Groin pain causes, starting with hernia.

Hernia complications can cause severe groin pain, with a hard, tender lump in your groin which has come on suddenly. This needs urgent attention and possibly surgery.

You are likely to have been previously aware of a soft, non tender lump which came when you stood, and disappeared when you lay down.

The lump contains intestine, protruding out into a hernial sac. This is a tube of peritoneum, left over from our development in our mothers womb.

If the contents of a hernia get stuck there, it is called an incarcerated hernia. This is not usually painful. If however, a sudden pressure jams too much into the sac, it is another matter entirely.

The upper opening of the sac, where it leaves our abdominal cavity, may be the narrowest point. Blood is now pumped into the bowel in the hernia, but finds the veins leading out again, obstructed. The bowel swells and the pain sets in.

This is called a strangulated hernia, and needs to be urgently corrected, by "taxis" or surgery. The first is the name of the manual method for "reducing" the hernia - returning its contents to the abdominal cavity.

This technique is by alternately squeezing the upper end and the main part of the hernia, FAIRLY GENTLY, to milk it back.

Uncomplicated groin hernia, a rupture?

The term rupture seems to have deservedly dropped out of use. It suggests something has torn, to allow the hernia to appear.

Inguinal hernias are a little tender when they first appear, but probably just due to stretching of the sac. I've operated on a recent hernia in a man in his 70s, and found the end of the hernial sac to be perfectly rounded, certainly not what you would expect to see if it were a rupture.

The sac has probably mostly been there since childhood, and the weakened abdominal muscles have only now allowed the bowel into it.

If a young person gets a small indirect inguinal hernia, a perfectly reasonable approach is to strengthen the abdominal muscles which hold the hernia back. These are internal oblique and transversalis.

It will rapidly become obvious if this approach works, as the hernia will no longer appear.

"Athletic pubalgia" and "incipient hernia" in athletes I have no experience of. Tears of the transversalis fascia are described in these elite athletes with groin pain.
The forces involved are obviously much greater here.

Hip joint pain is felt in your groin, or your knee

The sides of your hips aren't where you feel pain from your hip joint - that's your Gluteus medius muscle usually, tight and sore because of low back troubles.

Gluteus can also cause knee pain. This is on the referred knee pain page of this site.

Gluteus stops us falling over every time we take the other foot off the ground.

Gluteus medius and Adductor magnus

This is a first order lever system, with the pull of Gluteus (G) working against our body weight, and the hip joint the fulcrum.

Gluteus can aggravate groin pain coming from an arthritic hip joint, if it is unduly tight. The downward force on the hip joint is our body weight combined with the tension in Gluteus.

The hip joint itself can also send pain to our knee.

One of the classical medical mistakes, was to think knee pain was coming from a child's knee and miss their tuberculous hip joint.

A couple of days before writing this, I saw a man with a history of multiple knee surgeries, with undoubted knee problems. He walked out feeling much better and rather surprised, after treatment of his contralateral sacroiliac joint.

But back to your hip joint, there is an easy test to see if it is likely to be a problem.
Lay flat on your back with your feet two feet apart. Get that? Now roll your legs in and out, and note the angles of arc your feet rotate through.

You may have a "inset hip" on one side, which turns in further and out less, but the total degrees of the arcs should be similar.

In hip joint disease, this rotation will be restricted, and painful if pushed to its limits.

If you're also over 50, have had moderate pain on weight bearing for more than three months, with no aggravation by prolonged sitting, less than one hour of morning stiffness and have tenderness on pushing deeply in your groin, you've almost certainly an arthritic hip joint³.

If you're (mostly) over 5 and school-age, it may be Perthes disease or slipped epiphysis, so does need a visit to your health professional..

Enthesopathy at tendon and ligament attatchments to Pubic bone

Where a muscle tendon or a ligament is attached to bone, its collagen fibres just continue into the solid bone.
At this point, the mechanical forces on it are very great.
It can suffer overload here.

It has been proposed¹ that chronic obscure groin pain is commonly caused by this enthesopathy.

Dr. Ashby found most involved the inguinal ligament / pubic bone attachment, and fewer where the 6-pack Rectus abdominus or Adductor longus were connected to the bone.

Finding acute tenderness at these specific sites is the first step. Infiltrating with a local anaesthetic injection then proves the point by abolishing the pain temporarily.

Inguinal lymph nodes - groin pain if inflamed

Cuts and scratches are very common on lower extremities, so these lymph nodes are often dealing with germs, and are a bit swollen.

They will be tender as well if the infection is more virulent.

They are lumps which do not shift when pushed sideways, in or just below the groin crease.

Testicle - likewise

Sudden onset of groin pain with a tender and possibly swollen testicle on the same side, may be a surgical emergency.

Torsion of the testicle needs urgent surgery to prevent the testicle strangling itself to death.
A "bell clanger" testicle is dangling free in its sac rather than attached to the wall of the sac.
It is able to twist around, blocking its blood supply.

Epididymo-orchitis is inflammation of the testicle, either due to infection (as in mumps) or pressure damage. This is distinguished from torsion by ultrasound examination.

Referred pain felt in your groin

Groin pain can be referred from the thoraco-lumbar junction or from the lumbo-sacral joint.

The nerves to the skin around the groin are from your 12th thoracic and 1st lumbar segments, but the dura mater covering the nerves at the bottom end of your spine can also send pain here.

Psoas and iliacus muscles act together and may be referred to as iliopsoas. They can cause groin pain, if tight and sore.

If you get your coccyx on the edge of a table, then lay back on the table holding your other knee to your tummy, the leg should dangle with thigh horizontal.

If it hangs with a slope up towards your knee, iliopsoas is tight. It may be a bit tight and sore even if your thigh is horizontal. If this position causes pain, it is worth just staying in it until the pain eases.

In this position, your lower leg should hang vertically. If it isn't, rectus femoris muscle on the front of your thigh, is tight. This position is usually too painful to stretch this muscle.
It is better to do it standing...

Lean forward against a wall, supporting yourself with your other hand. Bend the knee, holding your foot up to your bottom, then keep your trunk still as you move your knee backwards. It is important not to bend yourself forward as you do this.
Hold it in the position where mild pain first appears, until the pain goes. Then move it further back and repeat, until pain is all gone.

Diseases of ovary, bowel and major blood vessels can also send pain to the groin, so it is best not to disregard it.

Ureteric colic from passing a kidney stone

This sudden,severe pain spreads from your loin to your flank then your groin and into the testicle.

If you are going to the emergency room, try to hold off passing urine until you get there. They will prefer to have it passed freshly to test.

If you do have to pass urine, do it into some receptacle you can inspect it in, in case you pass a stone.
It is very valuable to have a stone analyzed. Different types of stones have different prevention strategies.

Superficial venous thrombosis and groin pain

This is important if it is anywhere near your groin, as the long saphenous vein joins the main deep vein of your leg in the groin. Clots in the deep veins are dangerous.

Thrombophlebitis is inflammation around and clotting in a vein. The clotted vein can be felt in the middle of the red area, like a thin rope under the skin.

It is of concern if near a perforating vein, which joins the veins under your skin with the deep muscle veins.
Perforating veins are often near your groin, on the inside of your thigh just above the knee and in the inside lower leg above your ankle.

Hip impingement

"Femoro-acetabular impingement is the abutment of the acetabular rim and the proximal femur. This is increasingly recognized as a common etiology of hip pain."

This quote is from a comprehensive article² on hip pain in the American Family Physician journal.

Acetabular labral tears

Groin pains, with episodes of very sharp pain and inability to bear weight on that side, can be caused by the gristle around the edge of the hip joint tearing off the bone.

This can happen to athletes and also if one has an arthritic hip joint. The symptoms are "mechanical" - changing suddenly with movement, associated with clicking and snapping sensations.

See article at...

From groin pain page back to home page

From groin pain page to pelvic pain page

To slipped upper femoral epiphysis page


1. Br J Surg. 1994 Nov;81(11):1632-4, abstract at...


3. Journal of Rheumatology 2002, 29. pp 1713-1718
J Orthop Sports Phys Ther. 2009:39


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The contactpage.

Our peritoneum is the sac which lines our tummy and covers our abdominal contents.

Contralateral is a fancy medical term for "on the other side" - It is quite common for one to have pain on one side, caused by joint disturbance on the opposite side.

This point is called the enthesis and when it breaks down and becomes inflamed, "enthesopathy."

The dura mater or tough mother, is the strong envelope which contains our brain in the head and spine down to lumbar 2 level (the part called the spinal cord.) It covers the start of the nerve roots coming from the latter.

If you are interested in a home study course on examination of the spine, please send me your e-mail address by the contact form.