Hip & Groin Injury

Overview

Hip and groin injuries are common in sports involving sprinting, kicking, rapid direction changes and contact. They are frequently under-managed due to their complex anatomy and the overlap between multiple potential injury sites including the adductors, hip flexors, labrum and pubic symphysis.

Groin pain in athletes can be acute or chronic, and identifying the primary cause requires careful assessment. In older athletes, hip joint pathology including osteoarthritis should also be considered. Significant trauma to the hip can result in fractures — particularly in equestrian or cycling falls — which require urgent management.

Common Causes

• Adductor muscle strains from sprinting, kicking or lateral movements
• Hip flexor strains from explosive acceleration or overstretching
• Femoroacetabular impingement (FAI) — bony structural abnormality causing hip pain
• Labral tears of the hip joint
• Athletic pubalgia (sports hernia) — chronic groin pain from abdominal or adductor injury
• Hip fractures or femoral neck stress fractures from falls or overuse
• Osteitis pubis — inflammation of the pubic symphysis from overuse
• Referred pain from the lumbar spine

Signs and Symptoms

• Pain in the groin, inner thigh or front of the hip
• Pain reproduced by squeezing the knees together against resistance (adductor strain)
• Stiffness and reduced range of hip movement
• Pain worse with sprinting, kicking or climbing stairs
• Clicking or catching sensation within the hip joint
• Tenderness on palpation of the groin or inner thigh
• In acute fracture: severe hip or groin pain following trauma, inability to bear weight, shortened and externally rotated leg

Immediate Actions

• Remove the athlete from activity and assess the mechanism of injury
• If fracture is suspected, do not allow weight-bearing — call 999 and immobilise
• For acute soft tissue injury, apply PRICE: Protection, Rest, Ice, Compression, Elevation
• Apply a cooling wrap or ice pack to the groin area, protecting the skin
• Advise rest and avoidance of aggravating activities
• Refer for physiotherapy and further investigation if symptoms persist

When to Seek Medical Attention

Prevention Advice

• Strengthen adductor and hip flexor muscle groups through targeted conditioning
• Include dynamic hip mobility exercises in warm-up routines
• Avoid sudden increases in training load particularly involving sprinting and kicking
• Ensure adequate recovery between intense training sessions
• Address any strength imbalances between left and right sides
• Seek early physiotherapy assessment for persistent or recurrent groin pain

Event Environment Considerations

• Pitchside assessment of hip injuries should include evaluation for fracture, particularly following falls
• Suspected hip fractures require immediate immobilisation and emergency transfer
• In equestrian and polo events, falls from horses can generate significant forces and hip injury should be carefully assessed
• Soft tissue hip and groin injuries should be documented and athletes advised regarding return-to-play timelines
• Long-term groin pain should be investigated by a sports medicine clinician — it is rarely managed effectively without specialist input