Back Pain Doctor
Adductor-Related Groin Pain
Written by Dr Joshua Hatch, Musculoskeletal GP, RACGP Fellow, Diploma in Musculoskeletal Medicine (FSEM UK).
“Groin pain” describes a location, not a single diagnosis. The Doha agreement on groin pain in athletes defines adductor-related groin pain by adductor tenderness and pain on resisted adduction testing. The same person may also have hip-related, iliopsoas-related, inguinal-related or pubic-related pain, so examination matters more than applying a broad label such as “sports hernia”.
Symptoms may start with a sudden stretch, sprint or kick, or emerge gradually after a rise in training load. A pop, marked bruising, a palpable gap or substantial loss of strength raises concern for a larger tear. Pain that is not clearly load-related, a groin lump, abdominal or testicular symptoms, fever, night pain or difficulty weight-bearing needs assessment for other causes rather than being assumed to be an adductor problem.
Strength first, then sport-specific load
Rehabilitation starts at a level the adductors can tolerate and progressively rebuilds strength through range. It then adds trunk and hip control, faster running, acceleration, lateral movement, cutting and kicking according to the demands of the sport. A landmark randomised trial of long-standing adductor-related groin pain found an active strength and coordination program outperformed passive physiotherapy without active training.
The Copenhagen adduction exercise can be useful, but it is one exercise rather than a complete program and must be scaled to current capacity. Return to sport should follow successful exposure to the movements that caused the problem, not merely the disappearance of pain during day-to-day activity.
Common symptoms
- Groin or inner-thigh pain with sprinting, kicking, cutting or changing direction
- Pain when squeezing the knees together or against resistance
- Tenderness over the adductor muscles or their attachment near the pubic bone
- Reduced confidence or power with acceleration, lateral movement and kicking
Commonly seen in
Evidence for twelve treatment options in adductor-related groin pain
This is not a fixed ladder or a package of treatments. Every option is assessed independently against this diagnosis, including treatments with limited direct research that may still be reasonable for a clearly defined tissue target. The evidence level, likely benefit, risks, cost and alternatives are weighed at consultation.
Foundation — diagnosis, education and rehabilitation
The part of care with the broadest relevance. For many people it is enough on its own; other options are judged against it, not automatically added after it.
Diagnosis, education and progressive rehabilitation Working out what is driving the pain, explaining what your imaging does and does not mean, and building a graded loading plan you can actually follow. Core care
What it involves
Assessment to identify the likely pain source, an explanation of what the diagnosis means, adjustment of the loads that aggravate it, and a progressive strength and conditioning plan — with weight management where that is clinically relevant.
What the evidence shows
Loading is the treatment, and the trials say adjuncts add little to it. A living network meta-analysis of 68 randomised trials across Achilles and patellar tendinopathy and gluteal tendinopathy found no convincing evidence that any adjunct, alone or added to exercise, beats exercise by itself — and recommended exercise alone for at least three months before an adjunct is considered (Challoumas, Sports Med Open 2023). A meta-analysis of 110 studies and 3,953 patients found greater effect where the programme added external load rather than body weight alone, and where sessions were less frequent than daily, allowing recovery (Pavlova, Br J Sports Med 2023). A 204-study synthesis found exercise safe, beneficial and acceptable to patients, with no clear superiority for the eccentric-only protocols long treated as standard (Cooper, Health Technol Assess 2023).
Pairing reviewed 2026-09-02.
Where it fits for you
This is the plan, not the preliminary. Expect a programme measured in months rather than weeks, with load progressed against your symptoms. Anything else offered here is an adjunct to it, and the evidence for adding one before three months of proper loading is weak.
Muscle and symptom-modifying options
Useful only when the examination identifies the tissue they target or when short-term pain control creates a useful rehabilitation window.
Wet needling and trigger point injection (trigger point injection) A fine needle into a tender band of muscle, with a small volume of dilute glucose solution injected through it. Plausible — no studies
What it involves
The needle is placed into the tender muscle band and a small volume of 5% glucose with 0.02-0.08% lignocaine is injected. Often done in the same visit as your assessment, and usable where the tender area sits deeper. Dry needling — the same technique with nothing injected — is not offered here.
What the evidence shows
No trial of trigger point injection in this condition specifically, and none at all using 5% dextrose — the myofascial needling trials used local anaesthetic or saline.
Pairing reviewed 2026-08-30.
Where it fits for you
Considered only where examination finds a tender muscle contributing to the pain, as an adjunct to the loading programme.
Ultrasound-guided injections Guidance means we can see the needle reach the target. What goes into the needle depends on the diagnosis. Plausible — no studies
What it involves
The injection is performed under ultrasound so the needle can be watched into the target structure. What is injected is decided by the diagnosis — and corticosteroid is used sparingly, for the reasons set out below.
What the evidence shows
No trial has compared guided with unguided injection at this site. The general finding is that guidance improves accuracy everywhere but only improves outcomes where the target is small or deep (Aly, Br J Sports Med 2014; Fan, Arthroscopy 2021).
Pairing reviewed 2026-08-30.
Where it fits for you
Injection is not first-line for this problem. Where one is indicated and the target is small, guidance is used.
V-ACTOR vibration therapy (vibration therapy) Low-frequency vibration applied over tender muscle. Not a shockwave, despite sharing the machine. Plausible — no studies
What it involves
A vibration handpiece is moved over the tender muscle and fascia for a few minutes. It runs from the same STORZ MASTERPULS icon console as radial shockwave but is a separate handpiece delivering a different, gentler form of energy. No needles, no anaesthetic, no downtime.
What the evidence shows
No published clinical trial of this device in this condition. It is a vibration handpiece delivered from the same console as radial shockwave, and the rationale is myofascial rather than tendon- or bone-directed.
Pairing reviewed 2026-08-30.
Where it fits for you
A comfort measure used within a session where muscular tightness is limiting movement. Never the reason for the appointment, and not a substitute for the treatments that do have evidence.
Energy-based treatment options
Radial pressure wave, focused shockwave and EMTT have different targets and different evidence. They are assessed separately rather than treated as one category.
Radial or focused shockwave? Read the overviewRadial shockwave (radial pressure wave) Broad treatment across tender muscle and fascia, close to the surface. Plausible — no studies
What it involves
A handpiece is moved over the tender tissue while ballistic pressure pulses are delivered, using a transmitter head chosen for the tissue — including heads shaped for fascia and for the muscle either side of the spine. The pulse is strongest at the skin and weakens with depth, so this is mainly a myofascial treatment, though it can reach deeper in some areas. No anaesthetic, no downtime, usually a course of sessions about a week apart.
What the evidence shows
The shockwave trials in this condition used FOCUSED devices. Radial delivers its energy most strongly at the skin surface and disperses with depth, so the focused results do not transfer automatically.
Pairing reviewed 2026-08-30.
Where it fits for you
Reasonable where the target is superficial; where the studied target is deeper, focused is the form the evidence supports.
Focused shockwave (ESWT) A true shock wave converging at depth — for tendon, joint, ligament and bone. Worth discussing
What it involves
A focused system generates an acoustic shock wave that converges at a focal point set at a defined depth, concentrating the energy where the target is. This is the form we use for tendon, joint, ligament and bone. Typically four to six sessions about a week apart, no anaesthetic and no formal downtime.
What the evidence shows
Level I evidence supports shockwave as an adjunct to exercise in osteitis pubis in athletes (Rhim, Br J Sports Med 2024). Adductor-related groin pain is adjacent to, rather than the same as, the studied population.
Pairing reviewed 2026-08-30.
Where it fits for you
Reasonable to discuss as an adjunct where a loading programme has stalled, with the indirectness of the evidence stated.
EMTT (magnetotransduction therapy) High-energy magnetic pulses applied over the area. Painless, no contact. Plausible — no studies
What it involves
You sit with the applicator positioned over the area for a short session. Painless, no gel or contact required, and usually delivered as a course — commonly alongside shockwave.
What the evidence shows
There are no published randomised trials of EMTT in this condition, or in any musculoskeletal condition, that we can point to. The supporting work is laboratory work: EMTT increased tenocyte proliferation, migration and collagen expression in cultured human tendon cells (Mancini, Int J Mol Sci 2025). The nearest human evidence for a related electromagnetic therapy is negative — a randomised trial of pulsed electromagnetic field therapy added to eccentric exercise for Achilles tendinopathy found no improvement in outcome scores or tendon neovascularity over eccentric exercise alone (Ko, Orthop J Sports Med 2024).
Pairing reviewed 2026-08-30.
Where it fits for you
Offered only as an adjunct alongside treatment that does have evidence, never as the plan itself, and only after that gap is explained. Much of the EMTT literature is manufacturer-affiliated, which is part of why we describe it this way.
Biologic and joint injection options
Each injection is assessed independently for the named diagnosis. Cost, uncertainty, likely benefit, risks and alternatives are part of the decision.
Platelet-rich plasma (PRP) Your own blood, concentrated and injected under ultrasound guidance. Case reports; harm signal reported
What it involves
Blood is taken from your arm, spun to concentrate the platelets, and injected into the target under ultrasound guidance in the same appointment.
What the evidence shows
Not tested in a trial. A search for PRP in adductor-related groin pain, osteitis pubis and athletic pubalgia returned 23 records, and a pass for randomised trials found none at the groin. What exists is small and uncontrolled. There are single case reports of athletes returning to sport after an ultrasound-guided injection with rehabilitation, such as a 17-year-old footballer back at six weeks (Zeppieri, Int J Sports Phys Ther 2024). A series of 408 people with tendon problems at several sites, the adductor among them, improved after one injection, without the groin results being reported separately (Dallaudière, J Vasc Interv Radiol 2014). In 132 athletes with osteitis pubis, 63% of the 19 given PRP for a long-standing adductor problem returned to sport against 80% of the 31 given cortisone, a difference that was not statistically significant (Eraslan, J Orthop Traumatol 2025). A systematic review of conservative treatment rated the evidence for PRP here as conflicting, below exercise-based care and prolotherapy (Bisciotti, Biol Sport 2020). There is also a caution specific to this region. At one surgical centre that saw 3,642 people with groin and lower abdominal muscle injuries, bone forming in the injured tissue was found mostly in those who had already had PRP: 44 of the 68 cases, and 22 of 28 professional American footballers given PRP against none of 28 matched players. Their results at three months after surgery were poorer, and had caught up by six months. That is an observation in people whose PRP had not worked, not proof of cause (Poor, Am J Sports Med 2024).
Pairing reviewed 2026-10-10.
Where it fits for you
Not something to choose ahead of the rehabilitation program, which has the best evidence for this condition. Where an injection is being considered for groin pain that has not settled, prolotherapy has two published case series at this site and PRP does not, and the reported risk of bone forming in the tissue is discussed before PRP would be.
Prolotherapy (dextrose) A course of dextrose injections into and around the structure and its attachments. Case series in athletes
What it involves
Hypertonic dextrose is injected at the tender ligament and tendon attachments, and into the joint where relevant, usually as a series of treatments a few weeks apart.
What the evidence shows
Tested in athletes, in case series rather than controlled trials. In 24 elite rugby and soccer players with chronic groin pain from osteitis pubis or adductor tendinopathy that had not responded to therapy, monthly injections of 12.5% dextrose into the adductor origins, lower abdominal insertions and pubic symphysis took pain during sport from 6.3 to 1.0 out of 10 after an average of 2.8 treatments. Twenty of the 24 had no pain and 22 were playing without restriction at an average of 17 months (Topol, Arch Phys Med Rehabil 2005). A second series from the same clinic enrolled 75 elite athletes, 72 of whom completed at least two treatments: pain with sport improved by 82%, 66 returned to unrestricted sport in an average of three months and six did not improve, at an average follow-up of 26 months (Topol, Am J Phys Med Rehabil 2008). A systematic review of conservative care for long-standing adductor-related groin pain placed prolotherapy among its three best-supported options, alongside compression garments and manual therapy with strengthening, while rating that evidence only moderate and the recommendation grade D (Bisciotti, Biol Sport 2020). The limits are plain. Neither series had a comparison group, both come from one clinic, every athlete was elite, and there is still no randomised trial (Choi, Br J Sports Med 2011; a search on 6 October 2026 found none since).
Pairing reviewed 2026-10-06.
Where it fits for you
Worth discussing where adductor-related groin pain has not settled with a proper course of strengthening and load management, which remains the first treatment. The injections go into the tender tendon attachments on the pubic bone, usually as a short monthly series alongside continued rehabilitation. The published results are encouraging but come from uncontrolled series, and that is explained before treatment.
Viscosupplementation (hyaluronic acid) A gel-like injection into an arthritic joint. Widely used, and genuinely contested. Not offered for this
What it involves
One or a short series of hyaluronic acid injections into the joint under ultrasound guidance.
What the evidence shows
Hyaluronic acid evidence is concentrated in osteoarthritis—especially the knee—and remains contested; it cannot be extrapolated to a non-arthritic tissue or a different diagnosis. Condition reviewed: adductor related groin pain.
Evidence source: Pereira et al., large-trial injection review (2024)
Pairing reviewed 2026-08-30.
Where it fits for you
For adductor related groin pain, this is relevant only when a symptomatic arthritic peripheral joint is the actual target. It is not used for muscle, tendon, ligament, nerve, fracture or spinal pathology.
Nerve-targeted options
Relevant when examination identifies a superficial neuropathic pattern or a compressed peripheral nerve—not simply because pain is present.
Lyftogt perineural therapy (perineural injection therapy) A series of small dilute dextrose injections just under the skin, over tender superficial nerves. One case report only
What it involves
Small injections of low-concentration dextrose, usually 5%, placed just beneath the skin along tender superficial nerves. Given as a series of short sessions.
What the evidence shows
The technique in this row has a single report at the groin: a 45-year-old man with nine months of left groin pain attributed to the superficial fascia had 5% glucose injected below the inguinal ligament by feel, with complete resolution within four weeks (Lam, Cureus 2024). One case, no comparison, and not described as an adductor tendon problem. The better-known dextrose work in athletic groin pain is a different procedure, prolotherapy into the tendon attachments on the pubic bone. In 24 kicking-sport athletes with chronic groin pain from osteitis pubis or adductor tendinopathy, monthly 12.5% dextrose took pain during sport from 6.3 to 1.0 out of 10, with 22 of 24 back to unrestricted sport (Topol, Arch Phys Med Rehabil 2005), and in a later series 66 of 72 returned to unrestricted sport (Topol, Am J Phys Med Rehabil 2008). Neither had a control group, a systematic review of athletic osteitis pubis found no randomised trial of any treatment (Choi, Br J Sports Med 2011), and a randomised-trial search on 6 October 2026 across the dextrose and perineural terms and the groin, adductor and osteitis pubis terms returned no record. Nerves can also produce groin pain: in 58 people with neuralgia of the ilioinguinal, iliohypogastric or genitofemoral nerves, CT-guided injections around the nerve improved pain after 53 of 63 procedures (Poh, AJR Am J Roentgenol 2019). Those are nerve blocks placed deep under imaging, not small injections under the skin.
Pairing reviewed 2026-10-06.
Where it fits for you
Not a treatment for the adductor tendons or the pubic joint, which are managed with the options higher up this page. Considered only where examination finds tender, hypersensitive skin over the groin or inner thigh rather than pain on resisted squeezing alone.
Ultrasound-guided nerve hydrodissection Fluid placed around a nerve to free it from the surrounding tissue. Only if relevant
What it involves
Under ultrasound, fluid is placed in the plane around the nerve to separate it from the tissue that is tethering or compressing it.
What the evidence shows
Hydrodissection has not been studied in adductor-related groin pain. Searching the technique against groin pain, adductor tendinopathy and osteitis pubis — setting aside the many surgical papers that use the word for a step in hernia repair — leaves two case reports, and both are nerve problems presenting as groin pain rather than tendon problems: groin pain referred from an overlooked lumbar transverse process fracture that settled after three ultrasound-guided dextrose hydrodissections at the fracture site (Yoon, Cureus 2025), and a femoral nerve injury after groin flap surgery relieved by hydrodissection with the gain holding at six months (Hasnain, Pain Med Case Rep 2026).
Pairing reviewed 2026-09-15.
Where it fits for you
Only where the assessment suggests a nerve is contributing — an obturator, ilioinguinal or genitofemoral pattern, or pain referred from the lower back — rather than the adductor tendons themselves. The tendon problem is treated by the options higher up this page.
This is general information only and suitability is assessed individually. Treatments with limited or condition-dependent evidence may still be discussed, but only with clear explanation of the uncertainty, the expected benefit, risks, cost and alternatives. Red flags, progressive neurological symptoms or suspected serious pathology require a different pathway.
Every treatment above is described in full on the non-surgical treatments page, including what each one is used for and what the evidence supports. Ratings apply to the named diagnosis; an adjacent muscle, tendon, joint or nerve problem is assessed as a separate target. The method behind the ratings, and the treatments we do not offer, are set out on the evidence page.
Corticosteroid injection is reviewed separately for each diagnosis.
Cortisone reliably reduces pain in the short term, and that can be genuinely useful when pain is stopping you sleeping or moving enough to rehabilitate. Beyond that window the picture changes. A systematic review of 41 randomised trials and 2,672 participants found that corticosteroid injection reduced pain in the short term but that the effect reversed at intermediate and long term; in pooled analysis for lateral epicondylalgia the short-term effect was large (SMD 1.44, 95% CI 1.17 to 1.71) while no intervention was favoured at 26 weeks (-0.40, -0.67 to -0.14) and at 52 weeks (-0.31, -0.61 to -0.01) (Coombes, Lancet 2010). In a randomised trial in lateral epicondylalgia, 83 per cent of the corticosteroid group had completely recovered or much improved at one year against 96 per cent given a placebo injection, and recurrence ran at 54 per cent against 12 per cent; adding physiotherapy made no significant difference at one year (Coombes, JAMA 2013). In joints, repeated corticosteroid injections have been associated with cartilage loss. It does not repair anything.
So we do not build treatment plans around it. Where an injection is the right call, we review the specific diagnosis and target, discuss what is being injected and why, keep the number low, and pair it with the loading work that changes the longer-term course.
When we would still consider it
- Pain severe enough to block rehabilitation
- A clear inflammatory or bursal target on imaging
- A specific short-term goal — a trip, a procedure, a return to work
- Diagnostic use, where the response tells us where the pain is coming from
When a cortisone injection is worth doing, and when it is not
Other hip & pelvis conditions
Pain in the same area can come from more than one source, and the label matters less than what the examination and history point to. These are the other guides for this region.
Frequently asked questions
Is adductor-related groin pain the same as a groin strain?
Do I need an ultrasound or MRI?
Should I stretch a sore groin?
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