Theories on the underlying pathology of inguinal-related groin pain in athletes in chronological order divided into theories on nerve irritation and musculoskeletal (MSK) injuries
Nerve irritation theories | Year and authors |
Nerve entrapment Peripheral nerves may become entrapped after direct trauma or inflammatory conditions. The ilioinguinal nerve transmits sensation from the proximal part of the penis and the base of the scrotum. These sensations may be elicited by intensive abdominal muscle training leading to entrapment of the nerve, where it goes through the different layers of the abdominal muscles6 | 1980; Renstrom and Peterson6 |
Posterior abdominal wall weakness/bulge (‘incipient hernia’/‘sports hernia’)
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Tear of the external oblique Nerve irritation caused by single or multiple tears in the external oblique aponeurosis at the site of the emergence of neurovascular bundles containing the terminal branches of the iliohypogastric nerve15 16 | 1995; Williams and Foster15 1999; Ziprin et al16 |
Musculoskeletal pathology theories | Year and authors |
Muscle imbalance causing pain and changes at pubic bones Muscle imbalance at the level of pubic symphysis due to weak anterior abdominal wall and hypertrophic lower limb muscles causing an excessive functional overload of muscular and tendon insertions on the pubic bone17 | 1987; Nesovic17 |
Severe musculotendinous injury Severe musculotendinous injury, such as a torn external oblique aponeurosis or conjoined tendon torn from the pubic tubercle. Dehiscence between conjoined tendon and inguinal ligament18 19 | 1991; Gilmore18 1998; Gilmore19 |
Pubic joint concept Pain is due to an insertional shearing injury of the muscular attachments at the pubis, mainly inguinal canal, rectus abdominis and adductor muscles, causing pain at the pubic symphysis20 21 | 2000; Meyers et al20 2012; Meyers et al21 |
Inguinal ligament enthesopathy Inguinal ligament enthesopathy at the pubic tubercle. This is due to excessive stress during lateral abdominal muscle contraction. The abdominal core muscles play a pivotal role in the cause of pain as their forces are transmitted through the inguinal ligament onto the pubic tubercle22 | 2008; Lloyd et al23 2009; Mann et al24 2017; Rennie and Lloyd22 |