Why does my groin hurt when I skate, kick or change direction?

What it feels like

Pain in the groin or inner thigh with skating, kicking, sprinting, changing direction, or squeezing the legs together. It may come on suddenly as a strain or build gradually.

What is actually happening

The international Doha agreement classifies groin pain in athletes by its main source: adductor-related, iliopsoas-related, inguinal-related, pubic-related, and hip-related. Identifying the category guides treatment. Adductor-related pain is the most common.

When to see a doctor

See a doctor if you notice a lump in the groin that gets bigger when you cough or strain, testicular pain or swelling, fever, or pain that is not linked to activity.

See a doctor promptly if groin or front-of-hip pain builds with running or walking, or is present at rest, as this can be a stress fracture of the hip.

How it is assessed

Assessment uses the Doha clinical tests: tenderness and pain with resisted movements of the adductors and hip flexors, examination of the inguinal region and pubic bone, and a screen of the hip joint. Strength, such as squeeze testing, is measured to track progress.

How it is treated

A Cochrane review found low-quality evidence, from one trial, that an active strengthening programme did better than passive treatment for long-standing adductor-related groin pain. Treatment progresses adductor and hip strengthening, such as Copenhagen adduction exercises, trunk and hip control, and a graded return to skating, kicking and sprinting. Hip-related pain follows the consensus recommendations for physiotherapist-led care.

What to do first

Reduce the kicking, skating and change-of-direction load that provokes it rather than stopping all training, and have it assessed to identify the type of groin pain.