Adductor-Related Groin Pain: Causes, Symptoms, and How We Can Help
- staystrongtherapy
- 4 days ago
- 6 min read
All information in this blog is supported by peer-reviewed research. There is currently no dedicated NICE guideline for this condition, so current evidence is used throughout. Reference numbers appear throughout, with the full list at the bottom of the page.
What Is Adductor-Related Groin Pain?
Adductor-related groin pain is the most common type of groin pain seen in athletes, particularly those playing football, hockey, rugby, and other sports involving rapid changes of direction, kicking, and side-to-side movements. ¹ The adductor muscles are the group of muscles on the inner thigh responsible for pulling the legs together. They run from the inner thigh up to the pubic bone, and it is at the upper end, where the muscles meet the pubic bone, that pain most commonly develops.
The term "adductor-related groin pain" comes from the internationally recognised classification framework developed in Doha in 2015, which categorised groin pain in athletes into four main types based on where the pain is coming from: adductor-related, iliopsoas-related, inguinal-related, and pubic-related. ² This classification was a significant step forward, since the older, vague term "groin strain" often failed to identify the actual structure causing the problem.
What Is Actually Happening?
Adductor-related groin pain can involve either a muscle strain (a tear within the muscle itself or at the junction between the muscle and tendon) or a tendinopathy (a gradual, degenerative change in the tendon where it attaches to the pubic bone). ³
Acute strains happen suddenly, typically during a rapid change of direction, a forceful kick, or a split-type movement where the leg is pushed beyond its comfortable range. Chronic presentations, which are much more common in clinical practice, develop gradually over time through repetitive loading without adequate recovery, and are often linked to underlying strength imbalances or a sudden increase in training demands. ¹
Common Signs and Symptoms
Pain in the groin and inner thigh, particularly in the upper, inner part of the thigh close to the pubic bone
Pain that comes on during or after activity, particularly with kicking, sprinting, or changing direction
Tenderness when pressing along the adductor muscles or at their attachment on the pubic bone
Pain with resisted squeezing of the thighs together (the adductor squeeze test)
Stiffness and discomfort first thing in the morning or after sitting for a long time
In more persistent cases, pain that begins to affect daily activities such as walking or climbing stairs
Risk Factors
A 2025 systematic review of risk factors across 4,249 athletes identified the following most consistent risk factors for adductor-related groin pain: ¹
Previous history of groin injury, one of the strongest and most consistent predictors of future groin pain across all sports
Reduced eccentric hip adduction strength, weakness specifically in the controlled, lengthening phase of adductor muscle contraction
Limited hip rotation range of motion
Inadequate preseason conditioning, not being physically prepared for the demands of the sport before the season begins
Excessive training volume or poor periodisation, doing too much too soon without adequate recovery
Absence of a structured prevention programme
Male sex, the vast majority of research involves male athletes, reflecting where the condition is most prevalent, though it does affect female athletes too
Age and muscle fatigue, particularly relevant to adolescent athletes whose musculoskeletal systems are still developing ³
When Should You Be Concerned? Red Flags to Watch For
Adductor-related groin pain is a benign condition in the vast majority of cases. Please seek prompt medical assessment if you experience:
Significant trauma to the groin or inner thigh, with immediate inability to walk
Sudden, severe groin pain at rest without any obvious activity trigger
Groin pain in a child or adolescent, particularly if associated with hip pain, since specific growth-related conditions require assessment
Fever or feeling generally unwell alongside groin pain
Testicular pain alongside inner thigh symptoms in men, which requires prompt medical review
How Is It Diagnosed?
Diagnosis is primarily based on history and clinical examination. The key findings are tenderness over the adductor tendons close to the pubic bone, and pain reproduced by resisted adduction (squeezing the thighs together) against resistance. ²
A previous systematic review identified significant differences between athletes with and without groin pain, including lower adductor squeeze test strength, reduced hip rotation range, worse self-reported function, and altered trunk mechanics, all of which form part of a thorough clinical assessment. ¹
Imaging, including ultrasound or MRI, can help identify the degree of tendon or muscle involvement where the diagnosis is uncertain, or where the person is not progressing as expected with conservative treatment.
How We Can Help
The good news from recent research is that both manual therapy and structured exercise are effective for adductor-related groin pain, and the two work particularly well together.
Osteopathic manual techniques and manual therapy: addressing restriction and compensatory tension in the hip, pelvis, and lumbar spine, alongside direct soft tissue work to the adductor muscles and tendons. Manual therapy combined with exercise consistently produces faster return to sport than exercise alone. ⁴
Deep tissue and sports massage: targeted release of the adductor muscle group and surrounding inner thigh structures, reducing tension and supporting the rehabilitation programme.
Medical acupuncture: used as part of a broader treatment plan to support pain management during rehabilitation.
Exercise: The Foundation of Recovery
Progressive, structured exercise is central to recovering from adductor-related groin pain and, importantly, to preventing it from coming back.
The Copenhagen adduction exercise has become one of the most well-evidenced
exercises for both treating and preventing adductor-related groin pain. It involves lying on your side with the top foot supported on a bench or partner's shoulder, and slowly lowering and lifting the bottom leg. A 2025 randomised controlled trial found that an 8-week adductor strengthening programme incorporating this type of eccentric adductor loading significantly improved eccentric hip adduction strength in youth football players, alongside meaningful improvements in groin-related symptoms and function. ⁵
The Hölmich protocol is a well-established, progressive exercise programme specifically designed for adductor-related groin pain. It begins with isometric adductor exercises and progresses through strengthening, functional, and sport-specific phases over a structured 8 to 12 week period. ⁶
General exercise principles for this condition:
Isometric holds first: in the early, more painful stage, holding a gentle squeeze against a ball or fist between the knees is a low-irritation starting point for loading the adductors
Eccentric adductor loading: progressively loading the adductor muscles through their lengthening phase, which is where the most significant strength deficits typically lie ¹
Hip and core strengthening: building overall pelvic and hip stability to reduce the demand placed on the adductors during sport
Sport-specific loading: gradually reintroducing cutting, sprinting, and kicking movements in a controlled, progressive way before return to full sport
Preventing It From Coming Back
Given that previous groin injury is the single strongest predictor of future groin pain, prevention is genuinely important. ¹ A scoping review of exercises for preventing groin pain in athletes, published in 2025, found that the Copenhagen adduction exercise remains the most widely adopted and evidence-supported exercise for groin pain prevention, with good evidence for building eccentric adductor strength when performed twice weekly. ⁷
Building adequate adductor strength before a season begins, alongside appropriate preseason conditioning, is the most evidence-based way of reducing the risk of this problem developing or recurring. ¹
What to Expect at Your First Appointment
We will take a thorough history including your sport, training load, and how the pain developed. We will carry out a hands-on assessment, including specific adductor squeeze tests and a broader assessment of hip range of motion and strength, alongside the lumbar spine and pelvis. We will explain clearly what we find and build a structured, progressive treatment programme combining manual therapy with a tailored exercise plan, including sport-specific return-to-play criteria rather than relying on pain levels alone.
Frequently Asked Questions
Do I need a scan? Not usually for initial assessment and treatment. Imaging is most useful where the diagnosis is unclear or where significant structural damage is suspected.
Can I keep training? Often with modification. Reducing high-load activities such as kicking and sprinting in the early stages, whilst maintaining conditioning through lower-irritation exercise, is generally the approach. Your practitioner will guide what is appropriate for your specific situation.
How long will it take to get better? Research suggests that multi-modal treatment combining manual therapy and exercise leads to return to sport in around 12 to 13 weeks on average, with exercise-only programmes taking somewhat longer at around 17 weeks. ⁴ This varies depending on severity and how long symptoms have been present.
Will it keep coming back? Without addressing the underlying strength deficits and training load factors, recurrence is common. A structured prevention programme, particularly eccentric adductor loading, significantly reduces the risk of re-injury. ¹
Think this sounds like what's going on with your groin? Get in touch using the contact form and we will assess and build the right treatment plan for you.
References
Risk Factors Associated with Groin Pain in Athletes: A Systematic Review. PMC. 2025. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC12653094/
Weir A, et al. Doha agreement meeting on terminology and definitions in groin pain in athletes. British Journal of Sports Medicine. 2015;49(12):768-774.
Comparative Effects of Copenhagen and Holmich Exercises in Hip Adductor. ClinicalTrials.gov. 2024. Available at: https://clinicaltrials.gov/study/NCT05970003
Pringels L, et al. Manual or exercise therapy for long-standing adductor-related groin pain: a randomised controlled clinical trial. British Journal of Sports Medicine. 2025;59(9):640-650. Available at: https://www.cochranelibrary.com/central/doi/10.1002/central/CN-00789009/related-content
Adductor strengthening programme improves groin injury risk factors in youth football players. Research in Sports Medicine. 2025. Available at: https://www.tandfonline.com/doi/full/10.1080/15438627.2025.2577893
Effect of Holmich protocol exercise therapy on long-standing adductor-related groin pain in athletes: an objective evaluation. Referenced via: Academia.edu. Available at: https://www.academia.edu/101063465/Manual_or_exercise_therapy_for_long_standing_adductor_related_groin_pain_A_randomised_controlled_clinical_trial
A Scoping Review of Exercises for Preventing Athletic Groin Pain. PMC. 2025. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC12824425/
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