Sports hernia, also called athletic pubalgia or core muscle injury, can cause chronic lower abdominal, groin, pelvic, hip-region, or adductor pain, especially with running, twisting, cutting, lifting, or core activity.
Groin pain that won't go away may be more than a muscle strain. Dr. Siefferman explains sports hernias (athletic pubalgia), how they're diagnosed, and the treatment options available to help you return to activity.
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Hi, I’m Dr. Jason Siefferman, interventional pain specialist and medical director at Manhattan Pain Medicine. Sports hernia is perhaps an improper name for an issue that occurs at the pubic symphysis. So, if we think of the pelvic ring, the pubic symphysis is where the bones come together right in the front. At this point is the attachment of multiple muscles and ligaments.
Very specifically the adductor longus which comes up from the leg and the rectus abdominis which are the main ab muscles which come down the inguinal ligament also inserts here. Where these muscles and ligaments assert they attach to a fibrocartilage. That fibrocartilage then attaches to the bone.
Sports hernia refers to that fibrocartilage popping off. But what we see with sports hernia or athletic pubalgia actually occurs on a spectrum and that pain may occur without a full sports hernia occurring. So we may see adductor tendinopathy. We may see rectus insertion tendinopathy. We may even see some periosteal, meaning the skin of the bone, irritation from stress from these structures pulling on the bone without the fibrocartilage actually detaching.
When we see pain at the pubic symphysis that seems like sports hernia, this pain is often quite sensitive, quite severe, and it doesn’t always just cause pain right there. It often will cause bladder sensitivity. It may even cause genital sensations, which can either be increased sensation or actually decreased sensation into the genitals or it can be a sharp jabbing pain into the genitals.
This is a diagnosis that we often find not because patients come in describing it exactly but because they’re having a lot of other pains that aren’t clearly explained. And when we examine the patient, we uncover this as a reasonable suspicion. We confirm the diagnosis with ultrasound exam and with a specific MRI study looking at this, and the treatment spectrum includes physical therapy with a physical therapist who actually specializes in this condition. We will often trial regenerative medicine and see how far that gets things. It depends on how severe the injury is.
If there is actually a full sports hernia, the regenerative medicine often is not that helpful. And then we also work closely with surgeons who treat this as their primary specialty.
A sports hernia is usually not a true hernia. The term often refers to athletic pubalgia or core muscle injury, a condition involving pain from injury, strain, weakness, or irritation around the lower abdominal wall, groin, adductor region, or tendons attaching near the pelvis.
Pain may worsen with running, twisting, cutting, kicking, lifting, sit-ups, coughing, or forceful core activity. Some patients feel lower abdominal pain, groin pain, pelvic-region pain, inner thigh discomfort, adductor pain, or pain that improves with rest but returns when activity resumes.
Because sports hernia symptoms can overlap with inguinal hernia, femoral hernia, obturator hernia, adductor strain, hip impingement, labral pathology, pelvic floor dysfunction, ACNES, peripheral nerve entrapment, endometriosis, anterior pelvic tilt, hypermobility, EDS, and abdominal wall pain, diagnosis-first evaluation is important. Manhattan Pain Medicine (MPM) evaluates the full pain pattern before recommending treatment or referral.
For patients looking for sports hernia treatment in NYC, MPM provides diagnosis-first evaluation for chronic groin, lower abdominal, pelvic, hip-region, adductor, and nerve-related pain.
MPM reviews the pain location, activity triggers, sports or exercise history, prior imaging, physical therapy response, pelvic mechanics, hip range of motion, adductor tenderness, abdominal wall pain, nerve symptoms, pelvic floor overlap, hypermobility, and prior surgical or hernia evaluation. Care may include diagnostic ultrasound when appropriate, ultrasound-guided injections, steroid injections in selected cases, nerve hydrodissection only when anatomically appropriate, peripheral nerve stimulation for selected chronic nerve pain patterns, acupuncture, and coordination with sports medicine, orthopedics, general surgery, pelvic floor therapy, or pelvic pain specialists when needed.
Sports hernia pain can be confusing because there is often no visible bulge. The pain may feel like a hernia, hip injury, adductor strain, abdominal wall injury, pelvic floor problem, nerve entrapment, or pelvic pain condition. It may improve with rest, only to return when the patient resumes running, twisting, lifting, cutting, kicking, or core work.
MPM’s diagnosis-first approach is designed to avoid treating every athletic groin pain pattern as the same problem. The evaluation considers athletic pubalgia, true hernia, hip impingement, labral pathology, pelvic floor dysfunction, ACNES, abdominal wall nerve pain, peripheral nerve entrapment, endometriosis, hypermobility-related pelvic mechanics, and post-injury pain sensitization.
Sports hernia and athletic pubalgia fit within MPM’s Pelvic Pain, Hypermobility, and Musculoskeletal issues Zones of Expertise when groin pain overlaps with pelvic mechanics, abdominal wall strain, hip dysfunction, nerve irritation, or connective tissue-related instability.
In patients with hypermobility spectrum disorder or Ehlers-Danlos syndrome, ligamentous laxity, joint instability, altered load transfer, recurrent strain, pelvic floor guarding, or abdominal wall vulnerability may make groin pain more complex. MPM evaluates these relationships carefully without assuming hypermobility is the cause of every sports hernia-type pain pattern.
I cannot say enough good things about Manhattan Pain Medicine. From the moment I walked in, I felt truly cared for and taken seriously. Dr. Nino Mikaberidze, Director of Rheumatology, is exceptional — knowledgeable, compassionate, and incredibly thorough. She takes the time to listen, explains every...
The best care I've received as a chronic pain patient. I traveled from out of state to visit Manhattan Pain Medicine because I could not find knowledgeable doctors in my hometown for my hypermobility, and Ehlers-Danlos syndrome symptoms and comorbidities. Let me tell you, it was worth every travel e...
I was injured in a bicycle accident over 8 years ago. I’ve suffered throughout the years since my accident with nothing seeming to work. PT, Yoga, lifestyle changes, NOTHNG! I finally made an appointment with Dr Kane and I’m feeling an improvement in my life. I no longer stay up all night in pain, a...
One of the best experiences, if not the best, I have ever had at the doctor’s office. From the front desk to the nurses to the PA assisting the doctor this was a great experience. Dr.Nino actually listened to me and came up with a game plan. Would recommend this practice to as many people as I could...
I have very unique & severe nerve pain from CRPS which has no known specific cure. Dr. Siefferman has a huge tool box, far greater than the other 23 Drs. I have seen. He saved me from jumping off a bridge and continues to help me with both treatments and advice. Dr. S. is in a different league!
After two years of searching and feeling lost and let down, I finally found real help at Manhattan Pain Medicine. With Dr. Siefferman, Adam Rosenberg, Dr. Mikaberidze, and the whole team, I feel heard, supported and understood. Every symptom is being considered and I’m finally getting answers with m...
Why is Dr Dr. Tayyaba Ahmed one of the top pevic Floor specialists - 1- She wants to know a full history of what led the patient to get to this point. 2 - She listens intensley to the patient 3- She does not rush you 4- Extremely skilled at giving pelvic floor injections 5- I thank my luck stars she...
The staff was friendly and helpful. Dr. Siefferman was thoughtful, listened, asked questions and proposed simple safe ways to come to further conclusions regarding my pain and discomfort. The office staff including Dr. Siefferman is responsive even after the initial in-person visit. Very pleased.
Dr. Siefferman is a brilliant provider. While my pain is still a work in progress, Dr Siefferman always gives me options and explains his reasoning behind things. He listens to my feedback and concerns. I never feel rushed; and am grateful he works to meet me where I am. I highly recommend him.
What a great find! They listen to me, I listen to them and the diagnosis is made and a plan developed to develop an approach to treat all of my chronic pain. I wish I could have discovered this type of treatment sooner. This doctor and group give me hope.
A sports hernia is a common term for chronic groin or lower abdominal pain related to athletic pubalgia or core muscle injury. Despite the name, it is usually not a true hernia with tissue or bowel pushing through the abdominal wall. It often involves injury, strain, weakness, or irritation around the lower abdominal wall, groin, adductor region, or tendons attaching near the pelvis.
In most cases, a sports hernia is not a true hernia. A true hernia involves tissue pushing through a weak spot and may cause a visible or palpable bulge. Sports hernia usually refers to athletic pubalgia or core muscle injury, which causes chronic lower abdominal or groin pain without a typical bulge. Because symptoms can overlap, careful evaluation is important.
Athletic pubalgia is a chronic groin and lower abdominal pain condition often related to core muscle injury, tendon strain, abdominal wall stress, or adductor overload near the pelvis. It is common in athletes and active patients who perform twisting, cutting, sprinting, kicking, lifting, or high-force core movements. It may improve with rest and return when activity resumes.
Sports hernia pain may feel like deep groin pain, lower abdominal pain, pelvic-region pain, adductor pain, or pain near the pubic bone. It may be sharp, aching, pulling, tight, or activity-related. Symptoms often worsen with running, twisting, cutting, kicking, lifting, sit-ups, coughing, or core activity. Pain may improve with rest but return when the patient resumes sports or exercise.
Yes. Athletic pubalgia can cause lower abdominal pain, groin pain, pelvic-region pain, pubic pain, adductor pain, or hip-region symptoms. However, pelvic and lower abdominal pain can also come from true hernia, pelvic floor dysfunction, endometriosis, ACNES, abdominal wall nerve entrapment, hip pathology, nerve irritation, or other conditions.
An inguinal hernia is a true hernia in which tissue pushes through a weak area in the groin and may create a visible or palpable bulge. A sports hernia usually refers to athletic pubalgia or core muscle injury without a true hernia bulge. Both can cause groin pain, so surgical evaluation or imaging may be needed when a true hernia is suspected.
Adductor strain usually involves injury or overload of the inner thigh muscles. Hip impingement or labral pathology may cause groin or hip pain related to hip motion. Sports hernia or athletic pubalgia often involves lower abdominal, groin, pubic, adductor, or core-related pain that worsens with twisting, cutting, kicking, sprinting, or core activity. These conditions can overlap and require careful evaluation.
Yes. Pelvic floor dysfunction can cause pelvic, groin, lower abdominal, genital, rectal, hip-region, or sitting-related pain that may resemble sports hernia symptoms. It may also coexist with athletic pubalgia, hip pathology, endometriosis, nerve irritation, or abdominal wall pain. MPM evaluates pelvic floor overlap when symptoms do not fit a simple sports injury pattern.
In selected patients, hypermobility or Ehlers-Danlos syndrome may contribute to pelvic mechanics, joint instability, recurrent strain, abdominal wall stress, or muscle guarding. This can make groin, pelvic, hip, or lower abdominal pain more complex. Hypermobility does not automatically cause athletic pubalgia, but it may influence evaluation and treatment planning.
Evaluation begins with a detailed history, activity review, physical exam, movement assessment, and review of prior imaging or treatment. MPM evaluates the lower abdominal wall, groin, adductors, hip, pelvis, pelvic floor overlap, nerve distribution, and hernia-related red flags. Imaging, diagnostic ultrasound, orthopedic evaluation, surgical consultation, or pelvic pain evaluation may be considered depending on the clinical picture.
Diagnostic ultrasound may help evaluate selected soft tissue, abdominal wall, groin, tendon, scar, or nerve-related pain patterns. It may also help guide certain injections when clinically appropriate. However, ultrasound does not replace surgical evaluation when a true hernia or surgically significant core injury is suspected.
Treatment depends on the pain generator. Options may include activity modification, rehabilitation coordination, pelvic and core mechanics work, medication management when appropriate, diagnostic ultrasound, ultrasound-guided injections, steroid injections in selected cases, acupuncture, nerve-focused treatments for selected patterns, and referral to sports medicine, orthopedics, general surgery, pelvic floor therapy, or pelvic pain specialists when needed.
Surgery may be considered when symptoms are persistent, function-limiting, and consistent with a surgically significant core muscle injury or true hernia after appropriate evaluation and conservative care. MPM does not replace surgical evaluation. When surgery may be appropriate, MPM coordinates with the right surgical or sports medicine specialists.
Groin pain may require urgent evaluation if it is severe or rapidly worsening, associated with a painful bulge that cannot be pushed back in, nausea, vomiting, abdominal distension, inability to pass stool or gas, fever, skin discoloration over a bulge, fainting, blood in urine, sudden severe testicular pain, chest pain, back pain with groin pain, new weakness, rapidly worsening numbness, or signs of bowel obstruction.
Before care begins, our team helps patients understand the practical side of treatment, including insurance verification, out-of-network benefits, cost-share estimates, self-pay options, and billing questions. We believe patients should have as much clarity as possible before moving forward.
If chronic groin, lower abdominal, pelvic, hip-region, or adductor pain is limiting sports, exercise, work, or daily activity, MPM can help evaluate what may be contributing. Our diagnosis-first approach considers athletic pubalgia, core muscle injury, true hernia, hip impingement, adductor strain, pelvic floor dysfunction, ACNES, abdominal wall nerve pain, peripheral nerve entrapment, hypermobility, EDS, and pelvic mechanics. Request an appointment to discuss your symptoms and care options.
A sports hernia is usually not a true hernia. The term is commonly used to describe athletic pubalgia or core muscle injury, a painful condition involving the lower abdominal wall, groin, adductor region, or tendon attachments near the pelvis.
Patients may notice pain during running, sprinting, twisting, cutting, kicking, lifting, sit-ups, coughing, or forceful core activity. The pain may improve with rest, then return when activity resumes. This pattern can be especially frustrating for athletes and active patients because symptoms may not appear during routine daily movement but become clear during higher-load activity.
The word hernia can make patients think there must be a visible bulge. In many cases of sports hernia or athletic pubalgia, there is no visible bulge and no bowel protrusion. Instead, the pain may come from soft tissue injury, tendon overload, abdominal wall strain, adductor involvement, pubic-region stress, or core muscle dysfunction.
However, true hernias can also cause groin or lower abdominal pain. Inguinal hernia, femoral hernia, obturator hernia, and umbilical hernia may require surgical evaluation. This is why diagnosis-first evaluation is important. The care pathway for athletic pubalgia is different from the care pathway for a true hernia.
Sports hernia pain often appears in the groin, lower abdomen, pubic region, inner thigh, adductor area, or pelvic-region. Some patients describe sharp pain with cutting or twisting. Others feel aching, pulling, tightness, or soreness after activity.
Pain may worsen with sprinting, kicking, lateral movement, core exercise, lifting, coughing, sneezing, or sit-ups. Patients may feel better after rest, but symptoms often return when they resume their sport or activity. In some cases, pain may spread into the hip-region, pelvis, adductors, or lower abdominal wall.
A true hernia occurs when tissue pushes through a weak point in the abdominal wall or groin region. It may cause a bulge, pressure, discomfort, or pain that worsens with coughing, lifting, or straining. True hernias can sometimes become urgent if tissue becomes trapped.
A sports hernia usually refers to athletic pubalgia or core muscle injury. It generally does not involve bowel protrusion and often does not create a visible bulge. Instead, pain is related to stress or injury around the lower abdominal wall, adductor attachments, pubic region, or core stabilizing structures.
Because these conditions can feel similar, patients with groin or lower abdominal pain should be evaluated carefully before assuming the diagnosis.
Athletic pubalgia can overlap with other common causes of groin and pelvic-region pain. An adductor strain may cause inner thigh pain with resisted movement or stretching. Hip impingement or labral pathology may cause groin pain, clicking, stiffness, or pain with hip rotation. Pelvic floor dysfunction may cause pelvic, groin, genital, rectal, urinary, bowel, or sitting-related pain.
Abdominal Cutaneous Nerve Entrapment Syndrome, also called ACNES, can cause localized abdominal wall pain that may be mistaken for a core injury. Peripheral nerve entrapment may cause burning, electric, radiating, or hypersensitive pain. Endometriosis may also overlap with pelvic, groin, abdominal, or hip-region pain in some patients.
MPM evaluates these possibilities together rather than assuming one diagnosis explains every symptom.
Hypermobility spectrum disorder and Ehlers-Danlos syndrome can make groin and pelvic-region pain more complex. When joints move beyond their stable range, muscles and tendons may work harder to control movement. This can increase strain through the hips, pelvis, lower abdomen, adductors, and core.
Anterior pelvic tilt, pelvic instability, hip mechanics, abdominal wall vulnerability, and pelvic floor guarding may also contribute to chronic symptoms. In some patients, hypermobility may make athletic pubalgia-like pain more persistent or recurrent.
MPM considers hypermobility and EDS when symptoms involve recurrent injuries, multi-joint pain, pelvic instability, abnormal load transfer, or pain that does not respond as expected to standard rehabilitation.
Sports hernia pain is often misdiagnosed because groin pain has many possible sources. A patient may be treated for adductor strain, hip pain, hernia, pelvic floor dysfunction, abdominal wall strain, sciatica, or nonspecific muscle pain without a complete explanation.
Imaging may also be inconclusive. Some soft tissue injuries are subtle, and some findings may not match the patient’s symptoms. A diagnosis-first approach requires matching the history, exam, movement triggers, imaging, and functional limitations before choosing treatment.
MPM begins by reviewing how the pain started, which activities trigger it, where the pain travels, what treatments have already been tried, and whether rest, physical therapy, medication, or prior injections have helped.
The evaluation may include assessment of the lower abdominal wall, groin, pubic region, adductors, hip motion, pelvic mechanics, abdominal wall tenderness, nerve sensitivity, pelvic floor overlap, hypermobility, and signs that a true hernia or surgical condition should be considered.
Diagnostic ultrasound may be used when appropriate to evaluate soft tissue, abdominal wall, groin, tendon, scar, or nerve-related pain patterns. If a true hernia or surgically significant injury is suspected, MPM coordinates with general surgery, sports medicine, or orthopedics.
Treatment depends on the source of pain. For some patients, the main pathway is rehabilitation focused on core stability, adductor control, hip mechanics, pelvic alignment, and gradual return to activity. Others may need evaluation for hip pathology, pelvic floor dysfunction, true hernia, abdominal wall nerve pain, or nerve entrapment.
When clinically appropriate, options may include medication management, diagnostic ultrasound, ultrasound-guided injections, steroid injections in selected cases, acupuncture, nerve hydrodissection for selected nerve entrapment patterns, or peripheral nerve stimulation for selected chronic nerve pain patterns.
These treatments are not automatic. The goal is to select the right intervention for the right pain generator.
Image-guided injections may be considered when the evaluation identifies a specific pain generator that may respond to targeted treatment. Injections may be diagnostic, therapeutic, or both, depending on the suspected source.
For example, an injection may help clarify whether pain is coming from a soft tissue structure, abdominal wall region, nerve pathway, or inflammatory pain source. Ultrasound guidance may help improve precision when the target is appropriate. However, injections do not replace rehabilitation, surgical evaluation when needed, or a complete diagnosis.
Some chronic groin or pelvic-region pain patterns may involve peripheral nerve irritation or entrapment. In selected cases, nerve hydrodissection may be considered when anatomy, symptoms, exam findings, and imaging support a nerve entrapment pattern.
Peripheral nerve stimulation may be considered for selected chronic nerve pain patterns when less invasive care has not provided sufficient relief and the suspected nerve target is appropriate. These options require careful diagnosis, risk discussion, and follow-up. They are not standard treatment for every sports hernia or groin pain presentation.
Surgery may be considered when the patient has a true hernia, a surgically significant core muscle injury, or persistent athletic pubalgia that has not improved with appropriate conservative care and has been evaluated by the appropriate specialist.
MPM does not replace surgical evaluation. Instead, MPM helps clarify whether pain appears to be surgical, musculoskeletal, pelvic floor-related, nerve-related, or mixed. When surgery may be appropriate, MPM coordinates with sports medicine, orthopedics, or general surgery.
Patients should seek urgent evaluation for severe or worsening abdominal, pelvic, groin, or testicular pain, a painful bulge that cannot be pushed back in, nausea, vomiting, abdominal distension, inability to pass stool or gas, fever, skin discoloration over a bulge, fainting, blood in urine, sudden severe testicular pain, chest pain, back pain with groin pain, signs of bowel obstruction, new weakness, rapidly worsening numbness, or rapidly worsening symptoms.
These symptoms may suggest a true hernia complication, bowel obstruction, infection, vascular issue, urinary condition, testicular emergency, neurologic problem, or another urgent medical condition.
MPM approaches sports hernia and athletic pubalgia through a diagnosis-first, coordinated model. The goal is to determine whether the pain is coming from a core muscle injury, adductor overload, abdominal wall strain, true hernia, hip pathology, pelvic floor dysfunction, ACNES, peripheral nerve entrapment, hypermobility-related mechanics, or overlapping pain generators.
For patients looking for sports hernia treatment in Manhattan or NYC, MPM offers a careful pain medicine perspective focused on pain generator identification, diagnostic ultrasound when appropriate, pelvic and musculoskeletal evaluation, nerve-focused assessment, hypermobility-aware care, and coordination with the right specialists. Treatment is individualized and selected only after the likely source of pain is better understood.
