Although running injuries like IT band syndrome, plantar fasciitis, and shin splints are more common among runners, groin pain can be a frustrating and persistent injury with the potential to sideline you from training.
Groin pain from running can be difficult to diagnose due to the intricate biomechanical nature of the area. As a result, many runners with groin pain simply assume they have a mild strain and keep running.
There are several potential causes of groin pain, from running from a pulled muscle to arthritis, and the key to treating the injury is to properly identify the problem.
In this guide, we will look to provide you with up-to-date science when it comes to groin pain, various causes of groin pain from running, and how to effectively treat it.
Why Does My Groin Hurt When I Run?
Diagnosing groin injuries in runners is notoriously difficult, primarily due to the complexity of the anatomical structures in the groin area.
It is a “busy” area from an anatomical perspective because it has a lot of bones, ligaments, muscles, tendons, and nerves attaching to or passing through it.
Groin pain causes can arise from a variety of issues, including muscular pathologies, pelvic problems, hip joint issues, and osteitis pubis.
Groin Pain From Running? Here Are 7 Possible Causes
Since 2014, medical professionals have agreed to categorize groin pain into four classifications; adductor-related, iliopsoas-related, inguinal-related, and pubic-related.1Weir, A., Brukner, P., Delahunt, E., Ekstrand, J., Griffin, D., Khan, K. M., Lovell, G., Meyers, W. C., Muschaweck, U., Orchard, J., Paajanen, H., Philippon, M., Reboul, G., Robinson, P., Schache, A. G., Schilders, E., Serner, A., Silvers, H., Thorborg, K., & Tyler, T. (2015). Doha agreement meeting on terminology and definitions in groin pain in athletes. British Journal of Sports Medicine, 49(12), 768–774. https://doi.org/10.1136/bjsports-2015-094869
Some runners with groin injuries experience groin pain while running and/or groin pain after running. The nature of your injury can provide clues as to the root cause.
These are a few considerations to look at when trying to identify the cause of your groin pain:
- Where is the pain located? The location of the pain is essential in identifying the muscles and bones that are involved. For example, if you feel pain in the front of the thigh, it is indicative of the iliopsoas. Whereas if the pain is located on the inner thigh is indicative of adductor-related groin pain.
- What were you doing when you injured it? Was there a specific change of direction as you were running on a trail or jumping up onto a curb? Reaching and jumping are usual culprits for groin injuries when running.
- Was there an acute or gradual onset? Deciphering whether the pain developed quickly or gradually gives you a lot of information on what caused it and how to manage it.
If the pain originated out of nowhere and is accompanied by more systemic symptoms such as fever, fatigue, unexplained weight loss, and painful urination you should seek medical attention.
Here are the seven most common causes of groin pain:
#1: Pulled Groin
A “pulled” groin or groin strain is the most common cause of hip pain from running and generally refers to a strain in the muscles or tendons of the groin.
Research shows that the majority of groin injuries in runners are adductor injuries. An adductor strain causes pain and tenderness near the pubic symphysis. You’ll likely feel pain when you move your legs toward the body, especially when there is a force resisting the movement. 2Holmich, P., & Renstrom, P. A. (2007). Long-standing groin pain in sportspeople falls into three primary patterns, a “clinical entity” approach: a prospective study of 207 patients * COMMENTARY. British Journal of Sports Medicine, 41(4), 247–252. https://doi.org/10.1136/bjsm.2006.033373
An easy test to try to see if you have an adductor injury is by placing an inflatable ball between your legs and trying to squeeze the ball. If this elicits pain, there’s a good chance your adductors are involved in the injury.
The iliopsoas, or hip flexors, are the other major muscle group that may be injured in a groin strain.
You will feel pain with resisted hip flexion and some pain to the outside of the pubic symphysis. You can test for this groin injury by trying to lift your leg towards your chest while simultaneously pressing against it with your hand.
We’ll delve into how to treat a muscle strain later!
#2: Adductor/Inguinal Tendinopathy
Adductor and inguinal tendinopathy are other common causes of groin pain caused by running.
It differs from a groin strain in that it is more of a chronic, inflammatory injury, usually in the tendons of the muscle, not the muscle fibers themselves. Tendinopathy usually occurs over a longer period and is often down to overuse.
In fact, “over-use injuries” account for 61% of all sporting groin injuries.3Hölmich, P., Thorborg, K., Dehlendorff, C., Krogsgaard, K., & Gluud, C. (2013). Incidence and clinical presentation of groin injuries in sub-elite male soccer. British Journal of Sports Medicine, 48(16), 1245–1250. https://doi.org/10.1136/bjsports-2013-092627
Therefore, a sudden increase or sustained high volume in mileage or intensity is the most likely cause of groin tendinopathy. The pain usually develops during a run but may appear after a hard workout and will linger for several hours or days.
#3: Hip Joint Impingement
Hip joint impingement, referred to as femoroacetabular impingement, is actually a hip joint issue, but the pain is often referred to in the groin.
Impingement pain usually develops gradually over several weeks.
Pelvic stability and lack of muscle strength often promote excessive internal rotation of your hips when you run, causing the bones in the groin to press against each other, resulting in inflammation and pain.
#4: Osteitis Pubis
Osteitis pubis is usually an overuse injury and a fairly common cause of groin pain in runners. It develops gradually over time, with pain usually in the center pubic bone, although it can often move to the adductors or abdominals.
Osteitis Pubis is caused by a lack of core strength and stability in the pelvis and hips, which causes excessive movement and strain on the tendons and connective tissue attached to the pubic symphysis.4Choi, H., McCartney, M., & Best, T. M. (2008). Treatment of osteitis pubis and osteomyelitis of the pubic symphysis in athletes: a systematic review. British Journal of Sports Medicine, 45(1), 57–64. https://doi.org/10.1136/bjsm.2008.050989
#5: Hip Arthritis
Hip arthritis is a degenerative condition that refers to a thinning of the cartilage between the bones of the hip joint. It can cause rubbing and crepitus in the joint, and pain can be referred to the groin.
Arthritis is not a sentence! Many people effectively manage arthritic symptoms and continue to run. Consult a local physiotherapist on how best to do this.
#6: Stress Fracture
A stress fracture of the femoral neck or hip is an overuse injury that can cause referred pain to the groin when running. 5Kiel, J., & Kaiser, K. (2022). Stress Reaction and Fractures. PubMed; StatPearls Publishing. https://pubmed.ncbi.nlm.nih.gov/29939612/
You can also get a stress fracture at or near the pubic symphysis. This injury usually causes dull groin pain after running, and the pain may be present at the start of a run as well.
Stress fractures are usually the result of mismanaged stress accumulating in the bones over time. We need to allow the body adequate time to rest to prevent this.
Most stress fractures in the hip or pubis will heal with noninvasive treatment. Depending on the severity of the fracture, it will generally take 1 to 3 months for a stress fracture to heal.
#7: Sportsman’s Hernia (Gilmore’s Groin)
A sports hernia can cause deep pain in the groin. However, it is less common in runners and more common in sports that involve large amounts of twisting.
A classical hernia is a hole in the abdominal wall in which contents of the abdominal cavity may protrude. However, a Sportsman’s Hernia doesn’t tend to bulge. It is usually the result of a tear within ligaments and tendons deep inside the inguinal area.
Pain is exacerbated when coughing or sneezing, depending on the location of the hernia.
The Anatomy Of The Groin
The key to fixing groin pain in runners lies in understanding the area.
So, let’s take a look at the anatomy!
The groin is the area in the front of your hips and pelvis between your stomach and thighs. Essentially, the groin is located where your torso ends and your legs begin both in the front and inside of your legs, near the top of the femur.
There are several “muscle groups in the groin”groin muscles,” firstly the adductor muscles, consisting of the adductor longus, adductor brevis, adductor magnus, gracilis, and pectineus.
The other muscle group to consider are the hip flexors, which cross the hip and include the psoas major, iliacus, and rectus femoris.
Another important aspect is the inguinal ligament, which connects the oblique muscle to the pelvis.
The pubic symphysis is a bony union of the two sides of your pelvis at the front portion of the bottom of your pelvis. It serves as the attachment point for the adductor muscles as well as the rectus abdominis muscle that forms your lower abdomen.
The pubic symphysis also plays a key role in balancing and stabilizing your pelvis when you walk and run.
It can all sound a little confusing, but knowing what goes where may help you get a bit of clarity.
Risk Factors For Groin Pain In Runners
There are several training errors and risk factors for groin injuries from running to consider, including the following:
- Sudden increases in volume or intensity
- Not warming up before a workout
- Osteoporosis and/or inadequate caloric and nutrient intake
- Excessive downhill running
- Tight/weak hips and glutes
- Overstriding
- Sudden twisting or turning
- Overtraining or insufficient rest and recovery
Preventing And Effectively Treating Groin Pain From Running
Determining the cause of your groin pain from running is the key to fixing the problem and getting back to pain-free mileage
Once you’ve determined the cause, how do you effectively treat it and prevent it from happening again?
Step 1: Rest
An initial period of rest is a crucial first step in the treatment plan of treating groin injuries. Rest doesn’t mean downloading half of Netflix and putting your feet up, although you’re more than welcome to do that in your own time.
How long should I rest for a groin injury?
If all activities aggravate the groin, then a period of rest similar to the one mentioned above, may be in order. Otherwise, the rest should be active.
There are plenty of exercises and activities that allow for low-impact cross-training so long as it is pain-free. To be more precise, a little bit of pain is usually okay. Watch out for pain that gets progressively worse during the activity; stop, and make the activity easier.
Depending on the diagnosis, ice, heat, NSAID’s and physical therapy are recommended.
Surgery is sometimes implicated, depending on the type and severity of the injury.
Step 2: Progressive Strengthening & Mobility Work
Overall, the focus of this stage of rehabilitation should be on improving the mobility and flexibility of your hips, as well as strengthening the muscles surrounding the groin.
There is evidence to suggest that strength training can yield a clinically-relevant reduction in groin injury risk in athletes.6Esteve, E., Rathleff, M. S., Bagur-Calafat, C., Urrútia, G., & Thorborg, K. (2015). Prevention of groin injuries in sports: a systematic review with meta-analysis of randomised controlled trials. British Journal of Sports Medicine, 49(12), 785–791. , E., Franklyn-Miller, A., Richter, C., O’Reilly, E., Doolan, M., Moran, K., Strike, S., & Falvey, É. (2018). Clinical and biomechanical outcomes of rehabilitation targeting intersegmental control in athletic groin pain: prospective cohort of 205 patients. British Journal of Sports Medicine, 52(16), 1054–1062. https://doi.org/10.1136/bjsports-2016-097089
Strength and mobility training should focus on the adductor and hip flexor muscles. Although an additional focus on the legs and glutes, more generally, will also help strengthen the area.
We want to progressively introduce load to these muscles through manageable exercise. As the specific exercises get easier, we add more load. This can be done by increasing resistance, time under tension, or volume.
A weak core leads to instability of the pelvis, which puts extra strain on the adductors and pubic symphysis.
A well-rounded strength training program for runners should strengthen the entire core, including the iliopsoas, and also target the hip’s internal and external rotators, adductors, and abductors.7Krommes, K., Bandholm, T., Jakobsen, M. D., Andersen, L. L., Serner, A., Hölmich, P., & Thorborg, K. (2017). DYNAMIC HIP ADDUCTION, ABDUCTION AND ABDOMINAL EXERCISES FROM THE HOLMICH GROIN-INJURY PREVENTION PROGRAM ARE INTENSE ENOUGH TO BE CONSIDERED STRENGTHENING EXERCISES – A CROSS-SECTIONAL STUDY. International Journal of Sports Physical Therapy, 12(3), 371–380. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5455186/
Step 3: Return To Running
As our rehabilitation progresses, we may start thinking about re-introducing running.
The same progressive principle applies. Don’t skip to this step, as the strength work and crosstraining are invaluable.
Most people get it wrong by returning to running too early.
Try interspersing walk/run sessions initially. Get a gauge of how you feel and then progressively make them harder by reducing walking time and increasing running volume.
As before, some pain is okay. Make note of it. If the next day you feel fine, great; if the next few days are incredibly sore, it was probably too much too soon.
How Can I Prevent Groin Pain While Running?
Warm-Up
It’s easy to warm up before jumping into your workout, but so few do so. Do 5-10 minutes of brisk walking or easy jogging, followed by dynamic stretches before heading out for your run.
Be Mindful of Volume Increases
Overtraining and sudden increases in mileage and intensity put you at a greater risk for groin injuries from running.
Heed the 10% rule, meaning you should only increase your mileage by a maximum of 10% from one week to the next. For example, if you are currently running 30 miles a week, run no more than 33 miles next week.
The 10% rule is a good benchmark but may be too much or too little for each individual. Listen to your body.
It’s also important to pay attention to jumps in intensity. Ensure you give your body ample recovery between hard efforts.
Stretch
Tight hip flexors, adductors, and hamstrings increase your risk of groin injuries. Ensure you are stretching frequently, especially after running.
Final Thoughts
Taking good care of your body should always be your number one priority, and following these helpful tips will assist you in avoiding groin pain from running.
If you have a sports injury, be sure to work with a physical therapist like a physio, they will ensure that you are on the right plan for you. This will likely make a big difference to your recovery time.
Whether you have a soft tissue injury or something that requires X-rays, having a proper sports medicine practitioner examine it will put you on the right track.
What are the best stretches for preventing groin pain in runners? Check out our pre-run routines and dynamic stretches to properly prepare for your workouts!
Thank you Ben. Very useful article. Just been to physio and he suggested MRI to rule out anything serious in inner upper thigh, groin area. I got persistent pain there and along the hip to knee on outer side as well. Been 3 weeks of rest as I strained my legs after half marathon race. One experienced runner said probably due to fast running downhill in that race, which was 2 laps. I usually train uphill and slow downhill. Never had this pain especially on while left leg, and this is 3rd year of marathon training. Hope to recover soon and get back to running which always gave joy but now pain 😀