Why Does My Groin Hurt when I Run?

Many runners deal with groin pain — it’s surprisingly common in the sport, yet the issue remains  enigmatic for those who experience it.

That’s because the groin is a complex part of the body. It comprises various structures between the hips and upper thighs, including anything from the musculature to the tendons to the bony anatomy.

All of these structures are also deeply interconnected, so unidentified pain in the groin could involve any one of the tissues. This makes it virtually impossible to self-diagnose your pain without seeking advice from a medical professional.

But, even if you can’t perform an accurate self-assessment, understanding how your pain presents can be a big help in learning how to manage it. (And, it can provide more guidance for when you do speak with a specialist for further help.)

So let’s take some time to dive into why groin pain happens in runners and what it might mean.

What Groin Pain with Running Feels Like

One of the tricky parts about groin pain is that there’s not just one part of the body that shows symptoms.

Runners may experience pain anywhere around the pelvic bone, essentially; if the symptoms aren’t directly within the groin, they could appear anywhere from the front of the hip to closer towards the pubic bone, or even along the inner thigh.

And here’s where the complex part kicks in: there are so many potential diagnoses associated with groin pain that it’s difficult to figure out what your particular symptom means.

While we can’t guarantee your diagnosis without a proper evaluation, here are some common correlations that may provide you some further insight into your symptoms.

Potential Diagnoses for Groin Pain

One of the most common pathologies we’ve found associated with groin pain and stiffness is femoroacetabular impingement (better known as FAI or hip impingement). With hip impingement, you’re likely to feel a more distinct pinching sensation. It most commonly occurs in the front side of the hip, though it could also occur in the back side depending on the type of impingement. Some people experience more of a dull ache around the joint, whereas others feel a sharp pang. Symptoms can vary from constant to intermittent, depending on how aggravated the issue is.

Many runners also experience groin pain due to muscular issues — particularly strains in the adductor or hip flexor muscles. With low-level strains, your muscles will err more on the side of feeling tight or achy, often worsening during more intense activity. But if you were to acutely pull one of the muscles, it would be a sharper, more painful sensation that would limit higher intensity activity.

These are the two most prominent pathologies for running groin pain, and typically the easiest to identify based on symptoms and assessments. Some diagnoses, however, are harder to differentiate…

Take sports hernias, for instance (officially termed “athletic pubalgia”). Sports hernias present similar symptoms, but they’re caused by inflammation of the pubic symphysis, which is the joint that connects the bottom of your left and right pelvic bones.

Another similar diagnosis is osteitis pubis, which also presents as pubic symphysis pain. It’s typically caused by aggravation in the joint cartilage, as the pubic symphysis acts as an attachment point for many of the hip adductor muscles.

(Because of where the pain is located, neither a sports hernia or osteitis pubis can be properly diagnosed with a standard physical therapy evaluation — you typically need an MRI to confirm either pathology. The severity of your pain varies with how inflamed the tissues of the joint have become.)

One other distinct diagnosis is a femoral neck stress fracture. This injury is particularly common in distance runners who add on a lot of mileage, thus increasing the sheer impact forces that affect the hip joint. Unsurprisingly, you’ll experience much more severe groin pain with a stress fracture, likely to the point where you can’t bear weight on the leg. If you exercise the same muscles that you’d use to target FAI, you’ll likely feel the pain worsen.

Granted, this is far from an extensive list. There are still plenty more pathologies (or general biomechanical issues) that could affect the different muscles, tendons, and bony structures that make up the groin.

How to Assess Your Symptoms

Now, you might be thinking: “If the five most common diagnoses all have such similar symptoms, how am I supposed to figure out what I’m dealing with, let alone how to fix it??”

It can be frustrating to see how vague the symptoms are when trying to deduce the cause of your pain… but thankfully, there are several assessments that can help narrow down what your diagnosis could be (or, at the very least, provide a process of elimination to figure out what you’re not dealing with and guide you to the best next steps). 

The thing with groin pain is that there aren’t any effective self-assessments that you can perform by yourself. Determining the root cause is more about working with a specialist who can facilitate functional movement tests that identify what is (or isn’t) the problem.

For instance, a physical therapist can typically determine hip impingement by performing one of two assessments: FADIR or FABER.

The FADIR assessment stands for flexion, adduction, and internal rotation. A physical therapist will facilitate this combination of movements on the affected leg if you experience pain in the front of the hip. If you experience pain in the back of the hip, they will perform the FABER test, which stands for flexion, abduction, and external rotation. Should you have hip impingement, either of these tests will aggravate the tissues in your hip joint and cause your symptomatic pain to flare up.

In a similar fashion, physical therapists can also test for groin strains by testing where and when your pain occurs. Based on where the relevant muscles attach (either your adductors or your hip flexors), they will prompt you with manual muscle tests and see what movements spark pain — if the muscle hurts when it stretches or contracts, that’s a pretty clear sign of a strain.

You can also identify a femoral stress fracture by performing the fulcrum test. Here, the physical therapist will place one hand underneath the thigh of the symptomatic leg and one hand on the knee. They will then gradually apply pressure against the knee joint while keeping their other hand against the thigh to act as the fulcrum. If the increased pressure creates discomfort or sharp pain, it’s a high indicator of a stress fracture (and the level of pain can suggest how severe the fracture is).

In most cases, runners’ symptoms will align with the first couple of assessments. But, if you don’t experience any distinct symptoms from any of the above tests, it may not be identifiable through functional movement. At this point, you can seek imaging to see if the problem is caused by other internal issues.

How to Fix Groin Pain with Running

Obviously, the answer here is dependent on the cause of the problem — some diagnoses simply require enough recovery time, whereas others will need rehabilitation and biomechanical training to eliminate the root cause for good.

Recovery Timeline after Groin Injury

In cases like a sports hernia or a stress fracture, there isn’t much functional training that can be done to speed up the healing process (at least not right out the gate). These pathologies simply need time to recover; which can be a surprisingly difficult mental challenge for ambitious athletes. But, you have to be respectful of these tissues and allow them enough time to truly heal.

Lower level sports hernias typically only need about 7-10 days of rest, which is just enough time to reduce the inflammation in the pubic symphysis. Once the tissues are less aggravated, you can work your way into a progressive rehab program that improves your hip strength and flexibility.

On the other hand, when you first sustain a stress fracture, the tissues in your bones need to regenerate for a longer period of time. Many stress fractures take an average of 6 weeks to heal, but if the injury occurs in the femoral neck, it could take anywhere between 8-12 weeks. From there, you’re able to transition into a rehab plan that eases you back into the foundational work for a safe return to running.

Problems like hip impingement and muscle strains are often a result of biomechanical issues at the hip. It could range anywhere from insufficient shock absorption in the joint to improper pelvic and hip alignment.

Thankfully, once you pinpoint the root cause, you have a clear roadmap for how to retrain your movement patterns for optimal biomechanics. This will usually involve some degree of muscular activation and strengthening, shock absorption training, and alignment control drills.

Progressive Rehabilitation after Injury

Although groin pain can suggest a wide range of diagnoses, a majority of them lead to the same result: a progressive rehabilitation plan.

Of course, every plan should be customized to the individual athlete and their injury — but, many of them will consist of similar building blocks to get you back to running. Most rehabilitation plans will involve a variety of targeted loading exercises, progressive shock absorption drills, and strength and motor control training to improve alignment.

Loading exercises are necessary to reacquaint your body with bearing weight, particularly in dynamic single-leg contexts. At the beginning of your progression, you’ll likely ease into these workouts to ensure that you aren’t overloading the tissues right after recovery. (This might take the form of double-leg drills, static weight bearing exercises, or slower single-leg workouts, depending on what your tissues are capable of handling.)

As your tissues adapt to the loading practice, your program will start transitioning you into progressive shock absorption training. You may start out with something as simple as small, quick hops (on one or both legs) to simply retrain your muscles for absorbing light impact forces. You’ll then move into drills like small, double-legged box jumps to advance those foundational absorption skills.

Ideally, it’d be best to perform these exercises on a force plate — the force plate readings would provide hard data about how much impact your body has to take upon landing. Not only does this show you how hard you land, but it also gives you the opportunity to adapt your form as needed and see how it improves your landing in real-time.

With enough practice, you’ll eventually progress into exercises like the Bulgarian split squat, which escalates your training to a single-leg position and more running-specific form. This will better prepare your body for when you actually begin to run again, where you not only recruit similar muscles and biomechanics, but you also learn cues for running softer.

These shock absorption cues will likely be paired with alignment training, as it’s an essential aspect of proper form. Ensuring proper leg alignment includes a mix of muscular and motor control training, often in the form of slow, single-leg work that challenges your muscle activation and stability.

Final Thoughts

Phew — that was a lot of information to take in.

Understanding groin pain with running can be a frustrating process. Everything feels similar to everything else, and some assessments may not yield concrete results… it’s all so complicated.

But, when all else fails, remember to keep asking questions. Just because diagnosing groin pain can be complex doesn’t mean it’s impossible, so it’s important that you pay close attention to your symptoms and seek help from medical professionals who specialize in groin pain and injury.

By Dr. Torey Page DPT OCS

Dr. Page is recognized as a specialist in evaluation and rehabilitation of the lower extremity, spine, and shoulder. He has had years of experience working as a physical therapist and as a strength and conditioning coach, so he is well-versed in the analysis of human movement and biomechanics (as well as advanced training in running mechanics and return to sport training). Torey has advised a wide range of clients, from sports teams to triathletes to the Woodside Fire Department. In his spare time, he enjoys spending time with his wife Joey, their beautiful daughter Savannah, and their dog Gatsby.

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