Current Concepts in Athletic Groin Pain: An Evidence-Based Narrative Review

Athletic groin pain is a common and clinically challenging condition in sports medicine, particularly among athletes in multidirectional sports, owing to its multifactorial aetiology and overlapping clinical presentations.This narrative review synthesises current evidence on the epidemiology, classification, anatomy, pathophysiology, risk factors, clinical assessment, imaging, conservative management, return to performance, prevention, and surgical treatment of athletic groin pain.PubMed/MEDLINE, Scopus, and Embase were searched up to March 2026, prioritising consensus statements, systematic reviews, metaanalyses, randomised controlled trials, and prospective studies published between 2000 and 2026.Current evidence supports a clinically driven diagnostic framework based on the Doha classification, distinguishing adductor-, iliopsoas-, inguinal-, pubic-, and hip-related groin pain, with multiple entities frequently coexisting in the same athlete.Imaging, particularly magnetic resonance imaging and dynamic ultrasound, should complement rather than replace clinical assessment, as structural abnormalities are also common in asymptomatic athletes.Management generally follows a criterion-based, progressive, exercise-based rehabilitation model centred on restoring tissue capacity, neuromuscular control, and sport-specific load tolerance, with return to sport guided by functional recovery rather than elapsed time alone.Adductor strengthening has been shown to reduce the prevalence of groin problems in male football players, whereas evidence for surgery derives mainly from case series, and surgery should be reserved for carefully selected athletes with persistent symptoms despite appropriate conservative management.Overall, athletic groin pain should be regarded as a multifactorial clinical syndrome rather than a single anatomical diagnosis.Future research should prioritise standardised diagnostic and outcome measures, prospective evaluation of rehabilitation and return-to-sport criteria, and inclusion of female athletes and sports other than football.