🧠 The Doha Agreement: Why Groin Pain Isn't Just One Injury

The Doha classification system breaks groin pain into specific categories based on clinical signs and structures involved:

1. Adductor-related groin pain

2. Iliopsoas-related groin pain

3. Inguinal-related groin pain

4. Pubic-related groin pain (osteitis pubis)

5. Hip-related groin pain (e.g. labral pathology)

6. Other causes (e.g. referred pain, hernia)

Most commonly in field sports, we see:

⚙️ 1. Adductor-Related Groin Pain

This is the classic “inner thigh” strain or chronic overload.

Symptoms include:

• Pain with resisted adduction (squeezing legs together)

• Tenderness along the adductor longus tendon

• Discomfort sprinting, cutting, or kicking

• Often occurs after overuse, spikes in load, or fatigue

If left untreated, it can become chronic and limit hip control or top-end speed. Early diagnosis and load management are key.

⚙️ 2. Pubic-Related Groin Pain (Osteitis Pubis)

This involves inflammation and bone stress at the pubic symphysis (where the left and right pelvis meet).

Symptoms include:

• Central groin or lower abdominal pain

• Pain when changing direction or decelerating

• Soreness with sit-ups, cutting, or long kicking sessions

• Often seen in kick-heavy sports or with poor pelvic control

Osteitis pubis often develops gradually and may be misinterpreted as a muscle strain. Recovery requires a slow reloading process and close control of running and change-of-direction drills.

🧠 Why These Injuries Become Chronic

Without a clear diagnosis, athletes often receive passive treatments (massage, rest) and return to play too early. This leads to:

• Ongoing weakness in the adductors or core

• Pelvic asymmetry and compensatory overload

• Delayed return to sprinting and change of direction

💪 How We Treat Groin Injuries at

We follow a performance-based protocol with clear benchmarks:

• Isometric and eccentric adductor loading

• Lumbopelvic control training (core, obliques, glutes)

• Sprint, change-of-direction, and kicking reloading

• Gradual return to full team training with confidence

• Ongoing reassessment using squeeze tests, hop symmetry, and video feedback

Every program is adapted to your sport, position, and level — whether you're playing semi-pro football or elite juniors.

⏱️ Recovery Timelines

• Acute adductor strain: 2–4 weeks

• Chronic adductor overload: 4–6+ weeks

• Osteitis pubis: 6–12 weeks, depending on severity and sport demands

Return to sport is guided by strength benchmarks, pain-free sprint and cut capacity, and video-supported movement screening.

✅ Final Word

Groin pain isn’t something to “just rest” or ignore. If you’re struggling with discomfort in the inner thigh, lower abs, or pubic bone — get it assessed properly.

At Pivot, we diagnose groin pain using the Doha classification and rehab it with a detailed strength and movement plan that ensures a full return to sprinting, kicking, and performance — not just day-to-day comfort.

Need to book an appointment to get your groin assessed? Book here