Abductor tendonitis, inguinal-groin pain, and pubic osteopathy are among the most common causes of inguinal pain in athletes, although they are not as frequent as previously believed. The differential diagnosis includes femoroacetabular impingement, which is now recognized as the most common cause of hip and inguinal pain in athletes (Philippon et al., AJSM, 2007). In fact, many cases of femoroacetabular impingement present with retraction or shortening of the abductor tendons.
The abductor muscles and abdominal muscles function as the arms of a mill, with the pubic symphysis acting as the axis. Any imbalance (muscular imbalance of the aforementioned muscles, repetitive use of heavy-wet soccer balls, sudden changes in training, improper training, etc.) will lead to altered forces, a shearing effect on the pubic symphysis, and consequently, a local pathology that results in pain and functional disability in the patient.
Abductor tendonitis is the inflammation of the abductors that manifests during exercise and improves with rest. In inguinal-groin pain, the pain is localized more around the inguinal ring due to weakness of the abdominal wall and increases with activities that raise abdominal pressure, such as coughing or sneezing.
In pubic osteopathy, all these pathologies are combined, and inflammatory-reparative changes can be seen at the pubic bone level, both at the insertion of the abductor muscles and the abdominal muscles, often associated with a weak abdominal-wall floor.
