Groin Pain: Why the Diagnosis Is Often More Complicated Than a 'Pulled Muscle'

A Region Notorious for Clinical Confusion

Groin pain, particularly in athletes, has long been one of the most clinically challenging presentations in sports medicine — a small anatomical region where adductor, iliopsoas, inguinal, pubic and hip joint structures all converge, frequently coexist, and can each refer pain in overlapping patterns.

The Doha Agreement: A Shared Clinical Language

To address inconsistent terminology in both research and clinical practice, an international panel of experts developed a consensus classification system — the Doha agreement — organising groin pain into defined clinical entities: adductor-related, iliopsoas-related, inguinal-related and pubic-related groin pain, alongside hip-related causes, based on clear, reproducible clinical criteria (Weir et al., 2015).

Why Precise Classification Changes Management

Labelling the presentation simply as a "pulled groin muscle" risks missing a co-existing hip joint pathology, an inguinal disruption requiring a different rehabilitation emphasis, or a bony stress response that would respond poorly to the aggressive early loading appropriate for a straightforward adductor strain. A structured, Doha-consistent assessment is considered best practice precisely because it reduces this risk of mismatched treatment.