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Whether you’re sprinting down the soccer field, powering through a workout, or just chasing your kids at the park, groin pain can be a frustrating roadblock. It’s not just an “athlete problem” — long-standing groin pain affects weekend warriors, fitness enthusiasts, and even people who’ve done an awkward twist getting out of the car (Maloy et al, 2025).
What’s tricky is that groin pain can come from many structures — muscles, tendons, joints, and even nerves around the hip. Getting the right diagnosis is the key to a fast and lasting recovery. And the good news is that most cases can be treated without surgery.
One of the most valuable tools for getting answers? Musculoskeletal ultrasound (Herring et al, 2024; Naal et al, 2015; Forlizzi et al, 2023).
Doctors often use terms like "Sportsman's hernia," “Sportsman’s Groin,” “Athletic Pubalgia,” or “Pubic Inguinal Pain Syndrome” to describe chronic groin pain related to sports or physical overload. But these terms are not specific and do not get to the underlying cause of pain (Weir et al, 2015).
Common causes of groin pain include:
Adductor tendinopathy – strain or overuse of the muscles that pull your legs together
Iliopsoas tendinopathy – injury to the hip flexor muscles
Inguinal-related pain – weakness or irritation in the groin ligaments or tendons, without a true hernia
Hip-related pain – labral tears, impingement, or cartilage injury
Did you know?
Research involving over 12,000 patients found that tendinopathies of the adductor tendon and iliopsoas tendon are the most common causes of chronic groin pain — and 82% of people got better without surgery (Santilli et al, 2025).
There are a number of muscles, tendons, nerves, and joints in this area. An injury in one structure often affects others, and symptoms can overlap. For example:
Hip joint injuries can mimic muscle strains (Feeley et al, 2008; Zuckerbraun et al, 2020; Herring et al, 2024).
Hernia-like symptoms can occur without a visible bulge (Miller et al, 2014; Wong et al, 2024; Fitzgibbons & Forse, 2015).
Nerve irritation can cause pain during exercise, coughing, or sneezing (Zuckerbraun et al, 2020; Verwoerd et al, 2016).
Because of this overlap, physical examination alone can sometimes miss the true cause — that’s where imaging comes in.
While MRI is sometimes used, musculoskeletal ultrasound offers several advantages for groin injuries:
Real-time imaging – see the tendons, muscles, and ligaments as you move
Dynamic testing – check for tendon snapping, hernia changes, or nerve entrapment during specific movements
Guided procedures – the same ultrasound can guide precise treatments like injections or percutaneous tenotomy
No radiation and quick results – safe for repeated follow-ups
Ultrasound can reveal:
Tendon thickening, tearing, or inflammation
Bone changes at tendon attachment sites
Fluid collections or bursitis
Areas of nerve compression
Most importantly, ultrasound findings are always interpreted alongside your symptoms and physical exam — because imaging alone doesn’t tell the whole story.
Experts agree that groin pain responds best when evaluated by a multidisciplinary team — often including (Santilli et al, 2025):
Non-Operative Sports medicine physicians – to lead diagnosis and treatment planning
Physiotherapists – to correct movement patterns and build strength
Radiologists – to perform and interpret imaging
Surgeons – only if nonsurgical care isn’t enough
The goal is to reduce pain, restore function, and prevent recurrence. Here’s how:
Relative rest – avoiding painful activities but staying active in ways that don’t flare symptoms
Progressive strengthening – focusing on the core, hips, and thigh muscles to support the groin
Flexibility and mobility – restoring balanced motion in the hips and pelvis
Sport-specific retraining – gradually returning to drills, cutting, and sprinting movements
For stubborn inflammation, targeted injections under ultrasound guidance can help:
Corticosteroids – reduce inflammation (short-term use)
Platelet-Rich Plasma (PRP) – uses your own blood’s healing factors to stimulate tendon repair (more below)
PRP is a regenerative medicine treatment where a small sample of your blood is processed to concentrate platelets — cells rich in growth factors. When injected into an injured tendon under ultrasound guidance:
It may stimulate tissue repair
Reduce pain over weeks to months
Provide longer-term relief than anti-inflammatory injections
Studies suggest PRP can be particularly helpful for chronic adductor or iliopsoas tendinopathy, especially when standard rehab hasn’t worked.
For tendinopathy that doesn’t improve with rehab and PRP, a tenotomy under ultrasound guidance is a minimally invasive option:
Performed under local anesthesia with ultrasound guidance
Uses a small probe (like Tenex®) to remove degenerated tendon tissue
Stimulates a healing response while preserving healthy tissue
Usually followed by a tailored rehab program
This approach can reduce pain and improve function without the downtime of open surgery (Shomal Zadeh et al, 2023).
In the large review, over 80% of patients recovered fully with structured rehab, and many others improved with advanced nonsurgical options like EPI, PRP, or tenotomy — meaning only 14% needed surgery (Santilli et al, 2025).
Surgery is reserved for cases where:
Pain persists after high-quality nonsurgical care
There’s significant inguinal weakness or tearing
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