SportsHip and Groin Sports InjuriesAdvanced LevelProfessionals
Adductor-Related Groin Pain: Doha Classification and Return to Sport
A practical, evidence-informed guide to adductor-related groin pain: doha classification and return to sport, with safety screening, clinical reasoning, intervention progression and outcome-based reassessment.
11 October 20269–12 min readEvidence sources included
What You Should Be Able to Explain After Reading
- Apply the Doha clinical entity framework to athletic groin pain.
- Differentiate adductor-related pain from hip, inguinal and pubic sources.
- Plan progressive adductor loading and return-to-play criteria.
Anatomy and load
- The adductor longus and neighboring adductors contribute to hip control during acceleration, cutting, kicking and deceleration. Rapid changes in kicking volume or direction-change load may provoke symptoms.
- A single anatomical label may not explain all groin pain; multiple clinical entities can coexist.
Doha examination
- Adductor-related groin pain is defined by adductor tenderness AND recognizable pain on resisted adduction. Palpate carefully and reproduce the athlete's familiar symptoms.
- Screen iliopsoas-related, inguinal-related and pubic-related patterns, hip range of motion and provocation, and lumbopelvic contributions.
Differential and red flags
- Hip joint disease, femoroacetabular impingement-related symptoms, inguinal hernia, bone stress injury and referred lumbar pain may require different management.
- Acute inability to bear weight, fever, severe night/rest pain, testicular symptoms or traumatic suspected fracture warrant prompt medical assessment.
Baseline outcomes
- Track pain during a standardized adductor squeeze, hip adduction strength where measurable, Copenhagen Hip and Groin Outcome Score (HAGOS) and tolerated sprint/kick volume.
- Document whether pain settles by the next day; match reassessment to the actual sport.
Early rehabilitation
- Temporarily reduce high-irritability cutting/kicking while preserving tolerable aerobic fitness. Start controlled short-lever adduction isometrics or isotonic work at an appropriate effort.
- A sample starting option is 2–3 sets of 8–12 controlled repetitions on alternate days, adjusted to irritability and 24-hour response; it is not a validated universal dose.
Progressive loading
- Advance toward longer-lever adduction, heavier resistance, multidirectional strength, sprinting and change-of-direction drills.
- Introduce Copenhagen-style adduction only when foundational strength and symptom response support it; scale lever arm and repetitions rather than forcing maximal loading.
Return-to-sport reasoning
- Require near-symmetrical strength and confident high-speed cutting/kicking without meaningful next-day flare; compare to preinjury demands rather than a single test threshold.
- Use graduated team training before unrestricted competition, considering psychological readiness and workload.
Common mistakes and summary
- Do not call all groin pain an 'adductor strain', rely on stretching alone or progress solely because resting pain is low. Classification plus load monitoring drives better decisions.
Evidence & Further Reading
These sources are provided so learners can trace the clinical recommendations and read the original guidance.