Groin pain is a complex issue — especially in athletes. For years, vague terms like “sportsman’s hernia” or “athletic pubalgia” have made clinical communication and rehabilitation planning inconsistent. The 2014 Doha Agreement changed that.
This international consensus introduced a clear, structured classification system based on clinical findings. It allows physiotherapists and clinicians to identify the true origin of groin pain and build more accurate, targeted treatment plans.
Whether you’re in a clinic or offering physiotherapy online, this approach helps eliminate guesswork and brings precision to your rehab strategies.
Clinical Entities: The Core of the Doha Agreement
The Doha classification breaks groin pain into five clinical categories, based entirely on physical examination and patient history — not imaging. These entities are:
- Adductor-related groin pain
- Pain on palpation of the adductor origin (usually the adductor longus)
- Pain on resisted adduction (squeeze test)
- Common in footballers, especially after cutting or kicking movements
- Iliopsoas-related groin pain
- Pain in the anterior groin, worsened with hip flexion (e.g. stair climbing, rising from deep chairs)
- Pain on palpation deep below the inguinal ligament or with the Thomas test
- Often associated with kicking or sprinting mechanics
- Inguinal-related groin pain
- Pain near the inguinal canal or pubic tubercle
- No tenderness on adductor palpation, but pain on resisted abdominal contraction or coughing
- Palpation through the scrotum may reproduce symptoms (in males)
- Misdiagnosed historically as “Gilmore’s groin” or “sports hernia”
- Pubic-related groin pain
- Central groin pain, often vague and diffuse
- Tenderness over the pubic symphysis
- Common in younger athletes (may involve apophysitis)
- Imaging may show changes, but not all changes are pathological
- Hip-related groin pain
- Pain related to intra-articular pathology (e.g. FAI, labral tears)
- Tests such as FADIR are often positive
- May radiate to the groin, buttock, or anterior thigh
Why This Matters in FMC SYSTEM
Understanding the clinical entity is fundamental in FMC SYSTEM diagnostics and rehab planning. Mislabeling a case as “adductor strain” when it’s actually iliopsoas-related or hip-driven can lead to weeks of ineffective treatment.
By classifying groin pain correctly, we:
- Choose the right tests
- Apply targeted manual therapy
- Prescribe exercise based on function, not assumption
We always integrate this with broader assessments — including stack, pelvic orientation, breathing, and load management. This applies equally in-person or via online consultation.
Summary
Groin pain is not a single diagnosis. The Doha classification gives us a clinically meaningful map to navigate it.
Takeaway: Always ask — what structure is really involved?
When in doubt, return to your clinical exam. Not all groin pain is adductor pain.