Football is a sport loved by millions across the UK, from children playing at school to adults pulling on their boots at the weekend, and professionals performing at the highest level.
One of the most common, and often frustrating injuries for footballers of all ages and abilities is a groin injury. These can keep players off the pitch for weeks or even months if not recognised and managed properly.
At LBSM we regularly see footballers of all backgrounds; young players beginning their careers, women competing in the rapidly growing female game, and older players who still love the buzz of a Sunday morning kick-about.
The one thing they all share is the frustration of being sidelined, which is why proper diagnosis and rehabilitation is so important.
We understand these injuries not only as clinicians, but also through years of experience working directly in professional football, which means we bring both advanced clinical expertise and a deep, first-hand understanding of the unique demands of the game.
This blog will explore why groin injuries are so common in football, what you can do to reduce your risk, and how to get back on the pitch safely.
Why Are Groin Injuries So Common in Football?
Football demands sudden changes of direction, explosive sprints, repetitive kicking, and physical challenges. These movements place significant stress on the groin muscles and tendons, which stabilise the hip and pelvis.
Research suggests that groin injuries account for around 10 – 15% of all football injuries, making them one of the leading musculoskeletal issues in the sport.
Notably, recurrence is common; some studies show up to 30% of players re-injure their groin within the same season if their rehab is poor or incomplete.
For players who are passionate about the game, whether they play recreationally or professionally, this can be incredibly disruptive.
Understanding the Anatomy of the Groin
The groin is not just a single muscle, but a complex region made up of several groups of muscles, tendons, and supporting structures.
Adductor muscles (inner thigh)
The adductor muscles, which run along the inner thigh, are especially important in football because they stabilise the hip and are heavily engaged during kicking.
Hip flexors (front of the hip)
The hip flexors at the front of the hip are essential for sprinting and striking the ball.
Abdominal muscles
The abdominal muscles help to stabilise the pelvis
Ligaments and tendons
ligaments and tendons in the area hold everything together under the intense strain of match play.
A groin injury can involve any of these tissues and may present as:
- Adductor strains – sudden sharp pain in the inner thigh.
- Hip flexor strains – pain at the front of the hip, especially when lifting the leg.
- Sportsman’s hernia (athletic pubalgia) – persistent groin pain linked to abdominal and tendon weakness.
- Tendon or ligament injuries – longer-lasting, often slower to recover.
When players talk about a “pulled groin,” or “groin strain” the injury could involve any of these structures.
Some experience an acute strain with sudden sharp pain in the inner thigh, while others develop a more chronic tendon issue that builds up gradually.
There are also conditions such as sportsman’s hernia (athletic pubalgia), where abdominal weakness contributes to long-term groin pain.
Because the groin is such a crossroads of muscle groups, it is often difficult for players to know exactly what has gone wrong without a proper assessment.
Who Is Most at Risk?
Groin injuries do not discriminate; they affect men and women, the young and the old, beginners and professionals.
That said, there are certain groups who are more vulnerable.
Younger or Older players
Younger players may lack the muscular strength or coordination to cope with the demands of high-intensity football, while older players may have reduced flexibility or slower recovery times.
Women in football
Women’s football deserves special mention. As the women’s game continues to expand, groin injuries are becoming more widely recognised. Research suggests that anatomical differences in the pelvis, hormonal influences, and differences in training load and conditioning programmes can all contribute to a higher incidence of hip and groin problems in female players.
At LBSM, we are proud to support women in football, ensuring they receive the same level of tailored rehabilitation and injury prevention support as their male counterparts.
Weekend warriors
Weekend players, often dubbed “weekend warriors”, are also particularly at risk. Many have busy lives during the week and then ask their bodies to perform at high intensity activity with little preparation. This sudden increased load on the muscles and tendons can be a recipe for injury.
How Groin Injuries Happen
Typical mechanisms include:
- Sudden sprints or deceleration.
- Rapid change of direction or twisting on the ball.
- Overstretching or mistimed tackle.
- Repetitive kicking, especially powerful long balls.
- Muscle fatigue late in a game.
Symptoms usually include:
- Sharp or aching pain in the groin or inner thigh
- Pain when sprinting, kicking, or changing direction
- In some cases, stiffness after rest.
- Immediate feeling of a ‘pull’ or ‘snap’
- Sometimes the pain develops more slowly, particularly with longstanding, tendon-related problems
Sports Medicine Assessment and Diagnosis
The pubic bone are a “crossroads” for various muscle attachments with forces moving in multiple directions; which is why one of the challenges with groin injuries is that they can be difficult to diagnose without specialist input.
Because pain in the groin can originate from a variety of muscles, tendons, or even the hip joint itself, a structured assessment is essential.
At LBSM, assessment starts with a detailed history and physical examination.
We look at:
- Mechanism of injury – how it happened and when pain occurs.
- Movement testing – muscle strength, flexibility, functional movement, and stability of the hip and pelvis.
- Palpation – gently pinpointing specific areas of tenderness.
- Diagnostic ultrasound or MRI – if needed, to confirm tendon or muscle damage.
Classification on Groin Injury – the DOHA agreement
The Doha Agreement provides a clinically driven system for classifying groin injuries in athletes, dividing them into five key entities based on history and physical examination rather than imaging.
These categories include:
- Adductor-related groin pain, identified by tenderness at the adductor origin and pain on resisted adduction.
- Iliopsoas-related groin pain, typically presenting as anterior groin discomfort worsened by hip flexion.
- Inguinal-related groin pain, characterised by pain near the inguinal canal that may worsen with resisted abdominal contraction or coughing.
- Pubic-related groin pain, which involves central groin discomfort and tenderness over the pubic symphysis.
- Hip-related groin pain, arising from intra-articular pathology such as femoroacetabular impingement or labral injury. This structured classification improves diagnostic accuracy and guides targeted rehabilitation by clearly identifying the anatomical source of symptoms.
Diagnostic Imaging
Our team also has the advantage of being able to perform diagnostic ultrasound scans in clinic, which allow us to visualise muscle and tendon injuries in real time.
In more complex or persistent cases, MRI scans may be arranged.
Image: MRI scan showing pubic symphysis inflammation and pubic overload
The goal is always to give the player a clear and accurate diagnosis so that a targeted treatment plan can be put in place asap.
Differential Diagnosis
Differential diagnosis of groin injuries requires careful consideration of several overlapping anatomical sources of pain.
Differential Diagnosis of Groin Injuries – Comparison Table
| Condition | Short Description | How It Is Similar | How It Is Different |
|---|---|---|---|
| Pubic symphysis pain (e.g., pubic symphysitis, early OA) | Inflammation or degeneration at the pubic symphysis causing central pubic pain. | Shares midline pelvic pain with pubic overload and some adductor issues. | Pain originates from the joint surface/articulation rather than the surrounding bone or soft tissues. |
| Pubic overload (superior/inferior pubic rami stress) | Stress irritation or inflammation of the pubic rami from excessive shearing forces. | Very similar location to pubic symphysis pain. | Driven by bony stress on the rami, not joint inflammation at the symphysis itself. |
| Hip-related pain | Groin pain referred from intra-articular hip structures such as FAI or labral issues. | Shares groin pain pattern with adductor and iliopsoas-related pain. | Originates inside the hip joint, not from soft tissue or pelvic structures. |
| Lower abdominal injuries / PLAC | Involves the lower abdominal wall or rectus abdominis insertion onto the pubic bone. | Overlaps with inguinal-related pain due to shared anatomical region. | Pain arises from abdominal wall insertion, not ligament or muscle fibre disruption as in sportsman’s groin. |
| Adductor-related pain | Pain at the adductor origin, worsened by resisted adduction or lateral movements. | Can feel similar to pubic or hip-related groin pain due to anatomical proximity. | Driven by muscle-tendon dysfunction, not bone, joint, or abdominal wall pathology. |
| Hip-flexor-related pain (iliopsoas) | Anterior groin pain triggered by resisted hip flexion, kicking, or sprinting. | Can mimic hip-related pain due to the same anterior hip/groin location. | Caused by iliopsoas muscle–tendon involvement, not intra-articular pathology. |
| Sportsman’s groin (inguinal ligament / oblique fibre disruption) | Disruption of inguinal ligament or oblique fibres; involves posterior inguinal wall weakness. | Similar region to PLAC and inguinal-related disorders. | Represents structural soft-tissue disruption and is not the same as a true hernia; also avoids the vague term “athletic pubalgia.” |
Treatment Options
Treatment will vary depending on the nature and severity of the injury, but a few principles apply across the board.
Acute management
In the acute phase, reducing pain and swelling is important, and this often means modifying activity rather than complete rest.
At LBSM, we encourage controlled mobility from the early stages to avoid stiffness.
Physiotherapy
Physiotherapy is the cornerstone of rehabilitation.
Most recreational players recover well with physiotherapy alone. Higher level players or Elite athletes may need a more intensive rehabilitation pathway to ensure they return at full capacity.
In the acute phase, reducing pain and swelling is important, and this often means modifying activity rather than complete rest.
Physiotherapy lead rehab involves progressive strengthening of the groin, hip, and core muscles, combined with flexibility and movement retraining.
Shockwave therapy or injection treatments
For more stubborn tendon problems, treatments such as shockwave therapy or guided injection therapies may be considered.
Gradual return-to-play programme
A structured return-to-play programme is also essential, gradually reintroducing sprinting, kicking, and competitive drills in a safe and monitored way.
Our team’s professional football background means we know what it takes for players to return to the pitch safely.
Having worked within professional football clubs, we have managed groin injuries at every stage; from initial assessment on the training ground to guiding players through structured rehabilitation programmes.
This insight allows us to tailor recovery plans not only for elite athletes under pressure to return quickly, but also for recreational players who want to get back to playing pain-free.
Prognosis and Outcomes
The outlook for groin injuries depends on the severity of the problem and how well rehabilitation is followed.
- Mild strains may resolve within a2-4 weeks with good rehab
- More significant injuries can take two to three months or longer.
- Chronic tendon problems or sportsman’s hernia can be even slower to resolve and may occasionally require surgical input.
The key predictor of a good outcome is completing rehabilitation fully before resuming play.
For elite or semi-professional athletes, there is often additional pressure to return quickly, but cutting corners in rehabilitation is the single biggest risk factor for recurrence.
At LBSM, we prioritise long-term outcomes to minimise the chance of repeated problems.
Preventing Groin Injuries
While not all injuries can be avoided, there is a lot that players can do to reduce their risk.
- Regular strength training for the adductor muscles and hip stabilisers is vital, as strong and well-conditioned muscles are less likely to tear under pressure.
- Core stability training and Pilates can improve pelvic control, which reduces the load on the groin.
- Flexibility work and mobility drills are also important, particularly as part of a structured warm-up before matches and training sessions.
- Load management is another key factor. Many injuries occur when players increase their training or match intensity too quickly, so gradually building up load is important.
For women in football, having access to tailored strength and conditioning programmes that address their specific risk factors can make a real difference.
At LBSM, we integrate injury prevention strategies into rehabilitation and also advise players on how to maintain them long-term.
Nutrition – Fuel for Recovery and Resilience
Nutrition is often overlooked when it comes to preventing and recovering from injuries, but it plays a vital role.
Muscles, tendons, and ligaments all need the right building blocks to repair and strengthen.
Adequate protein intake is essential to support muscle recovery, while collagen-rich foods or supplements, especially when combined with vitamin C, can aid tendon and ligament health.
Omega-3 fatty acids can help to reduce inflammation, and ensuring sufficient calcium and vitamin D is crucial for bone strength.
We also emphasise the importance of hydration and balanced fuelling around matches. Fatigue late in a game is a common time for injuries to occur, and good nutrition helps maintain energy levels and muscle function right through to the final whistle.
At LBSM our Sports Nutrition service is delivered by a highly experienced, qualified nutritionist with a clinical and elite sports background.
Final Thoughts
Groin injuries can be disruptive and demoralising, but with the right approach, most players return to football stronger and more resilient than before.
At London Bridge Sports Medicine, we combine advanced diagnostic tools, evidence-based treatment, and years of experience supporting professional footballers to help players of all levels – from weekend enthusiasts to elite athletes.
Our message is simple: don’t ignore groin pain, and don’t settle for quick fixes. With proper care, structured rehabilitation, and attention to prevention, you can get back to enjoying the game you love with confidence.
References
- Heijboer, W.M., Weir, A., Vuckovic, Z., Fullam, K., Tol, J.L., Delahunt, E. and Serner, A., 2023. Inter-examiner reliability of the Doha agreement meeting classification system of groin pain in male athletes. Scand J Med Sci Sports, 33, pp.189-196.
- 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;49:768-774.
- Werner, J., Hägglund, M. and Waldén, M., 2009. UEFA injury study: a prospective study of hip. Br J Sports Med, 43, pp.1036-1040.
