Mystery Groin Pain-- Sports Dr. Stumped

[Dr Damien]

Dear WannaRun

Reading what you have written so far my thoughts are you have issues in your left hip.

My thoughts are as follows an imbalance involving the internal and external rotators. Some degree of rotation seem to aggravate your groin pain...

It is possible that you have either an internal/ externally rotated hip which is anteriorly displaced so that everytime you do a twisting motion you have an anterior compression in the hip...

This rotation could happen when squeezing a ball in between your thighs...

Although a lumbar spine issue could be also the cause...

do you get the pain on hip flexion, extension?

I do not know the details of your assessment with your physio or sports doctor but what i would suggest is testing the strength and comparison length of your hip external and internal rotators...


the fact that its painful in the mornings now suggests some form of arthritis, which would support the theory of a hip muscle imbalance...

It would be helpful to know the details of how this groin problem started...

In the interim joint mobilization of the hip, prone kneeling and rocking forward and back within painless limits can be trialled

what did the MRI scan report say?

[WannaRun]

Greetings Dr. Damien,

Thanks for your response.

I have had 2 MRIs at this point now. The first MRI of the adducter muscle looked fine. The second MRI of the lower spine also looked good. No referred pain.

My case was taken to a sports medicine conference. It was suggested I had bone edema where the pubic bone attaches to the origin of the adducter. Perhaps a variant of pubis osteitis.

Looking at my training log this began from an acute incident where I did deep lunges strength training last March or a chronic injury from overuse. Running lots of road races and doing a half marathon in April.

I currently still feel very stiff in the morning in the left groin area. I have not "tested" it running. I have not attempted running for 2 months. I am focusing on core strength and swimming (front crawl and flutter kick only). I was biking for many months, but it was suggested I stop even though there is not pain when biking/spinning. It is sore if I squeeze my legs together, walk a long distance, etc.

Most recently I was injected with platelets (PRP therapy). It's been 10 days since the injection. Symptoms remain. I heard PRP may take 3-6 injections for any effect. I will return for another injection in 3 weeks if there is no progress.

In a week I will get another evaluation with another PT. This is the first diagnosis that sort of makes sense.

To answer your question, no pain in the hip flexon, extension. (If I do leg lifts lying on my side to build up hip flexors I feel it more on my groin as I twist over onto my other side to repeat exercise.) I feel it as I squeeze a ball together between my knees. I also feel some pain as I cross over in an IT band stretch.

You mentioned the morning pain could be an indication of arthritis, but MRIs and X-ray show no such evidence. Still curious about the morning pain. Not sure if we are on to the right track w/diagnosis, therapy. Any suggestions would help.

Thanks again for your input. I am trying my best to stay optimistic about returning to being an active father and running coach next fall.