Groin pain is one of the most stubborn and confusing issues athletes face. With so many muscles, tendons, joints and nerves packed into a small area, countless structures can cause similar symptoms, and to make matters worse, researchers frequently find “abnormal” imaging results even in athletes who feel perfectly fine. No wonder diagnosis is often messy.
To tackle this confusion, 24 international experts gathered in Doha in 2014 for the first World Conference on Groin Pain in Athletes. Their mission: create a clear, clinically useful language for diagnosing groin pain, something the sports medicine world has lacked for decades.
Why Terminology Needed an Overhaul
A systematic review found 33 different diagnostic terms used across 72 studies on groin pain. Even the same term could mean something different depending on who used it. This lack of consistency makes research hard to interpret and complicates clinical practice.
So the Doha meeting aimed to simplify and standardise the way clinicians talk about groin injuries.
What the Experts Reviewed
Before meeting, the group reviewed the best current evidence across major topics:
- Epidemiology: Groin injuries are common, especially in football, ice hockey and kicking sports. Men experience roughly twice the rate of groin injuries compared to women.
- Risk Factors: Previous groin injury, reduced hip adduction strength, and lower training levels increase risk.
- Clinical Characteristics: Athletes with groin pain usually show reduced hip rotation, weakness on adductor testing, and higher pain with specific movements.
- Diagnostic Tests: Most hip and groin tests lack strong accuracy. Only a few reliably screen for problems.
- Imaging: Many “abnormal” findings exist in pain-free athletes, making interpretation tricky.
- Treatment: Active, supervised rehabilitation has been shown to outperform passive therapies for long-standing adductor-related groin pain. Some surgical options show benefits for very specific diagnoses.
- Prevention: Evidence is mixed, and current programmes don’t clearly prevent groin injuries.
- Return to Sport After Hip Surgery: Most athletes return, but evidence quality is low.
Creating a Clear Clinical Classification System
After reviewing all the evidence, the experts agreed on a simple, clinically driven approach: use the athlete’s history and physical examination to categorise their groin pain into one or more of four clearly defined entities.
Adductor-Related Groin Pain
- Tenderness at the adductors
- Pain with resisted adduction
Iliopsoas-Related Groin Pain
- Iliopsoas tenderness
- More likely if pain occurs with resisted hip flexion or hip flexor stretching
Inguinal-Related Groin Pain
- Pain and tenderness in the inguinal canal
- No hernia present
- Often aggravated by abdominal resistance or coughing and sneezing
Pubic-Related Groin Pain
- Local tenderness at the pubic symphysis and adjacent bone
These categories may overlap, and often do.
Don’t Forget Hip-Related Groin Pain
Hip joint issues, like labral tears or femoroacetabular impingement, can mimic groin pain and frequently coexist with other groin conditions. Because clinical tests aren’t specific enough, hip concerns require careful history, examination and often imaging.
What About Everything Else?
The group emphasised that many other conditions can cause groin pain, from nerve entrapments to urological, gastrointestinal or even oncological issues. When symptoms don’t neatly fit the four main categories, clinicians must think broadly.
They also recommended retiring confusing terms like “sports hernia,” “osteitis pubis” and “athletic pubalgia,” which have been used inconsistently for years.
Where Research Needs to Go Next
The experts highlighted several priorities:
- Better epidemiology using consistent definitions
- More research on training loads as risk factors
- Studies testing the reliability of the new classification
- Improved imaging research with clearer clinical correlations
- Higher-quality treatment and prevention trials
How BeFit Can Help
Our Sports Physiotherapy team uses the Doha classification framework as part of a structured assessment for athletes presenting with groin pain, combining detailed history-taking with physical examination to identify which clinical entity or entities are contributing to your symptoms. From there, treatment is built around active, progressive rehabilitation, with a Return to Sport pathway for athletes working back towards competition.
Common Questions About Groin Pain in Athletes
What is adductor-related groin pain?
Adductor-related groin pain is one of the four main clinical entities identified in the Doha classification. It typically presents with tenderness at the adductor muscles and pain when resisting adduction movements.
Do I need imaging for groin pain?
Not always. Imaging findings around the groin are common even in athletes without any pain, so results need to be interpreted alongside a thorough clinical history and physical examination rather than in isolation.
How is groin pain treated in athletes?
Treatment depends on which clinical entity or entities are involved, but active, supervised exercise rehabilitation is generally the first-line approach for adductor-related groin pain, with surgery reserved for specific diagnoses that don’t respond to conservative management.
Do I need a referral to see a physiotherapist for groin pain?
No. You can book directly with a physiotherapist without a referral.
The Takeaway
The Doha agreement represents a major step toward clearer communication, better research and more accurate diagnosis for athletes with groin pain. By agreeing on straightforward clinical entities, clinicians worldwide can finally speak the same language, an essential foundation for improving outcomes in a notoriously challenging area of sports medicine.
Book an appointment at BeFit Training Physiotherapy — no referral needed.
Edgecliff: (02) 9327 7749 | Coogee: (02) 7205 2805 | befittrainingphysio.com/book-now
References
Weir A, Brukner P, Delahunt E, et al. Doha Agreement Meeting on Terminology and Definitions in Groin Pain in Athletes. Br J Sports Med. 2015.
Hölmich P, Uhrskou P, Ulnits L, et al. Effectiveness of Active Physical Training as Treatment for Long-Standing Adductor-Related Groin Pain in Athletes: Randomised Trial. Lancet. 1999.
Thorborg K, Reiman MP, Weir A, et al. Clinical Examination, Diagnostic Imaging, and Testing of Athletes With Groin Pain: An Evidence-Based Approach to Effective Management. J Orthop Sports Phys Ther. 2018.
Australian Physiotherapy Association. Clinical guidelines. physiotherapy.asn.au.
