Caring Medical - Where the world comes for ProlotherapyGroin pain in the athlete | Treating groin pain that does not heal

How stem cells heal degenerative joint disease after years of cortisone and painkillers

Ross Hauser, MD

We will often see athletes in our office who are frustrated and confused by their seemingly inability to recover from problems circulating in the lower abdomen, groin and hip. Long periods of rest, missed competitions, difficult recoveries are all the hallmarks of a patient ready to have a surgery because nothing else is working.

The subject of hip instability causing groin pain is covered at length in our website. Links in this article will take you to those articles.

To get at these patient problems, one must identify the patient’s problems, then we can assist the athlete in their desire to return-to-play.

Maybe it’s groin. Maybe it’s the hip. Maybe it’s the lower back.

Hip instability may commonly manifest itself as groin or inguinal pain. When a patient asks why they cannot heal, we explain to them that someone suffering from groin pain should be examined at the pubic symphysis, groin pain generators should need to be explored in the sacroiliac joint, iliolumbar ligaments. A complete examination of the hip joint and its range of motion is also needed. Below you will see research explaining how doctors can determine treatment courses based on the hip range-of-motion.

Treating groin pain that does not heal

When the hip joint becomes unstable, the hip muscles over the joint compensate for the instability by tensing. As is the case with any joint of the body, ligament instability initiate muscle tension (muscle spasms) in an attempt to stabilize the joint. This compensatory mechanism to stabilize the hip joint eventually causes the gluteus medius, piriformis muscle, and iliotibial band/ tensor fascia lata muscles to tighten because of chronic contraction in an attempt to compensate for a loose hip joint.

The contracted gluteus medius can eventually irritate the trochanteric bursa, causing a trochanteric bursitis. A bursa is a fluid-filled sac which helps muscles glide over bony prominences. Patients with chronic hip problems often have had cortisone injected into this bursa, which generally brings temporary relief. But this treatment does not provide permanent relief because the underlying ligament laxity is not being corrected.

Prolotherapy injections to strengthen the hip joint and iliocapsular ligaments will provide definitive relief in such a case.

Do you need a spinal surgery for your ligament related groin pain? No!

You have this chronic groin pain and the doctor is suggesting that the problem may be from your lower back. This includes the possibility that sciatica may be involved. Sciatica can be a long-term or chronic pain that is felt over  a wide area below the buttocks, its origins lie with injury or disruptions of the discs of the lower back. When the lower back is suspected, usually an MRI is called for. If the MRI shows some abnormalities in the discs, quickly and possibly without merit, a sciatica problem is identified.  But are you chasing the wrong thing? What does without merit mean? This means the problem may not be the sciatica at all and the MRI is sending you down the wrong trail. See our article Prolotherapy sciatica treatments.

Treating groin pain that does not heal

Häggström, Mikael (2014). “Medical gallery of Mikael Häggström 2014”. WikiJournal of Medicine 1 (2).

We find that patients suffering from so-called sciatica often have weakness in the sacroiliac joint, hip joint, sacrotuberous and sacrospinous ligaments, trochanteric bursa, and iliotibial band/tensor fascia lata.

The sciatic nerve runs between the two heads of the piriformis muscle. When the piriformis muscle is spastic, the sciatic nerve may be pinched.

  • Piriformis syndrome centers on the piriformis muscle as it rubs on the sciatic nerve causing irritation.
  • In Piriformis syndrome, like sciatica, the pain can often travel down the back of the thigh and/or into the low back. Some patients will report spasms in addition to muscle pain in addition to tingling, and numbness in the butt, leg, and thighs. You can read more information here: Piriformis muscle syndrome and sciatica

Lumbosacral and hip joint weaknesses are two main causes of piriformis muscle spasm. Stretches and physical therapy directed at the piriformis muscle to reduce spasm help temporarily, but do not alleviate the real problem.

Hip sprain creates groin pain

  • A posterior or back hip sprain can often be the cause of groin pain that radiates down the leg to the big toe.
  • The iliotibial band/tensor fascia lata extends from the pelvis over the hip joint to the lateral (side) knee. Its job is to help abduct (move away from the body) the leg, especially during walking so the legs do not cross when walking. When this band/muscle is tight, it puts a great strain on the sacroiliac and lumbosacral ligaments.

Stretching this muscle is beneficial to many people with chronic hip/back problems. Stretching and massage feels good to people with chronically “tight iliotibial band or IT bands.” Take this one step further though to understand why the bands/muscles become tight in the first place, which is joint instability generally in the hip or the knee. This instability needs to be properly identified and treated for the chronic tightness to be eliminated, along with the need to regularly stretch or massage the area in order to feel relief. Once the joint becomes stable, the continual tightness subsides.

It is clear to see that there are many factors that can cause groin pain
Wikicommons Public domain

Limited range of hip motion seen as risk factor in kicking athletes

Research lead by Dutch University researchers and published in the British Journal of Sports Medicine found that “there was strong evidence that total rotation of both hips below 85 degrees measured at the pre-season screening was a risk factor for groin pain development.”1

Research from another team of Dutch researchers and published in The Journal of sports medicine and physical fitness says that soccer players with groin injury refrain from kicking with maximum strike force because of previous groin injury related to decreased hip range of motion.2 The thinking is come up with a kicking kicking strategies for athletes with injury, or in our thinking, come up with a better way to repair the hip-groin damage.

In new research, doctors acknowledge that dance, gymnastics, figure skating, and competitive cheerleading require a high degree of hip range of motion and the use of the hip joint in a mechanically complex manner. Because of the extreme hip motion required and the soft tissue laxity in dancers and gymnasts, these athletes may develop instability, impingement, or combinations of both.3

Decreased muscle strength increases risk for future groin injury

University researchers in Spain and Canada teamed up to examine the unique problems of hip-groin injuries in tennis players. Writing in the medical journal Musculoskeletal science and practice, they found that despite the hip-groin injury prevalence in tennis, no studies have assessed the extent to which intrinsic groin injury risk factors, such as hip muscle strength, affect tennis players with a history of previous high-groin injury.

Study highlights:

  • Sixty-one tennis players completed this study: 17 in the hip-groin injury group and 44 in the NO hip-groin injury group.
  • Isometric adductor and abductor hip strength were assessed to include jumping ability.
  • RESULTS: Isometric adductor weakness and adductor/abductor strength ratio deficits suggest that adductor muscle strength is not fully recovered in these athletes, potentially increasing their risk of a repeat groin injury.4


If you have questions about hip instability causing groin and pelvic dysfunction and disrupting your sports, get help and information from our Caring Medical staff

1 Tak I, Engelaar L, Gouttebarge V, Barendrecht M, Van den Heuvel S, Kerkhoffs G, Langhout R, Stubbe J, Weir A. Is lower hip range of motion a risk factor for groin pain in athletes? A systematic review with clinical applications. Br J Sports Med. 2017 Apr 21:bjsports-2016. [Pubmed] [Google Scholar]

2 Langhout R, Tak I, van der Westen R, Lenssen T. Range of motion of body segments is larger during the maximal instep kick than during the submaximal kick in experienced football players. The Journal of sports medicine and physical fitness. 2017 Apr;57(4):388-95. [Pubmed] [Google Scholar]

3. Weber AE, Bedi A, Tibor LM, Zaltz I, Larson CM. The hyperflexible hip: managing hip pain in the dancer and gymnast. Sports health. 2015 Jul;7(4):346-58. [Pubmed] [Google Scholar]

4 Moreno-Pérez V, Lopez-Valenciano A, Barbado D, Moreside J, Elvira JL, Vera-Garcia FJ. Comparisons of hip strength and countermovement jump height in elite tennis players with and without acute history of groin injuries. Musculoskeletal Science and Practice. 2017 Jun 30;29:144-9. [Pubmed] [Google Scholar]



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