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What can we find in this region?
The adductors are muscles on the inside of the thigh that bring the leg towards the other leg. Many attach near the pubis, at the front of the pelvis. Nearby are the abdominal muscles, the pubic symphysis, which unites the two sides of the pelvis, and the inguinal canal. The iliopsoas muscle participates in hip flexion.
These structures are neighbors and work together, especially during changes of direction. The pain may involve the adductors, iliopsoas, inguinal region, pubis or hip joint. Several categories can coexist. The Doha Classification helps professionals to describe the problem precisely; it is not a tool for diagnosing yourself.
Understand the picture
A small region, several structures
Adductors
They connect the pelvis to the inside of the thigh.
Pubis and inguinal region
The symphysis and neighboring tissues may be involved.
Hip and iliopsoas
The hip joint and flexor are also part of the assessment.
Sudden onset or progressive discomfort: why specify it?
Sharp pain when accelerating or swerving may indicate a muscle injury. Swelling, bruising, or difficulty walking may accompany it. Progressive pain sometimes appears first after training, then during shooting, acceleration or ordinary exertion. Discomfort that disappears when you warm up is not automatically unimportant.
Explain whether you were able to complete the activity, what happened next, and whether symptoms return each time you do it again. Don’t compare your recovery to that of another athlete just because you both use the word pubalgia. Significant acute pain, inability to bear weight on the leg or an unusual sensation in the testicle first requires a medical assessment.
What factors can play a role?
A rapid increase in training, a return after an interruption, repeated sprints or insufficient recovery can contribute to the context. The level of strength and the ability to withstand the movements of the sport also count. However, it is difficult to prove that a single lack of flexibility, a difference in leg length or weakness explains all the pain.
The assessment should relate possible factors to your medical history. It is useful to bring the program for the week, matches and other physical activities. Stress and sleep can influence recovery without making pain an imaginary problem. Looking for a single culprit can lead to endless correction of posture while forgetting the real load of sport.
Pubalgia, hernia and organ pain: the limits to know
The English term sports hernia can refer to inguinal pain related to sports without a real visible hernia. A true inguinal hernia is the passage of tissue through an area of weakness in the wall and can form a lump. These words should therefore not be used as exact synonyms.
A painful lump, especially with vomiting, feeling very unwell or the inability to pass gas or stools, requires urgent help. Sudden testicular pain should be evaluated immediately. Urinary symptoms, abdominal pain or pelvic pain related to pregnancy also require appropriate referral. Adductor exercises do not address all causes of groin pain.
How does the exam take place?
The professional searches for the location, tests certain movements and strength, then assesses the hip and neighboring regions. He compares the results with the usual symptoms. Reproducing a discomfort with a test does not alone prove which structure is responsible. Examinations of the inguinal region must be explained and carried out with your consent and respect for your privacy.
An x-ray, ultrasound or MRI may be chosen depending on the question: hip, muscle, tendon, hernia or suspected bone lesion. The imaging is not identical for each pubalgia. An anomaly may exist without explaining all the symptoms. Deep pain when bearing weight on the leg, particularly after a strong increase in training or with bone fragility, requires that a stress fracture also be considered.
What to do at the start of a painful injury?
Interrupt the action that caused the pain and avoid repeating sprints or splits to check. Depending on the severity, an assessment makes it possible to specify which activities can be resumed. Significant pain, extensive bruising or very difficult walking justify seeking advice rather than directly following a chronic pain program.
Relative rest means adapting efforts, not necessarily remaining still. You can sometimes continue activities that do not clearly reproduce the symptoms. Do not use medication to mask the pain and participate in a match at all costs. The choice of painkiller treatment depends on your situation and should be discussed with a healthcare professional.
In everyday life
Return to football practice
Find a base
Walk and perform selected exercises with an acceptable response.
Testing the demands of sport
Gradually add running, acceleration and changes of direction.
Rejoin the team
Prepare a partial then complete session before the competition.
What place for active rehabilitation?
For certain persistent pain related to the adductors, a strength and coordination program has shown benefit in a clinical trial. This result concerns a specific sporting population; it does not allow prescribing the same program for a recent tear, hernia or any pain called pubalgia. The exam should guide the content.
The physiotherapist can gradually work on the strength of the adductors, other hip muscles and the trunk, then the movements necessary for sport. The exercises become more demanding as tolerance increases. A massage or another technique can sometimes provide comfort, but does not replace gradual exposure to the efforts to be regained. If pain persists, the original explanation should also be reviewed.
How to move from exercises to training?
Progression can range from simple tasks to brisk walking, then running and accelerations, before changes of direction or kicking. This sequence is a starting point for discussion, not a universal protocol. Each step should match your sport and the type of problem identified. A good tolerance for slow exercise does not prove that you can sprint at full speed.
Agree with the physiotherapist on the useful criteria: perform the movement with confidence, endure several efforts, recover without lasting aggravation and regain sufficient capacity. Partial resumption of training often precedes a full session, then the competition. The calendar can help organize work, but the pressure of a match should not replace the assessment of your function.
How to organize work, travel and daily life?
The total load also includes stairs, carrying loads and walking. If you train your adductors and then spend the day lifting or walking, that day is not a low-load day. Try to divide demanding efforts and plan an easier activity between them when possible.
In the car, adjust the position if hip flexion causes discomfort and take breaks during long journeys. When getting dressed, sit down if lifting your leg or standing on one foot is painful. It is not a question of avoiding these movements permanently, but of making them bearable while the capacity returns. Explain your constraints to the professional so that the program is feasible.
When to take stock of recovery?
The duration varies depending on the structure, severity, duration of the symptoms and the efforts to recover. An improvement in daily tasks may precede the resumption of acceleration and changes of direction. No duration announced for pubalgia in general can guarantee your return to sport.
Plan a checkpoint if progression stops or if each restart brings up the same symptoms. It may be necessary to change the load, examine another structure or seek specialist advice. Increasing rest pain, new genital or abdominal symptoms, fever or difficulty bearing weight on the leg change the priority: consult without waiting for the end of the program.
Your questions
Should you stretch your adductors every day?
Not automatically. Stretching can feel good in one situation and irritating in another, especially after a recent injury. The need for mobility and the dose are discussed with the assessment. Looking for severe pain or a wide stretch is not proof of good treatment.
Can I play if the pain goes away after warming up?
Disappearing during warm-up is not enough. You also have to look at the reaction after the effort and the next day, your strength and the actions you can perform. Pain that returns systematically deserves an adjustment to the program and an assessment.
Chapter sources [4]
Does pubalgia mean that an operation will be necessary?
No. The word is too broad to announce a treatment. Many situations first require appropriate treatment without surgery. A possible intervention is discussed for a precise indication after specialized evaluation, not because a fixed deadline has been exceeded.
Can testicular pain just come from the adductors?
The proximity of the regions does not allow us to conclude this. Sudden or intense pain in the testicle requires immediate evaluation, even after sport. Don't waste time trying stretches or waiting for it to behave like muscle pain.
Chapter sources [3]
Sources and references
- [1] Weir et al. — Doha agreement on groin pain in athletes
- [2] NHS — Hip pain in adults
- [3] NHS — Testicle pain
- [4] Hölmich et al. — Active training for adductor-related groin pain
- [5] NHS — Hernia
- [6] NHS — Pelvic pain
- [7] AAOS OrthoInfo · Stress fractures
- [8] Griffin et al. — Warwick Agreement on FAI syndrome
Text updated on
Medical review: awaiting Hasib Selimovic.