Running with Groin Pain: Athletic Pubalgia

Athletic pubalgia—commonly known as a sports hernia—is a frustrating and often misunderstood source of groin pain in athletes. Whether you're a soccer player, hockey player, runner, or weekend warrior, that deep, nagging discomfort in the lower abdomen or groin can sideline your training and impact performance.

One key—but often overlooked—piece of the rehab puzzle? Hip strength.

What Is Athletic Pubalgia?

Athletic pubalgia is not a true hernia. Rather, it’s a soft tissue injury near the pubic bone, involving one or more structures like the rectus abdominis, adductors, inguinal canal, or even the hip flexors. Athletes often feel pain during twisting, sprinting, kicking, or sudden directional changes.

While there are several contributing factors—limited core stability, poor movement mechanics, or tightness in surrounding muscles—weakness in the hip muscles is often a silent accomplice.

Why Hip Strength Matters

The hips are the engine of the body. Every explosive movement you make—whether it's a sprint, cut, or jump—requires strong, coordinated action from the hip abductors, adductors, flexors, and extensors.

When these muscles aren’t doing their job, the smaller stabilizers around the pelvis and groin often pick up the slack. Over time, this leads to overload, poor force transfer, and—eventually—injury. In the case of athletic pubalgia, that means microtears or strain in the tissue at the pubic aponeurosis.

The Key Hip Muscles to Strengthen

Let’s break down the most important hip muscles that need to be strong to both recover from and prevent athletic pubalgia:

1. Hip Adductors (Inner Thigh Muscles)

Ironically, these muscles are often painful in athletic pubalgia, but they’re also frequently weak. Studies show that eccentric adductor strength is particularly important. Controlled strengthening, not just stretching, is key here.

Top exercise: Copenhagen Plank (regression and progression depending on tolerance)

2. Gluteus Medius and Minimus (Hip Abductors)

These muscles stabilize the pelvis during single-leg movement. Weakness here can cause pelvic drop or overcompensation through the groin.

Top exercise: Side Plank Dips

3. Gluteus Maximus (Hip Extensor and External Rotator)

Strong glutes are essential for propulsion and stability. They help unload the anterior pelvis during sprinting and cutting.

Top exercise: Hip thrusts

4. Hip Flexors (Iliopsoas Group)

Often “tight” but sometimes underprepared for the activity you’re performing. Strengthening the hip flexors—particularly for athletes who do a lot of running—can help normalize pelvic mechanics. I like to include an emphasis on pelvic adduction and hip internal rotation while in lengthened positions.

Top exercise: Standing resisted hip flexion, lunge with OH reach and pelvic twist, and lunge to OH reach with a stomp.

A Word on Imbalances

Athletic pubalgia doesn’t arise from weakness in just one muscle group—it’s about imbalance. For example, if your adductors are much stronger than your abductors, or your hip flexors dominate your extensors, you’re likely to have inefficient movement patterns that load the pubic symphysis abnormally.

That’s why a comprehensive hip strength program is critical—not just focusing on the “sore” area.

Progressing Safely

It’s tempting to jump into heavy strength training or return to sport as soon as the pain starts to fade—but athletic pubalgia has a high recurrence rate if rehab is rushed.

A solid progression includes:

1. Isometric activation (e.g., adductor squeezes)

   
   
   
   

2. Isotonic strengthening (e.g., split squats, bridges)

   
   
   
   

3. Dynamic control (e.g., lateral bounds, single-leg hops)

   
   
   
   

4. Sport-specific drills (sprinting, change-of-direction mechanics)

   
   
   
   

Pain should always be your guide, and proper progression matters more than speed.

When to Get Help

If you’ve had groin pain for more than a few weeks, or if it returns when you ramp up your training, it’s worth seeing a sports physical therapist. A detailed assessment of your hip strength, flexibility, movement patterns, and core control can reveal hidden deficits that aren't always obvious.

Rehab for athletic pubalgia isn’t just about treating pain—it’s about correcting the underlying dysfunctions so you can return to your sport stronger than before.

Final Thoughts

If you're dealing with athletic pubalgia, don’t ignore your hips. Strengthening the right muscles can make the difference between chronic pain and a full return to play. Treat the root, not just the symptoms.

If you're not sure where to start or want a tailored program, reach out—we’re here to help you move better, feel stronger, and get back in the game.

Seeing some changes but still want a more individualized approach to your rehab? If you want to learn how to take control with some expert guidance and treatments to optimize your performance and longevity, then that’s exactly what we provide at Zenith Performance Physical Therapy. Call or text us at 562-502-1767 to schedule a free phone consultation and come in for an evaluation!

Thomas Bilodeau, PT DPT, USAW-L1

Zenith Performance Physical Therapy 

ICE Certified Specialist: Orthopedics, Fitness Athlete, Older Adult