Athletic pubalgia, often called a “sports hernia” or core muscle injury, is a strain or tear where the lower abdominal muscles and the adductor (inner thigh) muscles attach to the pubic bone. Despite the name, it usually is not a true hernia: there is no bulge. It is most common in sports with sprinting, kicking and quick changes of direction, such as soccer, hockey and football.
- Lower abdominal or inner groin pain with sprinting, cutting, kicking or sit-ups
- Pain eases with rest and comes back with sport
- Often occurs together with hip impingement (FAI) or a labral tear
- Many athletes improve with a focused rehab program
- Surgery is an option when rehab doesn’t work
Symptoms
- Pain in the lower abdomen or inner groin during exertion
- Pain with sprinting, cutting, kicking, sit-ups, and sometimes coughing or sneezing
- Pain that improves with rest but returns as soon as you play again
- Usually no visible bulge (unlike an inguinal hernia)
Why a hip specialist?
Groin pain in athletes has many possible causes: athletic pubalgia, adductor strains, osteitis pubis, true hernias, and hip joint problems such as hip impingement (FAI) and labral tears. Athletic pubalgia and FAI often occur together. A stiff, impinging hip may put extra strain on the core muscles. If only one problem is treated, symptoms can persist. Dr. Dold evaluates both the hip and the core so the full picture is addressed.
Diagnosis
Diagnosis is based on your history and a careful exam of the abdomen, groin and hip. Dr. Dold may order X-rays of the hip and pelvis and an MRI performed with a dedicated athletic pubalgia protocol. A diagnostic injection can help tell hip joint pain apart from core muscle pain.
Treatment
Non-surgical care is the first step for most athletes: a period of rest from aggravating activity, followed by a structured physical therapy program focused on core and adductor strength, hip mobility, and a gradual return to running and cutting. Anti-inflammatory medicine or an injection may also help.
Surgery is considered when symptoms persist despite a full course of rehab. Core muscle repair is performed by a general surgeon who specializes in this procedure. Dr. Dold coordinates your care with that surgeon and treats any hip problem, such as FAI or a labral tear, that is contributing to your symptoms.
Returning to sport
Return depends on the severity of the injury and whether surgery is needed. Athletes progress back to full activity through a staged program, returning when they can sprint, cut and kick without pain.
Why see Dr. Dold
- Board certified by the American Board of Orthopaedic Surgery, with subspecialty certification in Sports Medicine
- Fellow of the American Orthopaedic Association (FAOA), the American Academy of Orthopaedic Surgeons (FAAOS), the American College of Surgeons (FACS) and the Royal College of Surgeons of Canada (FRCSC)
- Sports medicine and arthroscopy fellowship at NYU Langone / Hospital for Joint Diseases; orthopedic residency at the University of Toronto
- Member of the International Society for Hip Arthroscopy (ISHA)
- D Magazine Best Doctors (Collin County), 2019–2026 · Rated 4.9 on Google
Frequently asked questions
What does a sports hernia feel like?
Pain in the lower abdomen or inner groin during sprinting, cutting, kicking or sit-ups that eases with rest and returns with sport. There is usually no bulge.
Is a sports hernia a real hernia?
Usually not. It’s an injury to the core muscles and tendons where they attach to the pubic bone, not a hole in the abdominal wall.
Can athletic pubalgia heal without surgery?
Many athletes improve with rest and a focused rehab program. Surgery is considered when symptoms continue despite a full course of therapy.
Is my groin pain from my hip or a sports hernia?
It can be either, or both. Hip impingement and labral tears often occur together with athletic pubalgia, which is why a careful exam of both the hip and the core matters.
Who performs sports hernia surgery?
Core muscle repair is performed by a general surgeon who specializes in it. Dr. Dold diagnoses the problem, coordinates care with that surgeon, and treats any related hip problem.
Medically reviewed by Andrew P. Dold, MD, FAOA, FAAOS, FACS, FRCSC. This page is general information, not medical advice.
