Groin Pain: What Is Actually Causing It

The groin is a crossroads. The hip joint, the inner thigh muscles, the abdominal wall, the low back and several organs that have nothing to do with muscles or joints all report pain into the same patch of skin. So the useful question is what sets it off, not how much it hurts. This page sorts the usual causes and says which ones belong elsewhere.

The hip joint is the source most people do not expect

The hip joint sits deeper and further forward than most people picture, and when it is the problem it reports pain into the groin rather than the side of the hip. That is why a lot of what gets called groin pain is a hip problem.

The pattern is a deep groin ache, worse putting weight through the leg, stiff after sitting, and often with less rotation available when the leg is turned inward. Pulling on a sock brings it on. That is joint behavior, not muscle behavior, and the treatment side of it is on our hip pain page.

Adductor strain, on the inside of the thigh

The adductors run from the pubic bone down the inside of the thigh, and they are what strains when you push off sideways, change direction hard, or slip on a wet deck. This pain sits closer to the inner thigh than to the crease of the groin, it is tender to press on, and it can be produced on demand: squeeze your knees together against resistance and there it is. Field and court sports account for most of these, and it improves with graded loading rather than rest.

A bulge or an ache that comes on with coughing, straining or lifting

Pain that appears when you cough, strain or lift, with or without a bulge you can see or feel, points at the abdominal wall rather than the hip. A hernia is a common reason for that pattern and it needs medical assessment, not chiropractic care. See a physician. Pain when I cough or sneeze covers the cough-provoked version in full.

The low back, less often

The upper lumbar segments can refer pain into the groin. It is not the usual explanation for isolated groin pain, but it is real, and worth checking when the hip examines cleanly and the pain changes with back position rather than leg movement.

Groin pain in a runner that keeps getting worse

This is the one that gets missed. A deep groin pain that started after a sharp increase in running or walking load, that is getting worse instead of settling, and that hurts when you hop or land on that leg, raises the question of bone stress in the femoral neck, the narrow part of the thigh bone below the ball of the hip.

That is a bone problem, not a muscle problem. It needs imaging and a medical opinion. Stretching does not help it, and running on it is what makes it worse. Say so when you call.

Groin pain in an older adult after a fall

Groin pain after a fall in an older adult raises the question of a hip fracture, and it does so even when the person can still walk. Not every fracture leaves the leg shortened or turned outward. Groin pain with difficulty bearing weight after a fall is an emergency room visit and an x-ray the same day, not an appointment.

When groin pain is not a musculoskeletal problem at all

Groin pain can also come from the urinary tract, the reproductive organs or the bowel. Groin pain with urinary symptoms, blood in the urine, fever, abdominal pain, testicular pain or swelling, or groin pain in someone who is or may be pregnant, belongs with a physician rather than a chiropractor. Sudden severe testicular pain is a medical emergency and needs immediate care.

How the exam sorts it out

At Tradewinds Chiropractic & Wellness in Estate Thomas, a groin pain visit starts with the history: how it began, what provokes it, and what changed in your training or your work. Then the hip is taken through its range under load, the adductors are tested against resistance, the low back and sacroiliac joints are checked, and the abdominal wall is examined. Digital x-rays are taken on site when the findings suggest a structural problem, and we refer out when they point away from a joint or muscle.

Dr. Keys is the Chair of the Virgin Islands Board of Chiropractic Examiners, a member of the Virgin Islands Chiropractic Society, and the International Chiropractors Association representative for the U.S. Virgin Islands.

If the hip also clicks or catches, see hip clicking and snapping. If the ache runs toward the knee, see pain that radiates hip to knee. What we use is on our services page.

When groin pain needs urgent care

Call 911 or go to the nearest emergency room for:

• Inability to put weight on the leg after a fall, which can mean a hip fracture, especially in an older adult
• Sudden severe testicular pain, which is an emergency
• A groin bulge that becomes hard and painful and cannot be pushed back in, which is a surgical emergency
• Leg weakness or numbness that is getting worse

See a physician the same day for groin pain with fever, urinary symptoms, or blood in the urine.

Getting seen

Tradewinds Chiropractic & Wellness is in the VI Medical Foundation Building, Suite 202, 9150 Estate Thomas, St. Thomas, USVI 00802. Hours are Mon, Wed, Thu: 10:00 am to 1:00 pm and 3:00 pm to 7:00 pm. Tue, Fri: 7:00 am to 2:00 pm. Closed Sat and Sun.

Call (340) 690-4994 or email info@tradewindschiropractic.com, and say what brings the pain on, not only where it is. We take walk-ins and same-day appointments. New patient forms are on the forms page to print and fill in.

Questions patients ask

Why is my groin pain not going away?

Usually because the thing being treated is not the thing causing it. Groin pain comes from the hip joint, the adductor muscles on the inside of the thigh, the abdominal wall, the low back, or from something that is not musculoskeletal at all, and each one responds to something different. Pain that has not settled in several weeks, or that is getting worse, is worth an exam rather than another round of stretching.

Why does my groin hurt when I walk?

Deep groin pain that worsens as you put weight through the leg, with stiffness after sitting and less rotation in that hip, is most often the hip joint itself referring pain forward. Pain closer to the inner thigh that hurts when you squeeze your legs together is more likely an adductor strain. A groin pain in a runner that is getting worse week on week is a different question and needs imaging to rule out bone stress in the femoral neck.

Is it a groin strain or a hip problem?

The provocation separates them. A strain is tender to press on the inner thigh and hurts when you squeeze your knees together or push off sideways. A hip joint problem is deeper, is felt in the crease of the groin, is worse bearing weight, and shows up as reduced rotation when the leg is turned inward. Some people have both, which is why the exam tests each one separately.

Can a chiropractor treat groin pain?

When the source is the hip joint, the adductor muscles, the pelvis or the low back, yes. When it is a hernia, bone stress in the femoral neck, a fracture, or something urinary, reproductive or bowel-related, no, and the right move is a referral to a physician. The first visit is an exam to find out which of those it is before anything is treated.

When is groin pain serious?

Groin pain after a fall with trouble bearing weight, groin pain with fever, sudden severe testicular pain, a groin bulge that turns hard and painful and will not push back in, blood in the urine, and leg weakness or numbness that is getting worse all need medical care rather than an appointment. Groin pain in someone who is or may be pregnant should be assessed by a physician.