What Causes Groin Pain in Athletes, and When Is It the Hip?
Groin pain in athletes usually comes from overloaded muscles or tendons around the inner thigh and pubic bone. But in many cases the hip joint itself is the real source, especially when pain lingers despite rest. A standing, weight-bearing assessment of the whole pelvis and hips can reveal alignment problems that lying-down scans miss.
Key takeaways
- Most athletic groin pain involves the adductor muscles, the pubic symphysis, or the hip joint, and often more than one at a time.
- Chronic groin pain that does not settle with rest should raise suspicion of a hip joint problem such as hip impingement (FAI) or a hip labral tear.
- Lying-down imaging relaxes muscles and unloads the pelvis, so alignment issues and subtle joint problems may not show up.
- A standing whole-body scan captures the pelvis, hips and legs under real weight, showing how the body actually loads during sport.
- An EOS scan uses about 90% less radiation than a standard X-ray, around ten times less.
What is athletic groin pain?
Athletic groin pain is a broad term for any persistent or recurring pain in the groin area linked to sport. It is extremely common in sports that involve cutting, kicking, sprinting and rapid changes of direction, particularly football, rugby, hockey and athletics. The Doha agreement, a widely used clinical framework, groups athletic groin pain into categories based on where the pain comes from: the adductor muscles, the inguinal canal (sometimes called a sportsman's hernia), the pubic bone, or the hip joint itself.
The challenge is that several structures sit close together in the groin. Pain from the hip can feel identical to pain from the adductor tendons. Pain from the pubic symphysis can blur into hip joint stiffness. Without a clear picture of the whole area under real weight-bearing load, the actual source is easy to miss.
What does chronic groin pain in sport feel like?
Chronic groin pain in sport typically builds gradually rather than striking in a single moment. You may recognise several of these patterns.
A dull ache that appears mid-session and worsens with volume, especially kicking or sprinting.
Pain or tightness when you first get up in the morning or after sitting for a long time.
The pain sits deep in the groin, inner thigh or front of the hip and is difficult to locate with one finger.
Weeks of rest reduce pain, but it comes back quickly when you return to full training.
What are the main causes of groin pain in athletes?
The most common causes fall into a few overlapping categories. Many athletes have more than one at the same time, which is why diagnosing groin pain can be so frustrating.
Overload of the inner-thigh muscles where they attach to the pubic bone. The most frequent cause in footballers.
Weakness or strain in the inguinal canal area, sometimes called a sportsman's hernia (though it is not a true hernia).
Inflammation at the pubic symphysis (osteitis pubis), often from repetitive shearing forces.
Conditions such as hip impingement or a labral tear that refer pain into the groin and often go unrecognised for months.
How do you tell if groin pain is coming from the hip joint?
Hip joint problems are one of the most under-recognised causes of chronic groin pain in sport. The hip joint sits deep inside the groin, so pain from the joint itself feels almost identical to adductor or pubic bone pain. Several clues suggest the hip is involved.
- Pain that wraps into the front of the hip or catches with deep flexion, such as squatting or getting in and out of a car.
- Reduced range of rotation in the hip compared to the other side.
- A clicking or locking sensation during movement.
- Groin pain that persists despite adequate rest and rehabilitation of the adductors.
Two hip conditions are particularly common in athletes. Hip impingement (FAI) involves extra bone at the rim of the hip socket or the top of the thigh bone. This limits movement and pinches the soft tissue inside the joint. A hip labral tear often occurs alongside impingement and can cause deep catching pain. Both are frequently missed on standard imaging because they can look subtle when the hip is unloaded.
Pelvic alignment also matters. If one side of the pelvis sits higher or rotates differently under weight, the hip and adductor tendons on that side take uneven load. This kind of asymmetry can contribute to SI joint dysfunction and create a chain of problems from the lower back down through the groin.
Why does a standing scan matter for groin pain?
A standing scan matters because it captures your bones, joints and alignment under real body weight, just as they load during sport. When you lie down for an X-ray, CT or MRI, your muscles relax and your pelvis unloads. Subtle leg-length differences, pelvic tilts and hip joint angles can disappear completely.
Pelvis under load. The scan shows the real position of each hip socket, any pelvic tilt, and how the legs align from hip to ankle. If one side is higher or rotated, the image makes it clear.
Full kinetic chain. Because the image captures from head to foot in a single exposure, your clinician can see whether a groin problem links to something higher (the lower back or SI joint) or lower (the knee or foot).
Low radiation. An EOS scan uses about 90% less radiation than a standard X-ray, around ten times less. That matters if you need repeat imaging to track progress.
Muscles relax. Gravity no longer pulls on the pelvis, so alignment problems flatten out and can look normal even when they are not.
Single area only. A standard hip X-ray or MRI focuses on one joint. It cannot show how the pelvis, spine and legs interact as a connected chain.
Missing context. The scan may show a normal hip when the real issue is how that hip loads relative to the pelvis and the opposite side, something only visible when standing.
ScanAlign standing EOS imaging captures both hips, the full pelvis and the legs in one low-dose standing exposure. Your images are reviewed by a specialist radiographer and reported by a consultant radiologist, giving you and your treating clinician a complete picture of what is happening under load.
When MRI is the better tool: EOS shows bones, joints and alignment. For soft-tissue detail, such as the adductor tendons, the labrum inside the hip, or the inguinal canal, MRI is usually the more appropriate scan. In many cases both types of imaging work together to give the full picture.
What helps with chronic groin pain in sport?
The right approach depends entirely on the cause, which is why accurate diagnosis comes first. In general terms, management may include load management and structured rehabilitation, addressing any underlying pelvic or hip alignment issue, and, where a hip joint problem is confirmed, discussion with an orthopaedic specialist about further options. ScanAlign does not provide treatment. It provides the imaging that helps you and your clinician understand exactly what is going on.
Struggling with groin pain that keeps coming back? A standing hip and pelvis scan can show whether alignment is part of the problem.
Book a free video consultationWhen to seek urgent help
If you develop sudden severe groin pain after an injury, notice numbness or weakness in the leg, or experience any loss of bladder or bowel control, seek urgent medical attention. Contact your GP, call 111, or go to A&E.
Frequently asked questions
Yes. The hip joint sits deep in the groin, so hip impingement, labral tears and early joint wear can all produce pain that feels like a muscle strain. If groin pain does not improve with rest and adductor rehabilitation, the hip joint should be assessed.
It is a term for pain arising from the inguinal canal area, often without a visible hernia. The current clinical term is inguinal related groin pain. It is caused by strain on the tissues of the lower abdominal wall and is common in sports involving twisting and cutting.
Rest reduces inflammation but does not fix the underlying cause. If there is a structural issue such as hip impingement, pelvic asymmetry, or tendon degeneration, the pain is likely to return when load increases again.
A groin strain is usually an acute muscle tear from a single event, such as overstretching during a tackle. Adductor tendinopathy is a chronic overuse problem where the tendon where the adductor longus attaches to the pubic bone becomes painful over time.
No. EOS imaging shows bones, joints and overall alignment. For detailed views of tendons, muscles, the labrum or other soft tissues, MRI is the more appropriate tool. In many groin pain cases, both types of imaging are helpful.
An EOS scan uses about 90% less radiation than a standard X-ray, around ten times less. This makes it a very low-dose option, especially useful if you need repeat scans over time.
No. ScanAlign is a private, self-pay clinic. You can self-refer and start with a free video consultation to discuss whether a standing scan is appropriate for your situation.
Details on scan costs and what is included are available on the book a hip and pelvis scan page or you can ask during your free video consultation.
Yes. If the pelvis is tilted or rotated, one hip and its surrounding muscles take more load than the other. This uneven loading can strain the adductor tendons or change how the hip joint moves, both of which produce groin pain.
You speak with a specialist diagnostic radiographer who will review your symptoms and history. They will advise whether a standing EOS scan is likely to add useful information to your case, with no obligation to proceed.
Get the full picture of your groin and hip pain
A standing scan shows how your pelvis, hips and legs load under real body weight. Start with a free, no-obligation video consultation.
Book a free video consultationWritten by Abbas Dhami (Specialist Diagnostic Radiographer)
Sources
- 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.
- Griffin DR, Dickenson EJ, O'Donnell J, et al. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome). British Journal of Sports Medicine. 2016;50(19):1169-1176.
- NHS. Hip pain in adults. nhs.uk/conditions/hip-pain.
This page is general information and not a diagnosis.
ScanAlign is the trading name of CoreMed Solutions Ltd and operates under The Harley Street Hospital's CQC licence.