Groin injuries are common in all forms of sporting endeavour, especially those in which a forceful inward movement of the hip occurs, known as hip adduction. Typical sports where this injury is more common are swimming, football, skating and hockey. Groin injuries may make up five percent of all injuries in football (soccer). Groin pain in younger people such as children and adolescents and in women can be due to more serious conditions than a simple groin sprain and should be investigated and referred on appropriately.

If children present with a limp and hip pain then particular attention should be paid to their history and examination as serious diagnoses such as slipped femoral epiphysis, Perthe's disease, avascular necrosis of the head of the femur and septic arthritis are possible. Urgent referral to an orthopaedic specialist is required in these cases. Knee pain can be referred from the hip area so the joints around the painful areas should be examined in the consultation. Athletic adolescents who have traumatic injuries around the hip may have involvement of the hip growth plate.

The hip is the largest joint in the body and has an extensive range of motion. It is vulnerable to damage due to its weight bearing function and repetitive activities performed. Stiffness of the hip joint may be present some time before the incidence of a groin strain and a strain may occur more readily in the presence of reduced range. Acute groin injuries such as tears, strains or sprains of the muscles and tendons occur with forceful adduction of the hip, a movement towards the midline, or if the splits occurs accidentally. Chronic groin injuries present in activities which typically overuse the muscles, such as breaststroke and running.

Examining a person with a groin strain can be complicated as the area of pain and its nature can be vaguely described. A wide variety of conditions can present as groin pain and the physician must be aware of these. A groin strain is the most common type of acute injury to this area. There are a large number of muscles which attach to the pelvis or thigh bone in the groin area and function to hold the legs in the midline under movement. Running and changing direction quickly, kicking or doing the splits can cause this kind of injury. Sharp pain in the groin is a typical symptom and the pain can radiate down the thigh on the inside.

The junction of where the tendon and the muscle meet is the main region of injury with bleeding from the locally ruptured muscle fibres. The formation of fibrous tissue followed by scar is the method of healing, leaving the area vulnerable to repetitive injuries, with older sports people being at higher risk than younger athletes. If the injury is severe, part of the bone can come off with the tendon, causing an avulsion injury with surgical repair being required at times. Conservative treatment is the standard management with physiotherapists employing exercise, rest and ice.

The adductor longus, one of the muscles in the adductor group of the inner thigh, is the main site of injury. The area of the junction between the tendon of the muscle and the bone is the most vulnerable spot. Muscle belly injuries can be treated relatively simply by graded stretching once the pain begins to settle, strengthening and getting back to normal function. Injuries to the tendon-bone junction need slower management with rest until there is a reduction in pain, graded exercise towards stretching, graded strengthening, and return to functional sporting activities.

Other diagnoses of pain in the groin areas include hernias of the abdominal wall which are often not detectable on physical examination, with conservative treatment initially and surgical intervention if it does not settle. Hip fractures are possible in high velocity events although elderly people can fracture with much less force. Attention should be paid to the severity of the pain and any limitation of hip movements, with orthopaedic evaluation. Repetitive sporting stresses can cause stress fractures of the pubic ramus or the femoral neck, with running a primary cause. Other possible causes include the severe and sudden pain of avulsion fractures, avascular necrosis of the femoral head and bursitis.