considered:

• Inflammation adductor muscle of the thigh
• Rupture of the superficial hip flexor
• Rupture of the deep hip flexor (rupture musculus iliopsoas)
• Outer snapping hip
• Inner snapping hip
• Fluid accumulation in the hip joint
• Stress fracture in the femoral neck
• Inguinal hernia
• “Sportsman’s hernia”
• Inflammation of the abdominal muscle fastening on the pubic bone
• Inflammation of the pubic joint
• Nerve entrapment

Special: Shock absorbing shoes or inlays will reduce the load in the groin. In case of lack of progress or relapse after successful rehabilitation, a running style analysis can be considered to evaluate whether correction of the running style should be recommended.

Anatomy: The pelvis consists of two halves joined at the back by the sacral bone (os sacrum) and at the front by the pubic joint (symphysis). The abdominal muscle (M rectus abdominis) if fastened on the pubic bone and the adductor muscles of the thigh (amongst others the M adductor longus) are fastened in the groin just below the pubic bone.

Symptoms: Pain around the pubic bone, the abdominal muscle fastening and in the groin. Aggravated with asymmetric loads (jumping on one leg).

Acute treatment: Click here.

Examination: Inflammation of the pubic bone joint is always an athletically serious condition that always requires medical examination. A normal medical examination is usually sufficient in order to make the diagnosis. Tenderness will often be present on the pubic bone joint (direct and indirect). The examination can be supplemented with X-ray, scintigraphy, MRI- and ultrasound scan. The diagnosis of groin pain can be particularly difficult (article)

Treatment: Inflammation of the pubic bone joint is often the end stage of a poorly treated chronic overloading of the muscle fastenings on the pubic bone and the groin. In severe cases the rehabilitation period can be expected to last a year (and in the worst case render a return to sports an impossibility). It is therefore of the utmost importance that the treatment be started as soon as possible, without continuing the condition inducing sports activity. The treatment primarily consists of relief and subsequently slowly increasing training of the musculature around the pubic bone joint (stomach, groin), pelvis and loin. In case of lack of progress with rehabilitation, a medical treatment can be considered in the form of rheumatic medicine (NSAID) or the injection of corticosteroid around the inflamed tendon fastening or in the pubic bone joint (article). The injection can advantageously be ultrasound guided. Since the injection of corticosteroid always is part of a long-term rehabilitation of a very serious, chronic injury, it is decisively necessary, that the rehabilitation course stretches over several months to reduce the risk of relapse. A rehabilitation period of ½ – 1 year before maximum load in the form of maximal running with directional change is allowed is not unusual. Some have tried operating for this condition, which usually returns to normal when the load (sports activity) ceases (article). Particularly careful consideration should be made before accepting a surgical offer with the risks this entails, for a condition that does not threaten mobility nor health (article).

Complications: If progress is not smooth the correctness of the diagnosis should be considered. In particular, the following should be considered:

• Inflammation of the adductor muscle of the thigh
• Rupture of the adductor muscle of the thigh
• Fluid accumulation in the hip joint
• Degenerative arthritis in the hip joint
• Rupture of the superficial hip flexor (ruptura musculus rectus femoris)
• Rupture of the deep hip flexor (ruptura musculus iliopsoas)
• Outer snapping hip
• Inner snapping hip
• Stress fracture in the femoral neck
• Inguinal hernia
• “Sportman’s hernia”
• Inflammation of the abdominal muscle fastening on the pubic bone
• Bursitis on the front of the hip joint (bursitis iliopectinea)
• Other bursitis
• Nerve entrapment

Special: Shock absorbing shoes or inlays will reduce the load in the groin. In case of lack of progress or relapse after successful rehabilitation, a running style analysis can be considered to evaluate whether correction of the running style should be recommended.

Anatomy: The pelvis consists of two halves, joined at the back by the sacral bone (os sacrum) and at the front by the pubic joint (symphysis). The abdominal muscle (M rectus abdominis) is fastened on the pubic bone and helps bend the back (so that the head is brought towards the knee). The adductor muscles in the thigh (amongst others the M adductor longus) are fastened in the groin just below the pubic bone.

Symptoms: Pain around the abdominal muscle fastening on the pubic bone, worsening when applying pressure, stretching and activation of the abdominal muscles (sit-ups, stomach crunches).

Acute treatment: Click here.

Examination: In light cases, medical examination is not necessarily required. Severe cases or cases not improved by treatment, should be evaluated by a doctor to make a precise diagnosis. A normal medical examination is usually sufficient in order to make the diagnosis. If upon examination there is pain when applying pressure on the muscle fastening in the groin, worsening at the same location upon stretching and activation (sit-ups), there is hardly any doubt concerning the diagnosis even though the diagnosis of groin pain can be particularly difficult (article). However, if there is any doubt concerning the diagnosis an ultrasound scan can be performed. Ultrasound examination is well suited to evaluate the muscles in the area.

Treatment: The treatment usually consists of relief and cautious rehabilitation. In case of lack of progress with rehabilitation, medical treatment can be considered in the form of rheumatic medicine (NSAID) or the injection of corticosteroid along the inflamed part of the muscle fastening on the pubic bone. Surgery is rarely necessary (and the results are not convincing).

Complications: If satisfactory progress is not achieved, it should be considered whether the diagnosis is correct or whether complications have arisen. In particular the following should be considered:

• Inflammation of the adductor muscle of the thigh
• Rupture of the adductor muscle of the thigh
• Inflammation of the pubic joint (osteitis pubis)
• Bursitis on the front of the hip joint (bursitis iliopectinea)
• Other bursitis
• Fluid accumulation in the hip joint
• Degenerative arthritis in the hip joint
• Rupture of the superficial hip flexor (ruptura musculus rectus femoris)
• Rupture of the deep hip flexor (ruptura musculus iliopsoas)
• Outer snapping hip
• Inner snapping hip
• Stress fracture in the femoral neck
• Inguinal hernia
• “Sportsman’s hernia”
• Nerve entrapment

Special: Shock absorbing shoes or inlays will reduce the load on the muscle fastenings. In case of lack of progress or relapse after successful rehabilitation, a running style analysis can be considered to evaluate whether correction of the running style should be recommended.

Anatomy: The adductors in the thigh (M adductor longus, M adductor brevis and M adductor magnus along with M gracilis and M pectineus) are all fastened in the groin on the pubic bone.

Symptoms: Pain when applying pressure along the tendon, worsening upon stretching and activation of the muscle tendon (closing of stretched legs against resistance).

Acute treatment: Click here.

Examination: In light cases medical examination in not necessarily required. Severe cases or cases not improved by treatment should be evaluated by a doctor so that a precise diagnosis can be made. A normal medical examination is usually sufficient in order to make the diagnosis. If in the medical examination there is pain when applying pressure on the muscle attachment point in the groin, and aggravation at the same location upon stretching and activation of the adductor, there is hardly any doubt about the diagnosis. The diagnosis of groin pain can be particularly difficult (article) However, if there is any doubt concerning the diagnosis an ultrasound scan can be performed. Ultrasound is well suited to evaluate the muscles in the area.

Treatment: Since tendinitis of the adductor (M adductor longus) in the thigh is one of the sports injuries with the highest risk of becoming chronic, it is imperative that treatment starts as soon as the first symptoms are felt (and not after months of increasing discomfort). The treatment involves relief, stretching and slowly increasing load within the pain threshold (article). Ice treatment should be used after training if tenderness is felt in the groin. If there is a lack of progress with relief and rehabilitation, medical treatment in the form of rheumatic medicine (NSAID) or the injection of corticosteroid around the inflamed part of the tendon may be considered. The injection of corticosteroid is always part of long-term rehabilitation of a very serious chronic injury. It is therefore necessary that the rehabilitation period after the injection treatment stretches over several months to reduce the risk of relapse and ruptures. The tendon can naturally not sustain maximal load after a long-term injury period and only a short-term rehabilitation period. It is not unusual for rehabilitation to stretch over six months, before maximal load in the form of running with directional change is permitted. In cases where there is lack of progress after rehabilitation and conservative treatment, operative treatment can be attempted. The long-term results of operations are often disappointing.

Complications: If satisfactory progress is not achieved, it should be considered whether the diagnosis is correct or whether complications have arisen. In particular the following should be considered:

• Rupture of the adductor muscle in the thigh
• Degenerative arthritis in the hip-joint
• Rupture of the superficial hip flexor (ruptura musculus rectus femoris)
• Rupture of the deep hip flexor (ruptura musculus iliopsoas)
• Outer snapping hip
• Inner snapping hip
• Fluid accumulation in the joint (traumatic athrtitis/synovitis)
• Stress fracture in the femoral neck
• Inguinal hernia
• Inflammation of the abdominal muscle fastening on the pubic bone
• Inflammation of the pubic bone (osteitis pubis)
• Nerve entrapment
• Inflammation of the bursa

Special: Shock absorbing shoes or indlays will reduce the load in the groin. In case of lack of progress or relapse after successful rehabilitation, a running style analysis can be considered to evaluate whether correction of the running style should be recommended.