Groin pain can have a variety of causes. This is because different structures all cause pain in the groin
can cause. Some structures cause localized pain others are the result of a
radiating pain from another region of the body. Groin pain is also common in athletes. Particularly in
Sports where many changes in speed occur. Think sprinting, turning, decelerating and jumping. In
This case is often a muscle injury. This is therefore the most common cause of groin problems in
Other possible causes of groin pain include:
Radiation from the back, for example
Tendon complaints of the upper leg
What influences the degree of pain in our groin?
The degree of pain depends on which injury is involved.
Complaints sometimes present as nagging, sharp or even burning. We also distinguish between acute
complaints and complaints the slowly got worse. Both are possible in the development of groin pain.
To find out what is causing your groin pain, a physical therapy examination is performed.
If necessary, consultation with your primary care physician will take place for further investigation.
A muscle injury
In the vast majority of cases, this is a muscle injury. Usually this also happens during sports. During braking or a quick change of direction, the forces on the muscles in the groin are too great and can result in a muscle strain or muscle tear. With a muscle tear, the pain is sharply present and immediately noticeable. The cause of the symptoms is obvious. The inside of the thigh up to the lower abdominal muscles can be sensitive and feel stiff. You may also be (temporarily) less able to use your strength.
The anatomy of our groin (inside): adductors.
The muscles in the groin are called the adductors and consist of 6 different muscles:
- Adductor longus
- Adductor brevis
- Adductor magnus
- Obturatorius externus
The above muscles are responsible for the force in the hip inward. Therefore, we call this movement adduction. The adductors are very important during different types of sports such as: soccer, sprinting, swimming, rugby and field hockey.
Gradations in muscle injury.
With a muscle injury we use different degrees of severity (1-3). It is possible that there is only a slight strain, but it is also possible that there is a muscle tear or even a complete tear.
- Stage 1: Mild sensitivity, often no limitations in normal walking, climbing stairs or even running.
- Stage 2: Moderate tenderness, often limitations in activities such as running and jumping. Possible blue discoloration and/or swelling in the groin region.
- Stage 3: High degree of pain, everyday activities are painful or even impossible to perform. Swelling is present along with stiffness of the muscles in the groin region. Possible blue discoloration.
When there is a serious muscle injury, it is necessary to have it examined by a professional. Signs of a serious muscle injury are:
- Difficulty or inability to walk
- Pain at rest
- Nighttime pain that does not subside when you change position
In rare situations, surgical intervention is necessary where the muscle needs to be fixed. This is almost non-existent, often it can also recover without surgery but under the guidance of a physiotherapist. Possible causes of a groin muscle injury. Groin injuries are usually the result of several factors such as:
- Strength of the surrounding muscles in the hip and abdominal areas
- general condition
- injury history
Training of muscle strength and overall fitness.
For this reason, it is important to ensure that muscle strength and general fitness is in order for the sport you are playing. For athletes, especially soccer players, it is important to train the abdominal muscles and adductors to prevent injuries. You often hear (personal) trainers say that performing compound exercises such as a squat and a lunge is sufficient to maintain the strength and load capacity of the adductors. However, research shows that the load on the adductors during these exercises is many times lower than during more isolated exercises for the adductors.
In order to achieve the best results, a training protocol has been developed that shows very good results with regard to injury prevention in soccer players. Research shows an increase in muscle strength of 35,7% in a period of 8 weeks. This concerns eccentric strength. In addition, it was found that with this exercise protocol also has a positive effect on the abductors of the hip. Here, an eccentric strength increase of 20% is achieved at the same 8-week intervention. The exercise is relatively easy to perform and is easy to incorporate into your current training. It is recommended to start with this exercise protocol in preparation for the season. You can then continue performing the exercise throughout the season.
Besides a muscle injury, other conditions can also cause groin pain. We list the most common causes for you below.
What is the labrum?
The labrum is a cartilage ring at the edge of the socket of the hip joint. It is a very thin ring only a few millimeters thick that, deeper into the joint, transitions into the articular cartilage. The function of the labrum is to create an airtight connection Its function is to create an airtight connection in which the joint moves. In addition, the labrum provides stability/firmness in the hip. Hip complaints as a result of labrum injury mainly occur at a relatively young age. We are talking about the age when a sport is fanatically practiced, often up to 30-35 years.
Why labrum injury occurs is not always clear. Several problems are known that may underlie the development of labrum problems.
There may be a bone abnormality in the hip. This deviation can occur in both the head and the socket of the hip or in some cases both. An abnormality in the head is called a CAM deformity, an abnormality in the socket is called a PINCER deformity. With a CAM deformity there is a deviation in the roundness of the hip head. This means that the head cannot move smoothly through the hip socket. Compare it to a ball that is not round, it will never roll nicely in one direction. With the pincer deformity we see that the hip socket is actually somewhat deeper than normal. This causes some extra bone to form at the edge of the socket, limiting its mobility. In both cases, an entrapment occurs when the hip is asked to move a great deal. With long-term complaints, damage to the labrum often occurs.
Injury to the labrum and characteristic pain.
Injury to the labrum can also occur after an accident or during sport. In general, we see that there is a clear (traumatic) moment of origin of the complaints. Sports in which labrum complaints occur more often are gymnastics, soccer, volleyball, martial arts and golf. Presumably, this happens because these are sports in which rotating movements are very important for the hip. In addition, it may be that the muscles around the hip are not strong enough to support you in your daily activities. Too much is asked of the labrum, which causes problems.
Hip pain where the labrum is the source of the pain can often be recognized by the following:
- Deep pain at the front of the hip.
- A painful click during hip movements (the feeling of dislocation).
- Pain that increases with prolonged sitting or standing.
- Pain in the hip when squatting.
- Reduced strength of muscles around the hip.
- Stiffness in the hip. (Reduced mobility?)
Labrum injury is not always easy to diagnose. Often other images are excluded and an MRI is used to confirm the diagnosis. A tear in the labrum does not heal on its own. If necessary, surgery is sometimes performed to repair the cartilage ring. In other cases, the symptoms are fine to control with physical therapy. Want to know more?
Sporthern hernia or inguinal hernia
Hernia Inguinalis. An inguinal hernia (hernia inguinalis) involves a weakness in the abdominal wall. So it's not like your groin is actually broken. Because of this weakness in the abdominal wall, there is a possibility that intestines, abdominal fat or peritoneum bulge slightly. This happens mainly when coughing, sneezing or pressing (increasing abdominal pressure). This creates a lump in the groin that can be felt but is sometimes also clearly visible. An inguinal hernia can be recognized by pain in the groin during the above activities or certain movements in combination with the presence of swelling/ a lump. Sometimes an inguinal hernia is less easily recognized. In such cases (when other diagnoses are also excluded) it can have added value when an ultrasound is made of the groin area. An inguinal hernia can occur in both women and men. However, it is a problem that occurs more often in men.
Possible problems with an inguinal hernia.
An inguinal hernia in itself does not have to be a problem or an obstacle. If the inguinal hernia is only very small, you may not even notice it's there. Risk factors for developing an inguinal hernia include smoking, obesity and pregnancy. A large inguinal hernia that causes a lot of symptoms is usually surgically repaired. The same is true when women have an inguinal hernia. This is because an inguinal hernia in women generally has a higher risk of complications.
What is osteoarthritis?
In hip osteoarthritis, the cartilage that lies between the head and the bowl is in a reduced condition. The quality of this often decreases as we age. In many cases this decrease in quality does not cause any problems. You don't always have to notice this. The development of osteoarthritis is largely determined by heredity. This factor has much more influence than, for example, the choice of sport or having a physically demanding profession. If you have symptoms, they often manifest as pain and stiffness in the hip. Crackling noises, limitation of movement and instability complaints can also be part of the symptoms. The pain in hip osteoarthritis may present in the groin region, among other places.
Gradations within osteoarthritis symptoms.
There are four degrees to classify hip osteoarthritis;
- Grade 1: The springy properties of the cartilage are reduced. There is minimal osteophyte formation (extra bone formation). This degree of osteoarthritis is not yet visible on an X-ray.
- Grade 2: There are irregularities in the cartilage surface. Osteophyte formation can sometimes be observed on the x-ray. This degree of osteoarthritis is also not always detectable on a photograph.
- Grade 3: Deeper cracks and grooves are visible in the cartilage. However, the bone surface is not yet exposed. The joint space can be narrowed, which is visible on an X-ray. Often abnormalities can be seen in the bone edges.
- Grade 4: The cartilage has almost completely disappeared and the joint gap is little to nonexistent.
Notable for osteoarthritis symptoms.
What is special is that more osteoarthritis does not equal more complaints (pain, stiffness, loss of strength). There are people with a lot of aging of a joint but relatively few complaints, and vice versa, little visible osteoarthritis but still many limitations. It is not the aging itself that causes complaints. This may have several causes. We see, for example, that in an area where the joint has aged, the nerve sensitivity to pain increases because of a kind of inflammatory process. Because of this, normal movements can be experienced as painful without any real danger. With osteoarthritis symptoms it is important to map out your daily limitations together with your physiotherapist. This allows you to work with the physiotherapist to reduce the symptoms and remain as vital and independent as possible in your daily activities. In some cases, an arthritic hip is replaced. Would you like to know more about this? Read it here
Complaints in the hip do not always have to have an origin in that area. There are several structures in the body with a radiation area. For example, when there are complaints of a nerve from the back, it can manifest itself in another area of the body. When a nerve from the spine causes problems, it sometimes affects the entire course of the nerve in the leg. So it can happen that you experience symptoms in the hip. It is also possible that complaints such as osteoarthritis in the back cause a different movement pattern in the hip. It is therefore logical that physiotherapists, if they suspect that this could be the case, also include the back in their diagnostic process. hip pain.
Bursitis trochanterica (bursitis)
We consider this a secondary complaint, so I wonder if we should mention it. There is nothing else we can do about the bursa itself. But we can do something about the primary source of the complaints. On the outside of the hip is a bursa. Its purpose is to reduce friction between muscles and bone parts in that area. This bursa can become irritated and give symptoms.
There are several known causes for the occurrence of a bursitis in the hip;
- Damage to tendons that run around the bursa
- Irritation of tendons around the bursa
- Calcification of tendons around the bursa
- Inflammation of the bursa itself
A bursitis in the hip can be recognized by pain at the side of the hip. This pain can radiate to the buttock or towards the knee. The pain is felt when walking or lying on the hip. Complaints can also occur when crossing the legs or while climbing stairs. It is typical that the pain is often present at night. Bursitis is a persistent complaint that can take weeks or months to recover. It is important (if there is an underlying cause) to tackle it. The treatment of bursitis is never focused on the bursa itself. Sometimes an anti-inflammatory injection is administered by a doctor to speed up the recovery process.
Tendonitis of the upper leg (Musculus rectus femoris).
Groin pain can also be caused when the attachment of the upper leg to the pelvis (front) is overloaded. This often occurs as a result of an overload in sports where there is faster and more explosive movement. Complaints often present themselves as follows:
- Pain when lifting the upper leg
- Support the leg with the hands when moving the upper leg(often getting in and out of the car)
- Radiation to the outside of the hip
Groin pain after surgery.
Sometimes people retain groin pain as a result of surgery. One example is groin pain after inguinal hernia surgery or cesarean section. Groin pain after surgery occurs in approximately 11% of men after inguinal hernia surgery and 7% of women after cesarean section. It often involves an irritation or damage to one of the three inguinal nerves:
- ilioinguinal nerve
- genitofemoral nerve
- nervus iliohypogastrica
A pinched nerve gives possible:
- Burning sensation, sometimes stabbing in the groin region
- Sharp presence when changing positions or coughing or sneezing
- Not being able to sleep well on the side
- Negative impact on sex life, pain with sex
- On the scar, there is a clearly identifiable sharp pain
- The skin feels dull or less sensitive
When it comes to groin pain after surgery, further examination and treatment by a physician is necessary.
The groin region is very complex there are many anatomical structures that can potentially cause the pain. This makes it difficult to determine the actual cause. It is necessary to come to a correct diagnosis before treatment is started. Are you suffering from groin pain and not sure what to do with it? Then take contact with us at the registration form for your first appointment at Physio Vital.