What it is

Athletic pubalgia describes pain where abdominal and adductor structures meet near the pubic bone without a true hernia.

People feel deep groin or lower abdominal pain with sprinting, cutting, and kicking. Coughing and sneezing may hurt in severe cases.

What happens when it occurs

Load transfer between trunk and thigh exceeds tissue tolerance near the pubic bone. Restoring strength and control across this junction reduces pain.

Common causes and risk factors

  • High volumes of sprinting, cutting, and kicking
  • Weakness or imbalance between lower abdominals and adductors
  • Limited hip rotation or prior groin injury

Who is most affected

Field and court athletes and running sports with frequent acceleration and kicking.

Typical symptoms

  • Lower abdominal and groin pain with sprinting, cutting, and kicking
  • Pain with resisted sit-ups or adductor squeeze
  • Tenderness near the pubic bone

When to seek care

If pain persists beyond two weeks, if coughing and sneezing are painful, or if progress stalls with rest.

How we diagnose

History and examination testing adductor and lower abdominal loads. Ultrasound or MRI helps when surgery is considered or to exclude true hernia.

Management

  • Deload sprinting, cutting, and kicking while strength is rebuilt
  • Heavy slow adductor and abdominal strength with anti-rotation work
  • Graduated return to sprinting and kicking
  • Surgery considered when structured rehabilitation fails

Rehabilitation milestones

Phase 1 weeks 0 to 2: deload, isometrics for adductors and abdominals.

Phase 2 weeks 2 to 8: heavy slow strength, anti-rotation tasks.

Phase 3 weeks 8 to 16: graded running, acceleration, cutting, and kicking.

Phase 4 months 4 to 6: full training and match play progression.

Readiness to progress

  • Pain-free squeeze tests and plank variants
  • Adductor and abdominal strength within 90 percent
  • Running, cutting, and kicking drills without next-day flare

Prevention

  • Balanced strength between adductors and lower abdominals
  • Manage weekly sprinting and kicking volumes
  • Technique coaching for acceleration and deceleration

Australia snapshot

  • Common in football codes and running sports that include frequent acceleration and kicking
  • Men present more often, though women in kicking sports are also affected
  • Workload spikes are common antecedents

Latest insights

Adductor and abdominal strength with anti-rotation control is the cornerstone of care.

Surgery is reserved for cases that fail a full rehabilitation block.

Frequently Asked Questions

Plan for 8 to 16 weeks of structured rehabilitation. Surgical pathways vary when used.

Yes, maintain fitness with bike or pool. Avoid hard accelerations and long kicks until pain is controlled and strength improves.

Imaging helps confirm the diagnosis and exclude a true hernia when surgery is considered.

Heavy slow adductor and lower abdominal work with anti-rotation drills.

When squeeze tests are pain-free, strength is within 90 percent, and run sessions do not cause next-day flare.

Most continue working with lifting and stance adjustments. Coughing and sneezing may be sore early.

Lower when strength balance and weekly sprinting and kicking volumes are managed.