ISMJ - Pathophysiology of Chronic Groin Pain in the Athlete

Chronic groin pain is a common symptom in the football and hockey codes. Although there is a large differential diagnosis, this review focuses upon the peri-pubic causes of isolated groin pain (pubalgia). Publications that included a hypothesis of the cause of pubalgia were reviewed. The competing views were that pubalgia arises from a single pathology, multiple unrelated pathologies, and multiple interdependent pathologies. An interdependent model is the most practical, in the absence of scientific proof for either paradigm. Posterior inguinal canal deficiency is established as a common finding in male athletes, but it may be asymptomatic. Osteitis pubis and insertional adductor tendinopathy are also both common entities that often are considered to coexist. Overuse in sports involving kicking, sprinting, and changing direction is implicated as a cause of pubalgia by all paradigms. Various surgeries to the pubic region may achieve results by i) correcting a force imbalance at the pubic symphysis and surrounding pubic rami created by abnormal adductor and abdominal muscles; ii) reducing compartment pressures; and iii) enforcing a rest period and gradual resumption of activities.