Inguinal-Related Groin Pain and/or Disruption in Athletes: Current Understanding, Assessment and Management Strategies

Inguinal-related pain and/or disruption involve the abdominal tendinous and fascial tissues that connect to the inguinal ligament and the pubic tubercle. Epidemiological studies show these issues comprise 5-20% of groin problems in male athletes but rarely occur in female athletes. In this narrative review, we aim to synthesize the current understanding, assessment and management strategies for inguinal-related pain and/or disruption in athletes. Although inguinal-related pain and/or disruption is less common than adductor-related problems, it is vital not to overlook it. While the condition is often referred to as "sports hernia" or "incipient hernia", it is now agreed that true hernias are rarely found in this context. Instead, these conditions are classified as muscle-tendon injuries, and our understanding of their pathology has evolved significantly over the past few decades. Key anatomical structures include the external and internal oblique muscles, transversus abdominis, rectus abdominis, inguinal ligament, fascia transversalis, conjoined tendon, and the inguinal canal, which contains important nerves and vessels. Clinically, inguinal-related groin pain is diagnosed from detailed history and physical examination. Consensus statements now clearly define inguinal-related groin pain and disruption providing a solid foundation for a clinical diagnosis. Pathological findings may include subtle abdominal wall deficiencies to more overt abdominal tears and overuse injuries and imaging may aid in establishing differential and more specific diagnoses. A standardized "one-size fits all" treatment algorithm does not exist; however, a multidisciplinary approach is essential. Collaboration among sports physiotherapists, sports medicine specialists, and experienced abdominal surgeons has proven effective, informed by data from randomized controlled trials. First-line treatment typically includes non-surgical strategies, such as targeted physical therapist-led rehabilitation and activity modification with a graded return to sports approach. If non-surgical approaches fail, laparoscopic repair techniques demonstrate higher success rates. Central to effective management is shared decision-making that weighs the athlete's goals, competition calendar, and overall health-status.