The groin is anatomically complex, with several structures located close together that can all produce pain:
Adductor muscles: These are the structures most commonly involved in “groin strains.” The adductor group — adductor longus, brevis, magnus, gracilis, and pectineus — originates from the pubic bone and runs down the inner thigh. The adductor longus is the most frequently injured.
Iliopsoas: The primary hip flexor complex, arising from the lumbar spine and pelvis and attaching to the lesser trochanter of the femur. Injury or tendinopathy in this area can cause anterior groin or hip flexor pain.
Pubic symphysis: The joint connecting the two pubic bones. High athletic loads can lead to stress-related injury in this region, often referred to as athletic pubalgia or sports hernia.
Inguinal region: Both true inguinal hernias and sports hernias (posterior inguinal wall disruption) can cause groin pain, particularly during exertion.
Hip joint: Conditions such as labral tears and femoroacetabular impingement (FAI) commonly refer pain into the groin region.
Pubic bone: Osteitis pubis is a stress-related inflammatory condition affecting the pubic symphysis and surrounding bone.
Accurate diagnosis is important because groin pain may originate from muscles, tendons, the hip joint, or the inguinal region. Treating all groin pain as a simple muscle strain can lead to poor outcomes if the underlying cause is different.
The groin is anatomically complex, with several structures located close together that can all produce pain:
Adductor muscles: These are the structures most commonly involved in “groin strains.” The adductor group — adductor longus, brevis, magnus, gracilis, and pectineus — originates from the pubic bone and runs down the inner thigh. The adductor longus is the most frequently injured.
Iliopsoas: The primary hip flexor complex, arising from the lumbar spine and pelvis and attaching to the lesser trochanter of the femur. Injury or tendinopathy in this area can cause anterior groin or hip flexor pain.
Pubic symphysis: The joint connecting the two pubic bones. High athletic loads can lead to stress-related injury in this region, often referred to as athletic pubalgia or sports hernia.
Inguinal region: Both true inguinal hernias and sports hernias (posterior inguinal wall disruption) can cause groin pain, particularly during exertion.
Hip joint: Conditions such as labral tears and femoroacetabular impingement (FAI) commonly refer pain into the groin region.
Pubic bone: Osteitis pubis is a stress-related inflammatory condition affecting the pubic symphysis and surrounding bone.
Accurate diagnosis is important because groin pain may originate from muscles, tendons, the hip joint, or the inguinal region. Treating all groin pain as a simple muscle strain can lead to poor outcomes if the underlying cause is different.
LPAW’s clinical team includes 19 practitioners, many holding postgraduate qualifications from UCL, King’s College London, and Guy’s and St Thomas’. Lead clinician Mr Arjun Viswanath MSc, MCSP, MPPA – Co-Founder and Consultant Physiotherapist – brings 25+ years of NHS and private experience including BMI London Independent Hospital and Harley Street.
Every clinician joining LPAW completes a mandatory intensive shadowing placement with our Consultant Physiotherapist before seeing patients independently. This is not a standard practice at most clinics – it’s our way of maintaining clinical consistency across the team.
Physiotherapy and sports therapy at LPAW follow an evidence-based groin rehabilitation programme, centred around the Copenhagen adductor strengthening protocol, which has the strongest evidence base for both treatment and prevention of adductor-related injuries.
Phase 1 — Pain management and initial loading (Week 1–2)
Isometric adductor squeeze exercises (e.g. ball between the knees), typically introduced within the first 48–72 hours
Low-load hip adduction exercises in supported positions
Maintenance of general conditioning using non-provocative activities
Phase 2 — Strength building (Weeks 2–6)
Copenhagen adductor programme: Side-lying adduction with the lower leg supported on a bench, progressed with bodyweight or added load. The Copenhague study (2018) showed a 41% reduction in groin injury incidence in professional football when used preventively
Hip flexor and hip abductor strengthening to address surrounding musculature
Progressive lunge and squat patterns
Core and lumbopelvic stability work, as the pubic symphysis acts as a key force transmission structure and is sensitive to poor control
Phase 3 — Functional loading (Weeks 4–8)
Linear running progression
Lateral movement and change of direction drills
Kicking mechanics work where relevant, including technical correction if needed
Phase 4 — Return to sport (Weeks 6–12 for Grade II injuries)
Full sport-specific training
Return to contact and competition once objective criteria for strength, control, and pain-free function are met
Physiotherapy and sports therapy at LPAW follow an evidence-based groin rehabilitation programme, centred around the Copenhagen adductor strengthening protocol, which has the strongest evidence base for both treatment and prevention of adductor-related injuries.
Phase 1 — Pain management and initial loading (Week 1–2)
Isometric adductor squeeze exercises (e.g. ball between the knees), typically introduced within the first 48–72 hours
Low-load hip adduction exercises in supported positions
Maintenance of general conditioning using non-provocative activities
Phase 2 — Strength building (Weeks 2–6)
Copenhagen adductor programme: Side-lying adduction with the lower leg supported on a bench, progressed with bodyweight or added load. The Copenhague study (2018) showed a 41% reduction in groin injury incidence in professional football when used preventively
Hip flexor and hip abductor strengthening to address surrounding musculature
Progressive lunge and squat patterns
Core and lumbopelvic stability work, as the pubic symphysis acts as a key force transmission structure and is sensitive to poor control
Phase 3 — Functional loading (Weeks 4–8)
Linear running progression
Lateral movement and change of direction drills
Kicking mechanics work where relevant, including technical correction if needed
Phase 4 — Return to sport (Weeks 6–12 for Grade II injuries)
Full sport-specific training
Return to contact and competition once objective criteria for strength, control, and pain-free function are met
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