Painful groin is only a symptome, which necessarily has to be examined by a specialist in order to be properly diagnosed. Many vital organs are huddled in a very small area, and finding out as early as possible which of them causes trouble is of grave importance. Next step is adequate treatment.
There is a considerable difference in meaning between lay and expert notion of the term „groin“. That is why what is initially described as „painful groin“ often becomes pain in the hip, pelvis, or abdominals. Some of the possible reasons for pain in the groin region will be listed, as opposed to „painful groin“ which is a term for chronic inflammation or injury of one of the upper leg muscles.
Osteitis pubis, inflammation of the pubic bones joint on the front side of the pelvis, can have different causes, but the most common is intense sport activity like football or tennis, which have fast frequent changes of movement direction that lead to slight shifts in symphisis (pelvis joint). Painful symphisis is one of the symptoms, but other symptoms include pain in the abdominal wall, groins, and hip, which can make adequate diagnosing more complicated. The pain amplifies with coughing, physical activity, lateral lying position, or lifting the upper or lower body from the recumbent position. Treatment of this syndrome can take up from a few weeks to several months, including a wide spectrum of physiotherapeutical methods, anti-inflammation drugs, and exercises for enhancing the strength of the abdominal muscles to stabilize the bone joint. Operation is rarely needed – only with the most persistent inflammations. Diagnostically, ultrasound or magnetic resonance are the best solution (along with physical examination).
Abdominal muscle and tendons injuries are a fairly common occurence in athletes. They are a result of many factors, but I would specifically mention bad physical preparation, disproportionate strength of abdominal and upper leg muscles (especially in football players), and untreated chronic inflammations of tendon annexations of upper leg muscles (that they share a common function with). Injuries can vary from pulled muscles and partial ruptures all the way to chronic inflammatory processes on the cross-sections of muscles and tendons or their bone vertices. Specialist exam is vital for a correct diagnosis, and ultrasound can be helpful as well. Treatment is based on physiotherapeutical procedures, especially strengthening and stretching exercises. It can take up from one week to several months depending on the type and scale of the injury or inflammation process.
Transfer of pain to the groin can occur from the lumbar spine; more specifically, from the disorder that creates pressure on the nerve egress (like cartilage hernia). Sometimes it is difficult to establish a correct diagnosis, and CT or MR can be quite helpful. Treatment is based on lessening the pressure on the nerve egress using methods of massage, manipulative therapy (chiropractic), and exercises for strengthening the abdominal wall and deep muscles of the back in order to stabilize that spinal segment.
Inguinal hernia is a common cause of pain in the groin region. It occurs on the vertices of the abdominals and the pelvis, where the muscles are weak.It is actually a protrusion of abdominal-cavity contents (most often part of the colon). One cannot practice sports in this condition and operation is necessary to successfully recuperate. But the diagnosis and decision on further therapy should be left to the specialist doctor of medicine.
Other than those mentioned, many other conditions and diseases (especially of reproductive, uric, and digestive systems) can cause pain in the groin region. That is why fast and adequate diagnosis is of great importance, as well as proper treatment.
Painful groin can specifically denote an injury or inflammatory process in the area of leg adductors. Namely, we mean five of them: adductor magnus, adductor brevis, adductor longus, gracilis, and pectineus. All of them have a basic purpose of moving one leg close to the other, and are used daily in regular and sports activities with lateral movement but also stabilizing the hip while walking, running, or standing. They help the main leg muscles while going up and down the stairs, and recently it was discovered they help stabilize the lower part of the spine. All in all, it is a fairly busy muscle group, which makes it vulnerable to all kinds of injuries.
Groin muscles are commonly exposed to injuries from lateral movements, changes in speed and direction, and kicks to the legs, which are common in football, handball, basketball, and martial arts. Simple and unilateral movements such as running and sprinting are rarely a danger to this muscle group. But, even a reckless step while walking, especially involving slipping, can cause the same problems for non-athletes.
When pain in the groin occurs, athletes ususally describe only the imminent event which caused the pain, it being sudden (rarely gradual), amplifying from weak or moderate to strong. However, today we believe that most non-contact muscle injuries happen in muscles with higher tonus (tension in inaction). But the causes for higher tension can be various, and need to be differentiated and removed along with treatment of the injury. Groin muscles can be damaged along the entire muscle length, or on its crossing to the tendon. Also, tendon fibres can break, or vertices of the bone and tendon can get injured. Very rarely a breakage of the entire muscle or tendon fibres occurs. Each of these has a somewhat different treatment regime, so it is important to pinpoint a place and size of the damage, as well as the damaged muscles. Exam includes locating the exact pain (palpation), and stretching and strength tests, but it is also advisable to use ultrasound diagnostics. Only then can we apply treatment, which is performed in two parts (unless the case involves a complete muscle rupture, which calls for operational procedure). Primarily, initial pain must be treated. Rest is advisable in the first few days, and then full physical therapy in order to diminish the inflammation and accelerate healing of the tissue. At the same time we must begin functional treatment by specific exercises. Initially those are directed at amplifying strength and stretching ability of the injured muscle group. Later we must treat the wider affected area, which is rarely done these days, and is one of the reasons of repetitive injuries and long-lasting conditions such as chronic painful groin. Strength and balance, along with the ability to stretch, of abdominal muscles, lower back, and legs, are a basic prerequisite for success in treating this condition. After the rehabilitation is completed, physical preparation and slow return into full training process is necessary, because going back too fast leads to new injuries and pain.
Chronic painful groin is a condition which is based on partially degenerated tendon, and is a result of a long-lasting and badly treated inflammatory process. It is very difficult to solve, and can result in giving up sports as well as undergoing operational procedure. A combined injury of groin and abdominal muscles is also often seen in practice, because of their common function in certain body movements. It is not unusual for abdominal muscles injury to happen as a consequence of injury of groin, and vice versa. Upper vertex of rectus femoris, leg muscle, can further complicate what is not known as a simple and fast recovery. So it is vital to immediately recognize the type of injury and start the treatment as soon as possible, as well as avoid self-treatment. Entire rehabilitation process is best left to the care of a doctor specialist and physical therapist.