Groin pain most often comes from one of four places: the adductor muscles along the inner thigh, the hip joint itself, a hernia, or an irritated nerve. In women it can also come from pelvic causes. The fastest way to narrow it down is not where it hurts, since everything hurts in the same small crease, but what brings the pain on.

Adductor strain and inner thigh pain

The adductors run from your pubic bone down the inside of your thigh. They pull your legs together and steady you when you change direction. A groin strain usually means one of these has been overloaded.

The pattern is fairly clear. It hurts when you squeeze your legs together, when you push off to change direction, and when you kick. Pressing the inner thigh near the pubic bone finds a tender spot. This is the most common sporting cause, and it can drag on for months if the leg returns to full load too early.

When the hip joint is the real source

This one surprises most people. A problem inside the hip joint is usually felt in the groin, not over the side of the hip. Osteoarthritis, where the joint surface wears down, and a labral tear, where the cartilage rim around the socket is damaged, both show up as deep pain in the groin.

Many people describe it by cupping the front and side of the hip with a C-shaped hand. Clinicians call this the C sign, and it is a good hint that the joint itself is involved. Pain over the bony point at the side of the hip is usually something else, and hip flexor pain sits higher and further forward.

Hernias and sportsman’s groin

An inguinal hernia is a weakness in the abdominal wall near the groin crease. The classic sign is a bulge that appears or enlarges when you cough, strain or stand for a while, and that often settles when you lie down. It tends to ache rather than sharply hurt.

There is also a condition called sportsman’s groin, or inguinal disruption, where the tissues of the inguinal canal are strained without an obvious bulge. It is common in sports involving twisting and kicking. A suspected hernia is a surgical question rather than a pain clinic one, and your family doctor can arrange the right referral.

Nerve pain in the groin

Three nerves supply sensation to the groin: the ilioinguinal, the iliohypogastric and the genitofemoral. Any of them can be irritated or trapped, and the pain then feels different from a muscle problem.

The clue is the quality. Instead of an ache that builds with activity, you get burning, sharp or electric pain, often in a narrow band, with a patch of skin nearby that feels numb or oversensitive. It can flare at rest or at night.

This most often follows surgery in the area: a hernia repair, a caesarean section, or another abdominal or pelvic operation, where a nerve is caught in scar tissue or stitching. This kind of nerve entrapment is often missed, because scans of the muscles and joint come back normal.

Pain at the pubic bone

Some pain sits right at the front of the pelvis, where the two halves meet. Irritation there is called osteitis pubis. It is common in kicking and running sports and builds gradually rather than tearing in one moment. It hurts on kicking, sprinting and sit-ups, and the bone is tender to press.

Groin and inner thigh pain in women

Groin pain in women can come from all of the causes above, and from pelvic structures as well. Endometriosis, ovarian cysts and pelvic floor muscle pain can all be felt as groin or inner thigh pain rather than in the abdomen. Pain that follows a monthly pattern is worth noting.

Pregnancy-related pelvic girdle pain is also common, with pain at the pubic bone and groin that is worse on walking, stairs and turning in bed. Pain sitting further back, near the dimples at the base of the spine, may come from the sacroiliac joint instead.

Persistent groin or inner thigh pain in a woman without a clear muscle or joint cause should be assessed by a doctor, who will consider pelvic causes too.

Pain referred from the lower back

The lower back can refer pain into the groin and inner thigh, usually from the upper lumbar levels. It tends to travel rather than sit in one spot, and it changes with back position rather than hip movement.

What makes it worse, and what that points to

• Worse squeezing your legs together or kicking: adductor muscles or tendon
• Worse on weight bearing, twisting or getting out of a car: the hip joint
• Worse coughing, straining or standing a long time, with a bulge: hernia
• Burning or electric pain with a numb or odd patch of skin: a groin nerve
• Worse in the second half of the monthly cycle: a possible pelvic cause
• Came on in one sprint, kick or lunge: a muscle or tendon strain

How groin pain is treated

Most cases start with load management: backing off the movement that provokes it without going fully still, then rebuilding strength in the adductors and deep hip muscles. Physiotherapy guides that progression.

When pain persists despite good rehab, an interventional pain clinic adds targeted options. Ultrasound-guided injections can be placed precisely around an affected tendon. Nerve blocks can test and treat entrapment of the groin nerves, including pain that began after surgery. When the hip joint is the source, image-guided joint injections, including hyaluronic acid injections, may be considered. A suspected hernia goes to a surgeon.

Warning signs that need urgent care

Most groin pain is not dangerous. Some patterns need same-day attention.

• Sudden severe groin or testicular pain in men. This can mean testicular torsion, where the blood supply is twisted off. It is an emergency.
• A painful groin bulge that cannot be pushed back in, with vomiting. This can mean a strangulated hernia, and it is an emergency.
• Fever with pain and swelling in the groin.
• Groin pain in a runner that worsens over weeks and hurts when you hop on that leg. This can indicate a stress fracture.
• Inability to bear weight on the leg after an injury.
• Unexplained weight loss, or a new lump in the groin.

Frequently asked questions

How do I know if my groin pain is a muscle or a hernia?
A muscle strain hurts when you squeeze your legs together, change direction or kick, and it is tender along the inner thigh. A hernia more often produces a bulge that appears on coughing, straining or standing and eases when you lie down, with a dragging ache. If you can see or feel a bulge, ask your doctor to look at it.

Why does my groin hurt when I walk?
Groin pain when walking often points to the hip joint, since walking loads and rotates it with every step. It can also come from an adductor problem or from pelvic girdle pain. Pain that builds the longer you walk, or that has you limping, is worth having assessed.

Can groin pain come from the back?
Yes. The upper part of the lower back can refer pain into the groin and inner thigh. This kind of pain tends to move around, change with your back position, and come alongside back stiffness. It usually does not produce local tenderness in the groin itself.

What helps groin strain heal faster?
Relative rest rather than complete rest, then graded strengthening of the adductors under guidance. Returning to sprinting and cutting before the muscle can handle load is the most common reason a groin strain drags on. A physiotherapist can set the steps and the timing.

This article is general information, not medical advice. It cannot diagnose your pain. If your symptoms are new, worsening, or worrying you, speak with your family doctor or contact us for an assessment.

Talk to a pain specialist

If your groin pain has lasted beyond a few weeks and rehab has not changed it, an assessment can work out which structure is involved. Our physicians in Toronto treat hip joint pain, tendon pain and nerve pain in the groin, including pain that began after surgery.

Most services are covered by OHIP with a physician referral, and you can also refer yourself without waiting for one. Your family doctor can send a physician referral directly.