Lies complaints

Training with knee pain

The fast facts


  • In about 33% of all cases, there is an acute injury
  • The moment of injury is then obvious and often happens during explosive movements during sports
  • In 66% of the cases, the complaints gradually increase to a point where the sport can no longer be performed adequately

Groin pain is common in athletes. Especially in sports where there are many changes in speed and direction. Think of sprinting, turning, slowing down and jumping. In this case it is often a muscle injury. This is therefore the most common cause of groin problems in adults. The muscles in the groin are called the adductors and are responsible for the force in the hip inwards. The adductors are very important during different types of sports such as: soccer, sprinting, rugby and field hockey. In addition to the adductors, other muscles of the hip and muscles in the abdominal region can be the reason for the symptoms. In addition to muscle injuries, groin pain can also be the result of problems with the hip joint.

Gradations of a groin muscle injury

With a muscle injury, we use different degrees. It is possible that there is only muscle pain or a slight strain. But it may also be that there is a muscle tear or even a complete tear. 


  • 1A Fatigue of the muscle which can result in muscle strain, usually from overuse or from exercising on a different surface.
  • 1B Muscle pain, generalized muscle pain of the adductors, usually caused by powerful moments of deceleration during sport.
  • 2A Muscle injury due to radiating pain from the low back 
  • 2B A local neuromuscular dysfunction of the muscle
  • 3A Minor localized muscle tear less than 1 muscle 
  • 3B Moderately large muscle tear, multiple muscle bundles involved in the injury 
  • 4 (Sub)total muscle tear, avulsion fracture 
  • Muscle bruising due to severe impact with person or object from outside
Cruciate ligament injury

Tendonitis in the groin

Groin pain can also be caused by a tendon injury. We call this a tendinopathy of the adductors. Previously, it was also called tendonitis. An acute tendonitis is called a tendinitis. Itis a suffix in the medical world indicating which part is inflamed. Tendo is tendon in Latin. So inflammation of the tendon. The irritation is from overuse and not from any other condition in the body. So you don't have a fever with this type of inflammation. Sometimes this accompanies an injury to the lower abdominal muscles. Often the complaints start with some stiffness before and after sports. After that, the pain is often continuously present during sports. Performance is often reduced and eventually you will no longer be able to perform your sport. Sometimes there can be swelling. Scientific research indicates that after the inflammatory phase, eccentric training is necessary to rebuild the quality of the tendon tissue. Eccentric training means that you provide power while the muscle lengthens. In this way, the tendon is stimulated to produce stronger new fibers in the correct tension load of the tendon. This allows the forces to be transferred back to the bone properly.

Risk factors for developing a groin injury

  • A previous injury to the groin region
  • Reduced strength of the adductors, proper rehabilitation is therefore crucial
  • Reduced hip mobility
  • Reduced pelvic/low back control
  • Top Sports
  • Fatigue
  • Moderate preparation for competition


Groin pain due to complaints in the hip joint

Possibly the groin pain is caused from a structure in the hip. So in this case it is not a muscle in the hip that is sensitive. The capsule of the hip, the labrum or extra bone growth on the head or socket of the hip may be causing the pain. 

Femoro Acetabular Impingement(FAI)

FAI occur when there is extra bone growth on the head or on the socket of the hip joint. Extra bone growth on the head of the hip is called the CAM type. Extra bone growth on the acetabulum (socket) is called the PINCER type. There can also be both, which is the mixed-type. In the long run this can cause problems with the cartilage of the hip and/or the labrum.

How is a groin injury diagnosed

A groin muscle injury is often confirmed by pain on tightening, stretching and palpation of the injured structure. You may be able to see some fluid or damage on an ultrasound image but in most cases, additional testing is not necessary for a muscle injury. In complaints that are caused from the hip, we often see a movement restriction in that joint. Also, the complaints have often been present for a long time and have slowly become worse over time. If the source of pain is the hip joint, additional examination is often indicated. First physical tests should give a suspicion of a problem from the hip. 

Physical tests for groin pain 

Different tests can be performed when an injury in the groin region is suspected. We make a distinction between muscle injuries and problems from the joint. 

Muscle strength testing hip 

The adductors bring the leg inward. In a flexed and extended position of the knee, the hip can be muscle tested inward. 

Stretch and palpation of the muscle group

With the knee in a stretched and flexed position, the leg is brought outward. If there is recognizable pain, the test is positive. Palpation of the adductors can also give a recognizable pain. 

Faber test 

Faber stands for Flexion ABduction and External Rotation. When there is pain with the combination of these three movements in the hip, a statement can be made about possible complaints in the hip, low back or pelvis. Depending on where the complaints occur.

Fadir test 

Fadir stands for Flexion, ADuction and Internal Rotation. When there is pain with the combination of these three movements in the hip, a statement can be made about the involvement of the joint in relation to the symptoms experienced.




Knee Osteoarthritis
Kevin van Geel

Low back & hip rehabilitation specialist Ruben Luijkx

The different phases in the treatment of a groin injury

Successful rehabilitation consists of several phases and steps. Good strength, stability and control are necessary to safely return to your sport. 

Adjusting the (training) load

In this phase, we focus primarily on symptom reduction. There is often pain and reduced mobility of the hip. Therefore it is important to regain good control of your movements in the hip. This is achieved by exercises of the muscles and possibly supportive treatments. With muscle injuries you may experience some discomfort when exercising. A pain score of 3 on a scale of 0-10 is acceptable. Also so the reaction to the exercises afterwards. 

Strength and coordination phase:

In this phase there is more of a build up in strength. How fast this is built up depends on the reaction to the given load. Because the risk of a new injury is greater after previous injury, it is extremely important to make a sustainable build up in strength and coordination. This is often greatly underestimated and the risk of a new injury is greater than intended. 

Sport-specific phase:

The final phase focuses particularly on maximum strength, jumping power and explosiveness. This is all necessary to be able to change direction quickly within your sport. We also work towards a competition condition so that you can continue to perform under fatigue. The quality of movement must remain good under these conditions and therefore much attention is paid to this.

Sports Resume: 

The timing of resuming sport remains a difficult decision. This is because there is a proven criteria for sports resumption. Wanting to start again too soon often leads to a new injury. The athlete must in all cases be able to sprint painlessly again, to tighten the leg muscles as much as possible and to perform sport-specific skills such as shooting a ball. In addition, the movement pattern must have improved sufficiently in order to be able to build up training again in a balanced way before (competition) matches can be resumed. 

Rehabilitation at Fysio Fitaal

In certain phases it will probably go slower than you had thought beforehand. Our specialists will guide you in this process as well as possible and motivate you where necessary. Fysio Fitaal works with specialists in the field of sports rehabilitation. Because of this combination of expertise, extensive facilities and passion for sports, you have come to the right place.

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