Pain guide · Hip pain

Sports hernia (inguinal-related groin pain): rehab, surgery and how it differs from a hernia

A sports hernia is pain where the lower tummy meets the groin, in people who sprint, kick, twist and change direction. It hurts with sprinting, kicking, sit-ups and sometimes coughing, but there's no lump. It isn't a true hernia: it's a painful problem in the tissues around the groin canal, which is why experts now call it inguinal-related groin pain.

Most people start with active rehab: trunk and hip strength, then running, then sprinting, cutting and kicking, often over 6 to 12 weeks. If that hasn't worked after a good 2 to 3 months, surgery is an option, though that timing is expert opinion. This guide shows how to tell it from a true hernia (and the hernia signs that need A&E), what the trials found, and a staged plan with 3D demos. Nearly all the research is in men.

4-stage exercise plan When to get help 24 sourcesUpdated 21 October 2026

When to get help first

Exercise is for pain that has been checked or is clearly mild and settling.

Get urgent medical help if

Call 999 or go to A&E if you have a hernia (a lump in the groin, upper thigh or tummy) and very bad tummy pain, you feel sick or are being sick, you cannot fart or poo, you have a high temperature or feel hot, cold or shivery, or you've suddenly become confused. The hernia may be trapped (strangulated) or blocking the bowel. Do not drive yourself.
Get help from NHS 111 if you have a hernia and pain in or around it, a bloated tummy, you feel sick or are being sick (including vomit that looks like coffee grounds), or you're constipated.
Go to A&E or call 999 for sudden, severe pain in a testicle, testicle pain with feeling or being sick or tummy pain, or testicle pain that has lasted more than an hour or continues at rest. It can be a twisted testicle (testicular torsion), which needs treating straight away. For a lump, swelling or a change in a testicle's size or shape, ask for an urgent GP appointment or get help from NHS 111.
Same day, and stop running now: groin or front-of-hip pain in a runner, sometimes felt in the thigh or knee, that builds with running, hurts with every step or at night, or hurts when the hip is turned to the end of its range. Keep weight off the leg, using crutches if you have them, and get an urgent GP appointment or help from NHS 111 the same day: a stress fracture of the hip (femoral neck) needs urgent imaging.
Buttock or leg pain with numbness around the genitals or bottom, new trouble controlling your bladder or bowels, or weakness or numbness in both legs.
A hot, swollen hip, or hip pain with a fever or feeling generally unwell (a possible joint infection).
After groin surgery, including a hernia repair: a wound that is leaking pus or is painful, swollen, warm or red; a high temperature, or feeling hot, cold or shivery; a swollen or painful tummy that is getting worse; or a throbbing or cramping pain in your leg. Get help from NHS 111. Call 999 for chest pain, severe breathlessness or coughing up more than a few spots of blood: it can be a blood clot in the lungs.

See a doctor or physiotherapist if

A lump in the groin, upper thigh or tummy, especially one that appears when you cough or strain and goes when you lie down: see a GP, as it may be a true hernia. A femoral hernia (a small lump at the top of the thigh, mainly in women over 50) needs treating in hospital.
Groin pain with a fever, blood in your pee or pain when you pee, or with no clear link to sport: see a GP, as it's unlikely to be a sports injury.
Groin pain that still stops you training after 2 to 3 months of good rehab: ask for a sports medicine or groin surgery opinion. That is when expert surgeons suggest considering surgery.
Groin pain with a deep pinch when you bend your hip, or catching or locking: the hip joint may be involved (see the hip impingement and labral tear guides).

Understand it

What it is, and its many namesStrong evidence

Sports hernia is a name for pain in athletes around the inguinal canal, the passage just above the groin crease, with tenderness there and no lump. An international agreement on groin pain in athletes (the Doha agreement) calls it inguinal-related groin pain: pain in that area, tender to touch, with no hernia you can feel, and more likely if a resisted sit-up, coughing, sneezing or straining brings it on. It recommends dropping the names sports hernia, sportsman's hernia, athletic pubalgia and Gilmore's groin, and a 2026 European consensus keeps its terms.

A UK consensus prefers inguinal disruption and says no true hernia exists. It describes too much tension around where the inguinal ligament attaches, sometimes with small tears in the external oblique, one of the side tummy muscles. Another name you'll see is core muscle injury.

Sources 1, 2, 3, 4

How it differs from a true herniaStrong evidence

A true inguinal or femoral hernia is tissue or bowel pushing through a weak spot. It causes a bulge in the groin or upper thigh that may get bigger when you cough, sneeze or strain and smaller when you lie down, sometimes with a heavy, dragging feeling. Femoral hernias mainly affect women over 50, often become trapped, and need surgery.

A sports hernia has no lump. The American Academy of Orthopaedic Surgeons (AAOS) says that over time a sports hernia may lead to an inguinal hernia; we found no figures on how often.

Sources 5, 6, 1, 4

Other causes of groin pain, and how often they overlapEmerging evidence

Groin pain in athletes has several defined types. Pain at the inner thigh or pubic bone, worse squeezing the knees together, is adductor-related and is the commonest: the main problem in 58% of 207 athletes (69% of footballers) at one clinic, and present in 61% of 100 athletes at another. Pain at the front of the hip when lifting the knee is iliopsoas-related; a deep pinch when bending the hip is hip-related; and groin pain in a runner that hurts with every step can be a stress fracture. Each has its own guide.

Overlap is common: a third of the 207 athletes, and 44% of the 100, had more than one source of pain. Among athletes who needed groin surgery, the commonest diagnoses were hip impingement (32%), athletic pubalgia (24%), adductor problems (12%) and inguinal problems (10%).

Sources 1, 7, 8, 9

Who gets itEmerging evidence

It's commonest in sports with sudden changes of direction and hard twisting, such as football, ice hockey, rugby and wrestling. In elite contact-sport teams followed for 2 years, long-standing groin pain of any kind affected 7.5% of players a year.

Nearly all the research is in men: 98 of the 100 athletes and 196 of the 207 were male, and the Pilates trial enrolled only men. Women with groin pain should also be checked for a femoral hernia, hip problems and pelvic causes (our suggestion).

Sources 4, 8, 10, 7, 11, 6

How it's recognised, and what scans showEmerging evidence

The diagnosis comes from your story and an examination: pain and tenderness over the groin canal, and pain with a resisted sit-up, coughing or sneezing. No single test is perfect. In a study of 44 male athletes, how well two examiners agreed on the tests ranged from slight to substantial, and the commonest positive finding was the athlete's usual pain when the examiner pressed into the groin canal through the scrotum while the athlete strained (79%). A 2026 European consensus says this check should be part of every routine examination.

Scans are a poor guide on their own. Up to 71% of footballers without pain had findings on MRI (magnetic resonance imaging), and swelling in the pubic bone was nearly as common in players without pain (47%) as in those with it (53%). Ultrasound is the first scan when a true hernia is suspected; no scan finding defines a sports hernia.

Sources 1, 4, 12, 2, 13, 10

How it usually goesEmerging evidence

With structured rehab, 73% of 205 athletes with long-standing groin pain of mixed types (they'd had it for a median of 32 weeks) returned to sport pain-free, on average about 10 weeks later. The AAOS says 4 to 6 weeks of physiotherapy settles many cases. No good study has followed people without treatment.

Sources 14, 4

What helps, and how strong the evidence is

Active rehab firstEmerging evidence

In a trial of 68 athletes with long-standing groin pain from the adductors, 8 to 12 weeks of strength and coordination training for the muscles round the pelvis got 23 back to sport without pain, against 4 with passive physiotherapy. The Doha review rated this moderate evidence for adductor-related pain; it hasn't been tested in inguinal-related pain on its own.

A Dublin clinic's programme worked in three levels: control and strength of the trunk, pelvis and hips; straight-line running; then changing direction and sprinting, with movement checks before each step up. Of 205 athletes with a mix of groin pain types, most often tenderness just above the pubic bone, 150 (73%) returned to sport pain-free at an average of 9.9 weeks. There was no comparison group, and 27% didn't complete the follow-up questionnaires. A UK consensus advises tailored physiotherapy as the first treatment.

Sources 15, 1, 14, 3

Surgery or rehab: one small trial, and a mixed wider pictureMixed evidence

In the only randomised trial, 60 athletes with 3 to 6 months of groin pain had either keyhole mesh repair or at least 2 months of active physiotherapy with steroid injections and anti-inflammatory medicine. At 3 months, 27 of the 30 who had surgery were back to sport, against 8 of the 30 in the other group, and 7 of those 30 later had surgery. The trial was small and not blinded.

A review of 56 studies (3,332 athletes), mostly case series at high risk of bias, found similar return-to-sport rates after surgery and after rehab, and rehab got people back faster when the pain was at the pubic bone. The Doha review judged the evidence that keyhole repair does better than care without surgery for inguinal-related pain as moderate.

Sources 16, 17, 1

When surgery is considered, and what it involvesEmerging evidence

Expert surgeons suggest considering surgery when 2 to 3 months of good rehab has failed, pain limits training or daily life, or there's a significant tear. That threshold is expert opinion, not a trial result.

Surgery releases tension in the groin canal and reinforces it with mesh or stitches, sometimes also cutting a small nerve or releasing the adductor tendon if inner thigh pain persists. The AAOS reports that more than 90% of athletes return to sport after surgery that follows failed rehab, usually 6 to 12 weeks after the operation, and that the tissue can tear again.

Sources 18, 3, 4

Pilates as an add-onEmerging evidence

In a trial of 88 men, adding 6 weeks of Pilates to laser and ultrasound treatment gave a little extra pain relief, less than the amount people notice, but clearly better function: a leg function score ended 17 points higher than in the comparison group. It was one trial, in men only.

Source 11

Prevention: the Copenhagen adduction programmeEmerging evidence

In 35 semi-professional teams (652 male footballers), a programme built on one exercise, the Copenhagen adduction, 3 times a week in pre-season and once a week in season, lowered the risk of groin problems by 41%. It targets the adductors, the commonest source of groin pain; its effect on inguinal-related pain alone isn't known.

Source 19

How much pain is OK while you exercise?

Up to 3 out of 10 at first, then up to 5, settled by the next morningEmerging evidence

In the first stage, keep groin pain at 3 out of 10 or less, as the groin strain guide does. After that, use the hip pain guide's rule: up to about 5 out of 10 during exercise is acceptable, as long as it settles afterwards and is no worse the next morning. These rules are borrowed from pain-monitoring studies in arthritis and tendon pain; they haven't been tested in sports hernia.

Coughing, sneezing, sitting up from lying and a resisted sit-up are the movements that bring this pain on. If they're more painful the next morning than before, the load was too much: drop back a step (our suggestion).

Add speed, kicking and cutting in short blocks over several sessions, never all in one. The Dublin programme moved people on only when they passed movement checks. With the Copenhagen plank, expect muscle soreness for the first fortnight; sharp groin pain is a reason to step back.

Sources 20, 21, 1, 14

The exercise plan: 4 stages

Start at the first stage. Each move opens a full guide with a 3D demo.

Stage 1

Settle: calm it, keep fit and start trunk and hip control (about weeks 0 to 2)

Stop sprinting, kicking, cutting and sit-ups for now, and keep fit with cycling or walking if they're comfortable. Keep groin pain at 3 out of 10 or less. After a sudden injury, the AAOS suggests rest and ice for 7 to 10 days, then physiotherapy. Doses are editorial.

Lying adductor ball squeeze demonstrated on the 3D figure

3D demoLying adductor ball squeezeBeginner · Other / check instructions

5 to 10 holds of 5 to 10 s · Squeeze only as hard as you can without bringing on the groin pain. The first exercise in the active training trial

Harder: Copenhagen plank

Dead bug heel taps demonstrated on the 3D figure

3D demoDead bug heel tapsBeginner · No equipment

2 sets of 6 to 8 each side · Trunk control is the first level of the Dublin programme

Harder: Forearm plank

Glute bridge demonstrated on the 3D figure

3D demoGlute bridgeBeginner · No equipment

2 to 3 sets of 10

Easier: Pelvic tilt into bridge · Harder: Glute kickback (quadruped hip extension)

Knee side plank demonstrated on the 3D figure

3D demoKnee side plankBeginner · No equipment

3 holds of 15 to 20 s each side

Harder: Side plank

3D demoBird dogBeginner · No equipment

2 sets of 6 to 8 each side

Easier: Bird dog, one limb at a time · Harder: Bear Crawl

Stationary cycling demonstrated on the 3D figure

3D demoStationary cyclingBeginner · Cardio machine

15 to 30 min, easy · Only if it's pain-free

Harder: Air bike intervals

Move on when: Coughing, sneezing, sitting up in bed and brisk walking no longer hurt, and the ball squeeze is pain-free at a firm effort.

Follow along: a timer, a cue and the next move, one step at a time.

Stage 2

Build: trunk, inner thigh and hip strength (about weeks 2 to 6)

Strength for the muscles round the pelvis 3 times a week, which was the focus of the active training trial. Keep cycling or walking. The beginner core workout suits this stage, leaving out its curl-up if that brings on the groin pain. Doses are editorial.

Standing band hip adduction demonstrated on the 3D figure

3D demoStanding band hip adductionBeginner · A band + An anchor point

3 sets of 10 to 12 each side

Harder: Copenhagen plank

Half-kneeling Pallof press demonstrated on the 3D figure

3D demoHalf-kneeling Pallof pressBeginner · A band + An anchor point

3 sets of 10 each side · The trunk resists turning, with no curling up. Pad the knee

Harder: Pallof press

Side plank demonstrated on the 3D figure

3D demoSide plankIntermediate · No equipment

3 holds of 20 to 30 s each side

Easier: Knee side plank · Harder: Side plank with leg lift

3D demoDead bugBeginner · No equipment

3 sets of 8 each side

Harder: Forearm plank

Split squat demonstrated on the 3D figure

3D demoSplit squatIntermediate · No equipment

3 sets of 8 each side

Easier: Bodyweight squat · Harder: Reverse lunge

Lateral band walk demonstrated on the 3D figure

3D demoLateral band walkBeginner · A band

3 sets of 10 to 15 steps each way

Easier: Hip abduction machine · Harder: Lateral band walk, band at the feet

Move on when: Daily life is pain-free, these feel comfortable at a moderate load, and a resisted sit-up no longer hurts.

Follow along: a timer, a cue and the next move, one step at a time.

Stage 3

Run: straight-line running and landing (about weeks 4 to 8)

Straight-line running and building up the running, the second level of the Dublin programme, with strength work twice a week. Doses are editorial.

Treadmill jogging demonstrated on the 3D figure

3D demoTreadmill joggingIntermediate · Cardio machine

Walk-jog intervals building to 20 to 30 min, every other day at first · Once 30 minutes of brisk walking is pain-free. Running outdoors on the flat counts

Easier: Treadmill walking · Harder: Sprint intervals

3D demoSkippingBeginner · No equipment

3 sets of 20 m

Harder: Alternate-leg bounding

Snapdown to athletic landing demonstrated on the 3D figure

3D demoSnapdown to athletic landingBeginner · No equipment

2 to 3 sets of 5

Harder: Box drop landing

Copenhagen plank demonstrated on the 3D figure

3D demoCopenhagen plankAdvanced · A bench or box

Short lever (knee on the bench): 2 sets of 3 to 5 each side, 3 times a week · Not while the groin is acutely painful. Expect soreness for the first fortnight

Easier: Hip adduction machine

Single-leg Romanian deadlift demonstrated on the 3D figure

3D demoSingle-leg Romanian deadliftAdvanced · A dumbbell

3 sets of 6 to 8 each side

Easier: Dumbbell Romanian deadlift

Move on when: 20 to 30 minutes of steady running is pain-free on the day and the next morning.

Follow along: a timer, a cue and the next move, one step at a time.

Stage 4

Change direction, sprint and kick (about weeks 6 to 12)

Changing direction and building back to full-speed sprinting, the third level of the Dublin programme, with kicking last (see the steps below the plan). In that programme, people returned to sport after about 10 weeks on average. Keep the Copenhagen plank going once a week; the hamstring and groin injury prevention workout and the FIFA 11+ warm-up suit this stage. Doses are editorial unless marked.

Shuttle runs demonstrated on the 3D figure

3D demoShuttle runsAdvanced · No equipment

Short sets, building speed over the weeks · Wide, unhurried turns first

Easier: Treadmill jogging

Lateral bound (skater jump) demonstrated on the 3D figure

3D demoLateral bound (skater jump)Beginner · No equipment

2 to 3 sets of 5 each side

Harder: Box push-off jump

Sprint intervals demonstrated on the 3D figure

3D demoSprint intervalsAdvanced · No equipment

Build towards full speed over several sessions · Add speed over weeks, not within a session

Easier: Treadmill jogging

3D demoCopenhagen plankAdvanced · A bench or box

Long lever (foot on the bench), 3 times a week, then once a week in season · The prevention programme's frequency; the volume is editorial

Easier: Hip adduction machine

Move on when: Sprinting, cutting, kicking, sit-ups and coughing are pain-free at full effort; then full training before matches. If pain still stops you training after 2 to 3 months of good rehab, see a specialist: that's when expert surgeons suggest considering surgery.

Follow along: a timer, a cue and the next move, one step at a time.

What to change for now

Bringing kicking back

Kicking comes back last, over several sessions, once running and sprinting are pain-free. An expert surgical team's programme ends with sport-specific drills before competing; these kicking steps are our suggestion, the same as in the quad strain guide. Move on only when the last step stayed within the pain rule on the day and the next morning.

1. Short passes with the inside of the foot.
2. Longer passes.
3. Crossing and shooting, building to full power.

Source 18

After surgery, as your surgeon advises

After a hernia repair, the NHS says recovery usually takes up to 4 to 6 weeks: keep moving with gentle exercise such as walking, and do no heavy lifting or strenuous activity for at least 4 to 6 weeks. Most people need 1 to 2 weeks off work, or up to 6 weeks if the job involves heavy lifting. Recovery after a femoral hernia repair also takes about 4 to 6 weeks.

After sports hernia surgery, one expert surgical team's programme runs from early movement, gentle holds and trunk activation in weeks 1 to 3, through progressive trunk, pelvis and inner thigh strength in weeks 4 to 6, to running, sport-specific drills and tests before competing in weeks 7 to 12. That's expert opinion; your surgeon's plan comes first.

Sources 22, 6, 18

Positions to swap, and why

Habit or position	Why it matters	Instead
Sit-ups and crunches in the first weeks	A resisted sit-up is one of the movements that brings this pain on.	Trunk control without curling up.Try: Dead bug heel taps
Sprinting, kicking and cutting through the pain	They're the movements that aggravate it.	Keep fit on the bike, and build back in stages: run, then sprint, then cut and kick.Try: Stationary cycling
Total rest for weeks	Active training beat passive treatment in a trial, and structured rehab got most athletes back to sport.	Rest only from what provokes it, and keep exercising.Try: Glute bridge
The Copenhagen plank while it's acutely painful	The move's own caution: avoid it during acute groin pain.	Ball squeezes, then band adduction, then a short-lever Copenhagen plank.Try: Lying adductor ball squeeze
Straining or holding your breath to lift heavy weights	Straining brings on inguinal-related pain.	Breathe out on the effort, and use lighter loads for now.
Ignoring a lump that appears when you cough	It may be a true hernia.	See a GP.
Asking for an MRI scan first	Findings are common in players without pain.	An examination first; a scan if the diagnosis is unclear or before surgery.

Routines to follow

Beginner core workout

A 15-minute beginner core workout on the floor: dead bugs, bird dogs, knee planks, side planks and curl-ups.

15 minBeginner6 movesNo equipment

Hamstring and groin injury prevention

The Nordic hamstring and Copenhagen adduction programmes from the football trials: a 10-week build, three adductor levels, then once a week in season.

15 minIntermediate6 movesA wall, An anchor point

FIFA 11+ warm-up

FIFA's 11+ injury prevention warm-up as its manual sets it out: running drills, strength, balance and jumping at three levels, then faster running.

20 minBeginner20 movesCardio machine, A wall

10-minute dynamic warm-up

A 10-minute warm-up for any workout: raise your heart rate, move each joint through its range, rehearse the main movements, then ramp up to your first lift.

10 minBeginner12 movesA wall, A band

More moves for this area

Questions people ask

What is a sports hernia?

Pain where the lower tummy meets the groin, in athletes who sprint, kick and twist, with tenderness there but no lump. Despite the name, it isn't a true hernia, which is why experts call it inguinal-related groin pain.

Sports hernia or inguinal hernia: how can I tell?

An inguinal hernia causes a lump that may get bigger when you cough and smaller when you lie down; a sports hernia has no lump. A GP can examine you, and an ultrasound scan helps if it's unclear.

What are the symptoms?

Groin and lower tummy pain with sprinting, kicking, twisting and cutting, often brought on by a resisted sit-up, coughing or sneezing, and easing with rest. It often sits alongside pain from the inner thigh muscles.

Does it need surgery?

Usually not at first: most experts start with active rehab for 6 to 12 weeks. In one small trial, surgery got athletes back to sport faster, but across many studies return-to-sport rates were similar with rehab.

What exercises help?

Trunk and hip control, inner thigh and hip strength, then running, then sprinting, cutting and kicking. In one programme, 73% of athletes returned pain-free after about 10 weeks on average, and active training beat passive treatment in a trial.

Which exercises should I avoid?

For now, sit-ups and crunches, heavy straining and holding your breath, and sprinting, kicking or cutting through pain. Bring them back gradually in the later stages.

How long does recovery take?

It varies. With rehab, many athletes are back within about 6 to 12 weeks, and after surgery most return 6 to 12 weeks after the operation.

Do I need an MRI scan?

Not usually to start with. MRI findings are common in footballers without pain, so the diagnosis rests on the examination. Scans help if the diagnosis is unclear or before surgery.

Can women get a sports hernia?

Yes, though most research has been in men. Women with groin pain should also be checked for a femoral hernia (a small lump at the top of the thigh), hip problems and pelvic causes.

When is groin pain an emergency?

A hernia with very bad tummy pain, being sick or being unable to fart or poo needs 999 or A&E, and so does sudden, severe testicle pain. Don't drive yourself.

Can I prevent it?

A programme built on the Copenhagen adduction exercise cut groin problems by 41% in male footballers. It targets the inner thigh muscles, the commonest source of groin pain; whether it prevents sports hernia on its own isn't known.

Other pain guides

Sources

Exercise education, not a diagnosis or treatment plan. It is written from the guidelines and studies listed above; review by a clinician is pending. If your pain follows an injury, is severe, is getting worse, or comes with any warning sign listed on this page, get it assessed. Health disclaimer.