Hip and Groin pain can often be complex and multi-factorial in nature. It occurs in an anatomically dense area, where many structures can be responsible for, and contribute to pain and injury. Attempting to define specific structural sites of pain/injury hence becomes challenging, where having overarching sites can assist in diagnosis and management
The 2015 Doha Agreement allowed in assisting diagnosis for clinician’s by simplifying the types of pain into 6 distinct categories:
Adductor related groin pain
- Tenderness on palpation of the common adductor tendon
- Pain with resisted hip adduction
Inguinal related groin pain
- Pain location in the inguinal canal region
- Tenderness of the inguinal canal
- No palpable inguinal hernia
- More likely if pain with cough/sneeze/Valsalva, or with resisted abdominal testing
Pubic related groin pain
- Local tenderness of the pubic symphysis and immediately adjacent bone
Iliopsoas related groin pain
- Iliopsoas tenderness on palpation
- Pain with resisted hip flexion and/or stretching of the hip flexors
Hip related groin pain
- Mechanical symptoms such as clicking, locking, catching, or giving way
- Clinical suspicion
- Often co-exists with other types of hip/groin pain
- Special tests and passive range of motion used to exclude
Other types of groin pain
- Can be related to other orthopaedic, neurological, rheumatological, urological, gastrointestinal, dermatological, oncological and surgical
- Ruled in/out through history and physical examination
Trying to decipher this when you’re the one experiencing the pain can be even more challenging. Physiotherapy management should involve graded re-exposure to inciting activities, with a focus on biomechanical cueing and correction of contributing factors, identifying and addressing any underlying strength asymmetries or issues, manual therapy as appropriate, and education regarding specific expected timelines.