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Groin Pain In Football

Groin Pain In Football

If you play one of the football codes (Soccer, AFL, Rugby League or Union), chances are you have already or may in the future experience some groin pain. One study of almost 700 sub-elite male football players reported 50% of players had experienced groin pain in the previous season (Thorborg et al. 2017). Groin pain is highly prevalent, accounting for up to 14% of all injuries sustained in football (Haroy et al. 2017). It is common for groin pain to start in preseason training, when there is a spike in load following the off-season. The athlete is coming off a low training base into a high intensity training environment in a bid to regain fitness. The groin structures may struggle to adapt adequately to the rapidly increasing physical demands.

The typical pattern will be a gradual onset of discomfort in the groin which initially doesn’t affect your ability to train or play. You may feel stiff and sore post training and often into the next morning. As the weeks progress, you may notice that this worsens, and pivoting and kicking becomes increasingly difficult. A common scenario is that the athlete stops or modifies training to preserve him/herself for the weekend game. However, this can eventually progress to a point of being sidelined altogether.

How is groin pain diagnosed?

Groin pain diagnosis can be difficult in athletes due the overlapping anatomy in the region. Groin pain can emanate from several closely related structures and is categorised into groin pain arising from these different structures:

  • Adductor related groin pain (groin/inner thigh muscles and tendons)
  • Iliopsoas related groin pain (hip flexor muscles and tendons)
  • Pubic related groin pain (pubic bone, joint and nearby structures)
  • Inguinal related groin pain (structures in the groin crease)
  • Hip related groin pain (from the hip joint)
Anatomical image of different areas of groin pain

A detailed musculoskeletal assessment from your sports physiotherapist or sports physician usually provides the diagnosis. In some cases, scans (ultrasound or MRI) may be used to help clarify the reason for your groin pain. Once your diagnosis is established, it is then important to understand what may have contributed to the cause. Typically, this can be broken into three categories: load, muscle strength and biomechanics (the way you move).


Understanding the onset of groin pain is important for management. Fixture congestion or periods of high game demands will increase chronic overload to the groin region. This is often the case during preseason and towards finals when there are increasing number of games over short time frame. In addition, fluctuations in training patterns or game availability will influence injury risk. Ensuring consistent exposure to agility drills and sprinting in training or games will help reduce variations in loads. Working with your Physio to manage appropriate loads can help reduce overload and help you continue to play through groin pain.

It is rare complete rest will resolve athletic groin pain. Prolonged periods out of training and games will accelerate muscle weakening and reduce tolerance to physical strain across the hip, groin and pelvic region. Instead, modifying training loads to exclude components of training that are provocative (i.e., cutting, small-sided games, kicking) will allow you to maintain fitness and some resemblance of load whilst working on a rehabilitation program to address any strength deficits.

Muscle Strength

Assessment of hip muscle strength is vital for groin health. One Australian study showed that in A-League & EFL soccer players, increased hip abductor (glute) strength on the kicking leg and higher levels of overall hip abductor and adductor (groin) muscle strength were associated with a reduced likelihood of future injury (Bourne et al. 2020). Using muscle dynamometry, we can profile muscle strength and compare this to normative data available in professional athletes to understand testing benchmarks.

VALD, a leading sport science company demonstrated that the median adductor isometric strength score was 422N (43kg) in professional English and European footballers (over the 2020/21 season). In comparison, AFLW athletes on average, test just over 300N (30kg). Depending on your gender and sporting code, we can refer to research data to help understand how strong you need to be and use this to guide your rehab prescription.

Physiotherapist testing muscle strength for groin pain rehabilitation


Agility (cutting, pivoting and acceleration) actions are often amongst the most provocative movements for groin pain. Recent research (King et al. 2018) has highlighted the important relationship between how people move their body when changing direction and the load they put on their groin region. Due to the high physical demands of acceleration, being able to control your body during these actions influences how much force is being directed to the groin. Typically, athletes with inefficient strategies change direction with a greater side lean of the trunk, plant their foot too wide and have inadequate control of movement around the hip joint.

The cutting strategy used by a player will be related to the strength and athletic qualities that athlete possesses. One example is of reduced trunk strength (i.e., reduced ability to resist movement with the abdominal and/or back muscles) leading to increased trunk lean over the planted foot. This means the groin muscles have to work harder to push off. Another example is inadequate calf strength and ability to produce fast, forceful movements, resulting in poor ability of the calf to absorb landing forces. These forces are once again transmitted to the groin. Video analysis of cutting technique is used to develop drills and rehab programs to improve efficiency and reduce re-injury risk.

Two soccer players changing direction_groin pain mechanism

Restoring plyometric ability (explosive jumping) and power are important pieces of the puzzle in restoring effective control of the trunk and pelvis during dynamic movements. Force plates are used to help assess this. Using jump testing, we can break down data about how high you are able to jump, how fast you take off, how much force you generate when leaving the ground and on landing, and your ability to effectively break or stop quickly. These metrics are then used to help ensure the most effective exercise selection and rehab programs.

Treatment of groin pain takes a step-by-step approach. Load management is the initial priority and reducing provocation to the area can help reduce symptoms immediately. Following this, developing muscle strength and resilience to improve the ability of your groin structures to cope with sporting loads is next. Lastly, training cutting technique can be helpful to further reduce stress in the groin region and often has the added benefit of improved performance.

This blog was written by one of our Physiotec Sports Physiotherapists, Kevin Doan

If you would like to book with one of our Sports physio's, Kevin, Dave, Eric or Tyler please call, email or book online below:

Phone: (07) 3342 4284

Email: [email protected]


Music is Physical – The importance of exercise for musicians

Music is Physical – The importance of exercise for musicians

As a musician, you are likely to spend much of your time practicing. But how much time do you devote to keeping fit? Everyone knows that exercise is good for a person’s health, however did you know that fitness and exercise for musicians can also improve your performance?

In this blog, we discuss being fit to play

Fitness and exercise improves performance

Fitness for PerformanceSports medicine and performance research has well established that being fitter and stronger is probably going to mean you perform better, get injured less and have a longer career. Sportswomen and men do not get fit from playing sport – they get fit to play sport.

Professional sports have millions of dollars invested in strength and conditioning programs, GPS tracking of on-field movements and intensity, injury surveillance, early management and strict recovery protocols. They even have a fully or partially employed team of doctors, physios, exercise physiologists, strength coaches, psychologists, massage therapists, nutritionists and specialists, all on speed dial!

In the performing arts sector, the dance world has embraced these concepts to some extent, but it’s really only in the past 10-15 years that we have seen dancers “cross training” using weights, modern physical conditioning science and recovery techniques. Professional companies measured the cost of injuries and then implemented more stringent balances between dance floor time and body (and mind) care time!1 Dancers are learning that you can’t just dance and expect to be fit to dance.

But what about training and exercise for musicians?

Musicians, generally, have not embraced these concepts. Unlike dance, a musician’s physical appearance has not historically been important to the final product of the artistic performance. Hence, the physicality of one’s body has not been in the forefront of musicians’ training.

Demands of instrumental musicThe physical demands of instrumental performance are often only considered when things start to hurt. A study from Germany2 indicated the average age of onset of pain related to playing, in professional orchestral musicians, was 35. This indicates a realm of physical performance that is low load, high repetition – pain creeps up on you and can ‘suddenly’ take over your career or passion. There are no high impact injuries nor torn muscles from sudden explosive force (like dance or sport), but research3 shows that over 80% of professional orchestral musicians in Australia have had pain related to playing, that has interfered with or stopped them playing. Most musicians rely on the “gig economy” – with no guaranteed income, worker’s compensation or income protection insurance. So realistically, pain and injury will hurt more than just their bodies.

Music is physical.

Yes, music can be expressive, creative, therapeutic and passionate but to create music on any instrument (even digitally) musicians need to use their body as well as their mind. Musicians of all levels and ages will benefit from:

  • being fitter and stronger
  • physically warming up before playing
  • eating to perform, and
  • having a recovery protocol for after playing

In short – condition, prepare, play, recover (CPPR).

Exercises musicians can do to increase fitness levels

It’s easiest to break down your physical condition into two areas – cardiovascular fitness and strength. The latest W.H.O exercise guidelines4 recommend a minimum of 150 minutes a week of moderate intensity exercise (most people can get that fast walking) and 2 additional strength training sessions involving major muscle groups. I suspect some reading this will not be achieving that minimum.

Get fit to play musicAny gains in fitness or strength are made by challenging your body to respond to a load just greater than it is used to – challenging but achievable. You have to start low and slow, and build up to your target. Musicians should understand this concept as no one starts playing with a concerto – one must first learn the scales.

General cardiovascular fitness is gained, depending on your physical ability, by activities like walking, running, swimming or boxing, but all should be approached carefully and built on gradually.

Likewise, to gain body strength, start slowly and build gradually. Simple bodyweight exercises like calf rises, squats, bridges, dips and push ups (start on the wall or a bench) are enough to get you going and improve your general strength. From there you can progress to resistance bands or weights and just see the difference it will make to your playing endurance –  reduced fatigue, less pain – and often, improved performance!

Balance exercises are a very interesting area and can be surprisingly beneficial, particularly in the older musician. The ability to transfer body weight either standing or sitting can be an important part of injury reduction and also performance enhancement.

Is a warmup necessary for musicians?

A general body warmup before playing will increase the local muscle temperature and many people comment how it mentally places them in a performance space as well. Simple arm circles, body twists and leg swings are an easy way to start a routine that of course will flow into warmup on your instrument.

Recovery strategies are rarely seen amongst the musicians I have worked with (until I work with them!) Hydration (water), nutrition, some simple stretches and mentally ‘winding down” are proven sports practices based on a large body of research. Sleep is a huge area of current research and in musicians is currently rarely measured nor discussed.

CPPR – condition, prepare, play, recover.

Most musicians just play – until they can’t. Embracing sports science principles can not only minimise pain or injury, but improve performance and prolong careers.

For more information on fitness and exercise for musicians, pain or injury management or other aspects of musicians’ physical demands, call 3342 4284 to book an appointment with David Peirce at PhysioTec.



1. The “Cost” of Injuries in a Professional Ballet Company.
Ruth Solomon,B.A., John Solomon,Ph.D., LyleJ. Micheli, M.D., and ErnestMcGray, Jr. Medical problems of performing artists Dec 1999

2. Frequency, severity and predictors of playing-related musculoskeletal pain in professional orchestral musicians in Germany Steinmetz et al January 2014

3. Musculoskeletal pain and injury in professional orchestral musicians in Australia.
Bronwen Ackermann 1, Tim Driscoll, Dianna T Kenny Medical problems of performing artists 2012

4. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med: first published as 10.1136/bjsports-2020-102955 on 25 November 2020.

Try Torpedo Perturbation Training at PhysioTec

Try Torpedo Perturbation Training at PhysioTec

Perturbation Training

See one of our Physiotec staff, Colm Coakley, demonstrating some perturbation training using the CorMax Torpedo. Half filled with water, the Torpedo becomes an unstable load which your muscles need to figure out how to control. Consequently, it provides a great dynamic stability challenge! Also, due to the ever-changing stimulus, it keeps the nervous system guessing.  This requires the system to continually change the way muscles are stimulated to respond.

In response to pain, or sometimes due to excessive training in very rigid unvarying patterns eg like regularly holding a rigid plank for 2+minutes, the nervous system can begin to recruit muscles in very confined, ‘primitive’ patterns. This can lead to a loss of normal efficiency and load sharing-load sparing in muscle recruitment patterns. As a result, this can also potentially contribute to pain, injury and a loss of athletic performance. At Physiotec, we are always exploring and embracing strategies that can help our patients get the best out of their bodies and their lives. Come & join one of our highly qualified physio’s in an innovative and challenging workout.

Saturday Acute Injury Service

Saturday Acute Injury Service

Ever hurt yourself on a Friday night or Saturday and wished you could have your injury seen to? Did you know Physiotec now offers Injury Clinic every Saturday from 11:30am-1:30pm. One of our skilled Sports Injury & Performance Physiotherapists will be on staff every Saturday to cater for the acute injuries sustained during Friday night/Saturday. The right advice and early management makes all the difference. Get treatment/advice now. Don’t wait!!!

We also have a normal clinical service and pilates on Saturday morning, but reserve places with one of Sports Injury & Performance team specifically for acute injuries that require urgent assistance.

Why Gym Start?

Why Gym Start?

Welcome to the first blog post of our strength and conditioning series. Physiotec has recently recruited physiotherapists with specific experience in strength and conditioning. We recognise the need to give people access to strength training, especially coming back from injury. However, uninjured people will also benefit from the service.

In our clinic, we see more and more people who are engaging in gym based training and this ranges from young adolescents to elderly people.  The goals for strength training for the individual may be different but the fundamentals are the same: good form and appropriate loading. It is our goal to provide this service for our clients to enjoy strength training in a safe and effective manner.

We aim to update our blog regularly and provide some easy to digest content on all things strength training. In the meantime, keep up to date with our clinic via social media:


Instagram: @PhysiotecAUS

Are you planning on getting started in the gym?

Or do you want to get back in the gym after injury?

Under the supervision of our experienced physiotherapist, you will be professionally guided through your strength training, in a safe and effective manner.

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