Athletic pubalgia / sports hernia
Athletic pubalgia is load-related pain around the pubic bone and lower abdomen/groin, often seen in athletes performing repeated sprinting, changes of direction, and kicking. Despite the name, it does not necessarily involve a typical inguinal hernia.
Mild pain around the pubic bone, lower abdomen, or groin that mainly occurs during sprinting, kicking, or changes of direction and improves with rest.
The condition is often associated with repeated high loads on the muscles and tendons around the lower abdomen, adductors, and pubic bone during sprinting, changes of direction, and powerful kicking.
Common loading factors
- •Repeated sprinting and acceleration
- •Repeated changes of direction
- •Powerful shooting and passing
- •Sudden increases in training volume or intensity
- •Insufficient recovery between high-load sessions
Risk may be reduced through gradual load progression and balanced strengthening of the adductors, hips, trunk, and gluteal muscles.
- •Increase sprinting, kicking, and change-of-direction load gradually
- •Train adductor strength regularly
- •Strengthen the hips and trunk
- •Plan recovery between high-intensity football sessions
- •Address recurring groin or pubic pain early
Temporarily reduce activities that clearly provoke pain. Maintain pain-free activities and avoid repeatedly testing the area with hard sprinting or kicking.
Load management
Modify football load and reduce provoking activities.
Goals
Reduce pain while maintaining general physical capacity.
Progression criteria
Daily activities and light training are tolerated without significant pain increase.
Strength and control
Progressive strengthening of the adductors, hips, trunk, and gluteal muscles.
Goals
Restore strength and control around the pelvis and hip.
Progression criteria
Strength training is tolerated without significant worsening later the same day or the following day.
Football-specific loading
Gradual return to running, acceleration, changes of direction, and kicking.
Goals
Tolerate full football demands.
Progression criteria
Football-specific activities can be completed without symptom worsening.
- Pain-free or clearly symptom-controlled daily activities
- Adequate adductor and trunk strength
- Sprinting and changes of direction are tolerated
- Kicking and passing are tolerated
- Full training can be completed without significant symptom worsening
The information in the Injury Center is for educational purposes and does not replace professional medical advice. Always consult a qualified healthcare professional for diagnosis and treatment.
Athletic pubalgia / sports hernia
Athletic pubalgia is load-related pain around the pubic bone and lower abdomen/groin, often seen in athletes performing repeated sprinting, changes of direction, and kicking. Despite the name, it does not necessarily involve a typical inguinal hernia.
Mild — Ofta flera veckor vid rätt belastningsstyrning, men återhämtningstiden varierar.
Symptoms
Mild pain around the pubic bone, lower abdomen, or groin that mainly occurs during sprinting, kicking, or changes of direction and improves with rest.
Acute Treatment
Temporarily reduce activities that clearly provoke pain. Maintain pain-free activities and avoid repeatedly testing the area with hard sprinting or kicking.
Rehabilitation
Modify football load and reduce provoking activities.
Goals
Reduce pain while maintaining general physical capacity.
Progression criteria
Daily activities and light training are tolerated without significant pain increase.
Progressive strengthening of the adductors, hips, trunk, and gluteal muscles.
Goals
Restore strength and control around the pelvis and hip.
Progression criteria
Strength training is tolerated without significant worsening later the same day or the following day.
Gradual return to running, acceleration, changes of direction, and kicking.
Goals
Tolerate full football demands.
Progression criteria
Football-specific activities can be completed without symptom worsening.
Return to Play
- ☐ Pain-free or clearly symptom-controlled daily activities
- ☐ Adequate adductor and trunk strength
- ☐ Sprinting and changes of direction are tolerated
- ☐ Kicking and passing are tolerated
- ☐ Full training can be completed without significant symptom worsening
Moderate — Ofta flera veckor till några månader beroende på orsak, belastning och rehabilitering.
Symptoms
Recurrent or more pronounced pain around the pubic bone, lower abdomen, or groin that affects sprinting, kicking, changes of direction, or training. Pain may persist after activity.
Acute Treatment
Reduce high-load football activities and consider medical or physiotherapy assessment. Rehabilitation should focus on gradual loading rather than prolonged complete rest.
Rehabilitation
Assess possible causes of groin pain and modify load.
Goals
Reduce pain and identify an appropriate rehabilitation strategy.
Progression criteria
Pain is controlled and active rehabilitation is tolerated.
Progressive training of the adductors, hips, trunk, and pelvis with gradually increasing load.
Goals
Restore strength and load tolerance.
Progression criteria
Higher strengthening loads are tolerated without persistent symptom worsening.
Gradual progression from running to acceleration, changes of direction, kicking, and full training.
Goals
Tolerate the loads required in competition.
Progression criteria
Full training can be completed without significant symptoms afterward.
Return to Play
- ☐ Groin and pelvic pain is controlled
- ☐ Adductor, hip, and trunk strength are restored
- ☐ Sprinting and changes of direction are tolerated
- ☐ Powerful kicking is tolerated
- ☐ Full training is tolerated without significant post-training reaction
Severe — Kan kräva flera månader, särskilt om annan skada identifieras eller kirurgisk behandling behövs.
Symptoms
Severe or persistent pain, significant loss of function, sudden injury with severe pain, or symptoms that do not improve despite load modification may indicate a different or more extensive injury and should be assessed.
Acute Treatment
Stop provoking activity and seek medical assessment. Sudden severe pain, significant swelling, or suspected hernia or other acute injury requires specific assessment.
Rehabilitation
Assessment to identify the cause of pain and exclude other injuries.
Goals
Establish the diagnosis and appropriate treatment.
Progression criteria
Medical assessment allows active rehabilitation.
Load is gradually increased according to the cause of injury and medical recommendations.
Goals
Restore strength, function, and full load tolerance.
Progression criteria
Full football-specific loading is tolerated and a healthcare professional considers return safe.
Return to Play
- ☐ The diagnosis has been established or more serious causes have been excluded
- ☐ Full function and strength have been restored
- ☐ Sprinting, changes of direction, and kicking are tolerated
- ☐ Full training is tolerated
- ☐ Medical assessment has cleared return when required
When to Seek Medical Care
Recurrent groin or pubic pain affecting football should be assessed if it does not improve with appropriate load modification.
- Sudden severe pain
- Significant swelling or a lump in the groin
- Pain affecting walking or daily function
- Pain that persists or recurs despite rehabilitation
- Suspected hernia or other acute injury
- Pain accompanied by fever or other systemic symptoms
References
- Athletic Pubalgia (Sports Hernia) — American Academy of Orthopaedic Surgeons (https://orthoinfo.aaos.org/en/diseases--conditions/athletic-pubalgia-sports-hernia/)