Dr. Miller: Your coach tells you you have a groin pull. Is that really what it is? We're going to talk about that next on Scope Radio.
I'm Dr. Tom Miller and I'm here with Dr. Travis Maak, an orthopedic surgeon here at the University of Utah and he's in the Department of Orthopedics. Travis specializes in sports medicine. Travis, talk a little bit about that whole issue around groin pain. Is there such a thing as a pulled groin muscle or is that something else?
Groin Pulls & FAI
Dr. Maak: It could be and many athletes are very used to this type of injury and being told by their trainer or their coach that you bent down or you were running and just kind of exploded off the blocks if you're a running athlete. And all of a sudden, you have pain in your groin and you're told you pulled your groin and you need to take a little bit of time off, stretch it, out walk it off, take some anti-inflammatories like Aleve, ibuprofen, Advil and when the pain goes away, you get back doing what you were doing.
Yes, there are muscles, to your point, that you can literally pull in your groin. Those are called the adductor muscles. They are on the inside of your hip. Frankly, multiple groin pulls are not common.
Dr. Miller: They're not common?
Dr. Maak: They're not common.
Dr. Miller: Contrary to what everybody hears.
Dr. Maak: That is true.
Dr. Miller: We always talk about a groin pull. For the audience, I think that a groin pull is pain on the inside of your upper leg towards the pelvis, right?
Dr. Maak: That is correct.
Dr. Miller: If it's not a pulled muscle, then what is it?
Dr. Maak: Well, a person who's prone to groin pulls and has a history of playing sports from their childhood and being told they pulled their groin, they pulled their groin, they pulled their groin and it never seems to get . . . it will go away temporarily, but then it comes back. One of the other diagnoses, which can cause this, is something called femoral acetabular impingement or FAI.
Femoral Acetabular Impingement
Dr. Miller: That's a big word. What does it mean? What does that look like?
Dr. Maak: So the femur, that's the thigh bone
Dr. Miller: That's the big bone in the thigh?
Dr. Maak: That's the big hole in the thigh. Acetabulum, that's the socket or the ball and the socket of the joint. So the ball is the femur, the socket is the acetabulum. Just the two bones of the hip joint. And then impingement is a fancy word for the two bones hit together.
Dr. Miller: They rub?
Dr. Maak: They rub.
Dr. Miller: When they rub, they cause pain.
Dr. Maak: That's exactly right.
Dr. Miller: Are certain people predisposed to this problem?
Dr. Maak: They are. It tends to be a Northern European type of injury or at least the way the bones are shaped. Although it can happen in any type of ethnicity or group of population. Interestingly, we also have some evidence that specific sports put people at risk for this.
Which Sports Can Lead to FAI?
Dr. Miller: Do tell, which ones?
Dr. Maak: Lacrosse tends to be a fairly high incidence of sport, football, hockey.
Dr. Miller: Now, why lacrosse as opposed to basketball or soccer?
Dr. Maak: Interesting question. We believe it has to do with the rotation with the stick. Part of this, there's a current theory that this has to do with the growth plate of the hip and small growth plate injuries that occur over time can make your hip shaped a little differently.
Diagnosing a Pulled Groin or FAI
Dr. Miller: So if this happens, you have this pain, this discomfort. How is one reliably to separate this out from actually a pulled muscle or tendon versus you know this is a problem with the hip joint.
Dr. Maak: Sure. So the history is actually fairly classic here. So while the initial acute stabbing pain of a pulled groin can happen quickly, particularly when you're exploding off the blocks or you twister you get tackled, and then it goes away within a few days and basically you return to normal. With FAI, there's typically a subtle, continued discomfort, particularly when you sit for long periods of time. If you find yourself going to the weight gym and your coach says, get down, get deep and squat this weight and every time you find yourself not going . . .
Dr. Miller: Get discomfort.
Dr. Maak: Right.
Treatments for FAI
Dr. Miller: What do you do then? What are the treatments?
Dr. Maak: Well, the first treatment is physical therapy so athletic trainers are very good at this. Many physical therapists are as well. As long as you have the diagnosis, going and learning how to lift a little bit differently, avoiding deep squatting exercises and strengthening the muscles around the hip as well as a little an-inflammatory, like Aleve, ibuprofen, Advil can help you. When those fail, sometimes other interventions can help you.
Dr. Miller: How often is this a game changer for the young athlete?
Dr. Maak: So I can tell you is if this ultimately gets diagnosed in the athlete finds himself limiting their athletic participation because they're groin hurts when it's treated, the beautiful thing, while no one wants to get surgery, if it ends up getting surgery . . . and the surgery is basically to make the ball of the hip round again, it's done with a camera. It's minimally invasive and three little, tiny poke holes. And you go in and basically reshape the ball to make it round again. It's curative, it does not return and effectively, they return to their sports at a higher level without pain.
Dr. Miller: One of the things you started out with is the potential to have this problem misdiagnosed. So what would be your recommendation be to an athlete that has groin pain?
Dr. Maak: The first thing is probably to not worry about it initially. If it's a first time you're told by your trainer that you have a groin pull, odds are you probably did. That being said, if it continues to happen and you have a one or two or three or even four groin pulls that keep happening, my recommendation would be to go get an X-ray of your hip. It's nothing fancier than a simple X-ray of your hip and you can diagnose this problem.
Dr. Miller: They could very well do that through their primary care physician?
Dr. Maak: Absolutely.
Dr. Miller: So, in summary, this groin pain may not actually be a groin pain, it could be an impingement in the actual hip joint itself and that that ought to be checked out if you have repetitive groin pains.
Dr. Maak: That's exactly right.
updated: March 9, 2022
originally published: August 9, 2016
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