ATHLETIC PUBALGIA – A DIAGNOSTIC AND THERAPEUTIC CHALLENGE IN CLINICAL PRACTICE

Kamila Sobczyńska; Alicja Judzińska; Magda  Terbosh; Bartosz Piech; Julia  Osipowska; Justyna Ignarska; Sabina  Kubicz Mzabi; Magdalena  Dubaj; Emilia Trojanowska; Marlena Kwolek

doi:10.31435/ijitss.2(50).2026.5604

Authors

Kamila Sobczyńska Stefan Cardinal Wyszyński Provincial Specialist Hospital in Lublin, Lublin, Poland https://orcid.org/0009-0002-0938-1711
Alicja Judzińska University Clinical Hospital No. 1 in Lublin (USK1), Lublin, Poland https://orcid.org/0009-0007-7525-4012
Magda Terbosh University Clinical Hospital No. 1 in Lublin (USK1), Lublin, Poland https://orcid.org/0009-0006-3756-3394
Bartosz Piech University Clinical Hospital No. 1 in Lublin (USK1), Lublin, Poland https://orcid.org/0009-0003-4621-5226
Julia Osipowska University Clinical Hospital No. 1 in Lublin (USK1), Lublin, Poland https://orcid.org/0009-0007-9024-9908
Justyna Ignarska University Clinical Hospital No. 4 in Lublin, Lublin, Poland https://orcid.org/0009-0009-0340-8240
Sabina Kubicz Mzabi University Clinical Hospital No. 4 in Lublin, Lublin, Poland https://orcid.org/0009-0008-2788-5538
Magdalena Dubaj University Clinical Hospital No. 1 in Lublin (USK1), Lublin, Poland https://orcid.org/0009-0005-4429-2679
Emilia Trojanowska SP ZOZ MSWiA in Lublin, Lublin, Poland https://orcid.org/0009-0009-7331-6624
Marlena Kwolek University Clinical Hospital No. 4 in Lublin, Lublin, Poland https://orcid.org/0009-0004-1428-1103

DOI:

https://doi.org/10.31435/ijitss.2(50).2026.5604

Keywords:

Athletic Pubalgia, Sports Hernia, Groin Pain, Diagnosis, Conservative Treatment, Surgical Approach

Abstract

Introduction: Athletic pubalgia is a complex medical issue that affects athletes like footballers or hockey players. Chronic groin pain is caused by overuse injuries of the musculotendinous structures around the pubic symphysis. This review article aims to present the current knowledge on athletic pubalgia, including pathophysiology, epidemiology, diagnostic approaches and treatment strategies.

Methods: This article is based on 30 scientific publications from PubMed, Journal of Education, Health and Sport and Google Scholar. In this review we pay attention to the latest information about risk factors, diagnostic methods, significant symptoms and management strategies.

Results: Athletic pubalgia usually affects male professional athletes like football and hockey players. Groin pain coexisting with specific exercises and movements is the most common symptom. To make a correct diagnosis, the clinical picture, imaging studies, and clinical tests must be considered. First-line treatment is conservative therapy, which is sufficient in most cases. Further treatment includes special rehabilitation programs combined with surgical treatment, most often using endoscopic methods.

Conclusions: Athletic pubalgia is a condition that has long been known to clinicians in the professional and recreational sport population. However, it requires detailed diagnostics, including specially selected tests performed during a physical examination and imaging techniques—particularly MRI—performed by experienced specialists. Available treatment methods, tailored to the severity of the condition, allow the vast majority of patients to fully return to sport.

References

Ayhan, E. M., Wells, N. B., LaMonica, D., Jr., Feinn, R. S., & Bonadies, J. A. (2026). Groin pain syndrome: Analysis of surgical and nonsurgical outcomes between athletes and nonathletes with “sports hernia” using a standardized management algorithm. Orthopaedic Journal of Sports Medicine, 14(1), 23259671251405430. https://doi.org/10.1177/23259671251405430

Bisciotti, G. N., Bisciotti, A., Bisciotti, A., & Auci, A. (2025). What the radiologist needs to know about sport hernias: A systematic review of the current literature. Diagnostics, 15(6), 785. https://doi.org/10.3390/diagnostics15060785

Brito, R., Cruz, P., Costa, D., Afonso, S., & Barros, P. (2023). Nonsurgical interventions for the management of long-standing groin pain in athletes: A systematic review of randomized controlled trials. Cureus, 15(6), e40149. https://doi.org/10.7759/cureus.40149

Candela, V., De Carli, A., Longo, U. G., Sturm, S., Bruni, G., Salvatore, G., & Denaro, V. (2021). Hip and groin pain in soccer players. Joints, 7(4), 182–187. https://doi.org/10.1055/s-0041-1730978

Cohen, B., Kleinhenz, D., Schiller, J., & Tabaddor, R. (2016). Understanding athletic pubalgia: A review. Rhode Island Medical Journal, 99(10), 31. PMID: 27706276

de Castro Fernandes, J. V., Pedrinelli, A., & Rubio-Arias, J. Á. (2025). Comparative analysis of treatment strategies for groin injuries in athletes: Effects on successful recovery and recurrence of sports conditions—A systematic review. Apunts Sports Medicine, 60(227), 100481. https://doi.org/10.1016/j.apunsm.2025.100481

Dudai, M., & Paajanen, H. (2026). Narrative review and clinical recommendations for sportsman’s hernia and athletic pubalgia based on 30 years of expert experience. Journal of Abdominal Wall Surgery, 4, 15394. https://doi.org/10.3389/jaws.2025.15394

Elattar, O., Choi, H. R., Dills, V. D., & Busconi, B. (2016). Groin injuries (athletic pubalgia) and return to play. Sports Health, 8(4), 313–323. https://doi.org/10.1177/1941738116653711

Emblom, B. A., Mathis, T., & Aune, K. (2018). Athletic pubalgia secondary to rectus abdominis-adductor longus aponeurotic plate injury: Diagnosis, management, and operative treatment of 100 competitive athletes. Orthopaedic Journal of Sports Medicine, 6(9), 2325967118798333. https://doi.org/10.1177/2325967118798333

Goes, R. A., Teles, F. D. C., Figueiredo, F., Noronha, D. R., Coelho, O. N., & Peixoto, L. P. (2022). Epidemiological analysis of 245 patients with athletic pubalgia. Revista Brasileira de Ortopedia, 58(4), e563–e570. https://doi.org/10.1055/s-0042-1749431

Guarneri, B., Morrison, L., Martorana, A., Gujral, I., & Harris, L. (2023). Return to play rate and performance following surgical repair of athletic pubalgia in Major League Soccer players: A retrospective case-control study. Cureus, 15(4), e38023. https://doi.org/10.7759/cureus.38023

Ioffe, O. Y., Negria, N. M., Omelchenko, A. V., Stetsenko, O. P., Dibrova, Y. A., Kryvopustov, M. S., Tsiura, Y. P., & Tarasiuk, T. V. (2020). MRI and ultrasound criteria for the diagnosis of a sports hernia in football players. Wiadomosci Lekarskie, 73(4), 755–760. https://doi.org/10.36740/WLek202004125

Khan, J. A., & Gupta, S. (2022). Athletic pubalgia: A clinical reform. Journal of Advances in Sports and Physical Education, 5, 1–6. https://doi.org/10.36348/jaspe.2022.v05i01.001

Kopscik, M., Crisman, J. L., Lomasney, L., Smith, S., & Jadidi, S. (2023). Sports hernias: A comprehensive review for clinicians. Cureus, 15(8), e43283. https://doi.org/10.7759/cureus.43283

Kraeutler, M. J., Mei-Dan, O., Dávila Castrodad, I. M., Talishinskiy, T., Milman, E., & Scillia, A. J. (2021). A proposed algorithm for the treatment of core muscle injuries. Journal of Hip Preservation Surgery, 8(4), 337–342. https://doi.org/10.1093/jhps/hnab084

Lahuerta-Martín, S., Robles-Pérez, R., Hernando-Garijo, I., Jiménez-Del-Barrio, S., Hernández-Lázaro, H., Mingo-Gómez, M. T., & Ceballos-Laita, L. (2023). The effectiveness of non-surgical interventions in athletes with groin pain: A systematic review and meta-analysis. BMC Sports Science, Medicine and Rehabilitation, 15(1), 81. https://doi.org/10.1186/s13102-023-00684-6

Martins, T. B., Martins, T. B., Migliorini, F., Maffulli, N., & Okubo, R. (2025). Risk factors associated with groin pain in athletes: A systematic review. Life, 15(11), 1688. https://doi.org/10.3390/life15111688

McKeeman, J., Johnson, B., & Rivera, J. C. (2025). Rectus abdominis repair compared to posterior wall mesh reinforcement in athletes with sportsman’s hernia: A systematic review. Cureus, 17(2), e78580. https://doi.org/10.7759/cureus.78580

Meyers, W. C., McKechnie, A., Philippon, M. J., Horner, M. A., Zoga, A. C., & Devon, O. N. (2008). Experience with “sports hernia” spanning two decades. Annals of Surgery, 248(4), 656–665. https://doi.org/10.1097/SLA.0b013e318187a770

Mitrousias, V., Chytas, D., Banios, K., Fyllos, A., Raoulis, V., Chalatsis, G., Baxevanidou, K., & Zibis, A. (2023). Anatomy and terminology of groin pain: Current concepts. Journal of ISAKOS, 8(5), 381–386. https://doi.org/10.1016/j.jisako.2023.05.006

Neuville, A. J., Benge, C. L., Tjong, V. K., Lund, B. S., Baer, G. S., & Walczak, B. E. (2023). Risk factors for athletic pubalgia in collegiate football student-athletes: A retrospective cohort study. Sports Health, 15(5), 760–766. https://doi.org/10.1177/19417381221121127

O’Donnell, R., DeFroda, S., Bokshan, S. L., Levins, J. G., Hulstyn, M. J., & Tabaddor, R. R. (2023). Cadaveric analysis of key anatomic structures of athletic pubalgia. Journal of the American Academy of Orthopaedic Surgeons Global Research & Reviews, 7(6), e23.00070. https://doi.org/10.5435/JAAOSGlobal-D-23-00070

Paajanen, H., Syvähuoko, I., & Airo, I. (2004). Totally extraperitoneal endoscopic (TEP) treatment of sportsman’s hernia. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 14(4), 215–218. https://doi.org/10.1097/01.sle.0000136662.52454.01

Palumbo, P., Massimi, F., Lucchese, S., Grimaldi, S., Vernaccini, N., Cirocchi, R., Sorrenti, S., Usai, S., & Intini, S. G. (2022). Open surgery for sportsman’s hernia: A retrospective study. Frontiers in Surgery, 9, 893390. https://doi.org/10.3389/fsurg.2022.893390

Poor, A. E., Roedl, J. B., Zoga, A. C., & Meyers, W. C. (2018). Core muscle injuries in athletes. Current Sports Medicine Reports, 17(2), 54–58. https://doi.org/10.1249/JSR.0000000000000453

Schöberl, M., Prantl, L., Loose, O., Zellner, J., Angele, P., Zeman, F., Spreitzer, M., Nerlich, M., & Krutsch, W. (2017). Non-surgical treatment of pubic overload and groin pain in amateur football players: A prospective double-blinded randomised controlled study. Knee Surgery, Sports Traumatology, Arthroscopy, 25(6), 1958–1966. https://doi.org/10.1007/s00167-017-4423-z

Serafim, T. T., Oliveira, E. S., Migliorini, F., Maffulli, N., & Okubo, R. (2022). Return to sport after conservative versus surgical treatment for pubalgia in athletes: A systematic review. Journal of Orthopaedic Surgery and Research, 17(1), 484. https://doi.org/10.1186/s13018-022-03376-y

Tedeschi, R., Giorgi, F., Platano, D., Berti, L., & Donati, D. (2025). Optimizing conservative management of groin pain in athletes: Insights from a narrative review. Life, 15(3), 411. https://doi.org/10.3390/life15030411

Thorborg, K., & Sheen, A. J. (2026). Inguinal-related groin pain and/or disruption in athletes: Current understanding, assessment and management strategies. Open Access Journal of Sports Medicine, 16, 510774. https://doi.org/10.2147/OAJSM.S510774

Ząbek, A. J., Kuźniar, J. P., Chrzanowska, E. G., Zagalska, M., Turek, M., Tamborski, T., … Mitręga, K. M. (2025). Athletic pubalgia—A significant diagnostic and therapeutic challenge in athletes? Journal of Education, Health and Sport, 81, 59780. https://doi.org/10.12775/JEHS.2025.81.59780