Soccer Players: Where Your Groin Pain Is ACTUALLY Coming From

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Your groin pain probably isn't just a core muscle problem. Soccer players get this wrong constantly, and the fix isn't more rest or more core exercises. It's a missed step in the diagnosis that most workups skip entirely.

In this episode, I'm going to explain why groin pain in soccer players so often gets misdiagnosed, what structure hides beneath the core muscles, and the exact diagnostic step that tells you what's really causing your pain.

⏱️ TIMESTAMPS
0:00 Soccer Players: Where Your Groin Pain Is ACTUALLY Coming From 
0:56 The most common misdiagnosis in soccer players
1:36 Why core muscle injury and hip pain feel identical
2:44 The diagnostic step most athletes never get
4:32 Why MRI alone can't confirm your diagnosis
4:39 Four questions to ask about your groin pain
5:53 Alex's story: bilateral hip pain in a soccer academy player
9:29 Four steps to take before your next physio session
10:01 The real reason hip pain gets missed in soccer players

❓ QUESTIONS ANSWERED
Can a core muscle injury actually be a hip labral tear? Yes. Hip impingement and labral tears often cause pain in the exact same area as a core muscle or athletic pubalgia injury, which is why they get confused so often.

How do doctors confirm the hip joint is the source of groin pain? A diagnostic injection places numbing medication directly into the hip joint under ultrasound guidance. If pain improves significantly afterward, the joint is confirmed as the source.

Why isn't an MRI enough to diagnose groin pain in athletes? An MRI shows what structures exist, like a labral tear or bone shape, but it doesn't confirm what is actually causing your specific pain. Some athletes have abnormal MRIs with no symptoms, while others have clean MRIs and a joint that is clearly the pain generator.

📱 RESOURCES
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Instagram: https://www.instagram.com/cincy_hipdoc
Facebook: https://www.facebook.com/malmasri7/
LinkedIn: https://www.linkedin.com/in/mahmoud-almasri-md-2bb07145/

🔔 Subscribe for new episodes on hip pain, labral tears, treatment decisions, and recovery. Dr. Mahmoud Almasri helps you understand your hip, your real options, and how to make confident decisions about your care.

ABOUT MAHMOUD ALMASRI, MD: Dr. Mahmoud Almasri is a dual board certified orthopedic surgeon (FRCSC, ABOS) specializing in hip preservation, hip arthroscopy, and athletic hip disorders at Cincinnati SportsMedicine and Orthopedic Center. He has independently performed over 2,000 orthopedic surgeries and has seen more than 25,000 patients in practice, with more than 15,000 treated for hip related disorders. His approach centers on identifying the true driver of each patient's pain rather than relying on imaging alone. He uses a structured framework combining clinical assessment, imaging, and diagnostic injections to confirm the diagnosis before recommending any treatment.

#HipPain #HipLabralTear #HipSurgery #Orthopedics #HipArthroscopy

Transcript

SPEAKER_00 0:00

Your groin pain probably isn't a core problem. And here's what soccer players keep missing. If you've been told your groin pain is a core muscle issue, you've done the rehab and you're still not right, well, this video is for you. Groin pain in soccer players gets misdiagnosed almost more than any other injury that I see. And it's not because the treating clinicians are incompetent. It's because the injury itself is layered. And most evaluations just stop one step too short. I've treated hundreds, if not a thousand, athletes with hip pain, academy level, professional level. And the pattern I see over and over is the following months of appropriate treatment, persistent symptoms, and a hip joint that was never actually ruled out. So it's actually going inside that joint. And how do you know if it's a source of your pain? Well, that's what this video is about. And I'm going to show you how groin pain gets misread and what structures most people miss, and exactly what to do before your next deployment. Point number one, groin pain is rarely just one thing. When a soccer player walks in with groin pain into my office, the most common work-in diagnosis that they've already received is a core muscle injury or athletic pubalgia, sometimes called a sport hernia. And that diagnosis is often correct. The muscles and the tendons where your lower abdomen meets your pelvis, they take an enormous amount of load in a sport built on explosive cutting, kicking, and change of direction. Those tissues get strained, they get irritated, and those can make your groin hurt. But the problem isn't that athletic pubalgia is a wrong diagnosis. The problem is that it's frequently an incomplete one. Because the hip joint sits directly beneath that same region. When the ball and socket of the hip have abnormal contact, meaning extra bone on the femur of the ball pressing into the socket with every deep flexion moment, it creates a mechanical friction and it then tears the cartilage ring around the socket called the labrum. And that generates pain exactly where a core muscle injury would land. The same location, similar triggers, and almost identical on the surface. So an athlete gets treated for the core injury, does the right exercises, they arrest appropriately, and improves slightly, but it never fully clears. And the conclusion too often is that they just need more time, more rehab, or they're just not progressing. And what never gets asked is whether the hip joint was ever confirmed or ruled out as a source. And that's the one question that then changes everything. Because here's the thing the hip is a layered system. And structural problems, meaning the bone shape, the joint mechanics, they behave differently from muscle problems. They don't respond to rest and strengthening the way soft tissue injuries do. They need a different kind of evaluation. And without that, you end up treating a symptom while the source keeps firing. Point number two, the diagnosis most athletes never get. There's a step in the diagnostic process that most groin pain workups skip entirely. And it's that step that actually confirms whether the hip joint is your primary source of pain. It's called a diagnostic injection. And how that works is under ultrasound guidance, a numbing agent is injected directly into the hip joint, not around it, but straight into it. And so if your pain improves a lot within a short window after that injection, that's confirmation. Confirmation that the joint is the source. And now you know what you're treating. But here's the thing: if the pain doesn't change, then the joint is likely not primary. And now you know what that means too. Now this isn't experimental. It's not aggressive. It's a precision diagnostic step that takes the guesswork out of a presentation that's otherwise almost impossible to read from the outside. And yet it gets skipped constantly because the patient already had a work-in diagnosis, or because imaging suggested something else, or because the joint just wasn't even considered. And here's why that matters at a practical level. MRIs, they can show a labral tear, it can show camorphology in the ball of femur, but imaging tells you what's present, not what's causing your pain. An athlete can have a labral tear on imaging and not be symptomatic from it. And I see that all the time. But an athlete can also have a clean-looking MRI and have a joint that's unambiguously the primary pain generator. And so the image is one input, but it's not the conclusion. So think of it this way: the diagnostic injection is the tool that then bridges the gap between what's visible on imaging and what's actually the source. Without it, you're basically treating a guess. If this is helping you think through a situation or someone you know has been stuck in, subscribe. I break down these diagnostic gaps every week, the patterns that keep athletes from getting the right answer fast enough. And so on to point number three. Does this sound like your situation? Before we go further, I want you to honestly assess whether what I'm describing maps onto what you're experiencing. Now, not every groin pain is a hip joint problem, but there are patterns that show up consistently when it is. And so ask yourself these four questions. Number one, has your hip or groin pain persisted for more than six weeks despite rest and core muscle focus rehab? Number two, does your pain get worse with deep hip flexion, whether it's kicking, lunging, sitting for a long time, or even squatting? Number three, has the pain ever been described as deep, achy inside the groin discomfort rather than on the surface of the muscle? Number four, have you had imaging ordered but never had a diagnostic injection into the hip joint itself? And so if you answered yes to most of these, then I'll tell you, the hip joint has not been adequately evaluated as a potential source. Now, that doesn't mean surgery is in your future. It means that a step was skipped. And without that step, neither you nor your clinician may actually know what's driving your symptoms. And sadly, this is the part where a lot of athletes may lose months, sometimes years, because the treatment keeps targeting the wrong structure. On to point number four. And so treating the right structure changes the outcome. I want to tell you about a patient I'll call Alex. He's 18 years old. He had growing pain on both sides, and so bilateral, and his hip flexors were constantly tight no matter how much he stretched or trained around them. He was in a professional soccer academy, but he was playing through pain. He was losing performance and he was losing confidence with every game. And he was just watching his window narrow. He'd been treated appropriately for an athletic pubalgia diagnosis, rest, rehab, oral anti-inflammatories, activity modification, the right treatment for that diagnosis, but it just wasn't working. And so when I evaluated him, the clinical picture pointed towards the hip joints, specifically femoral astavidor impingement, or FAI, with labral pathology on both sides. And Alex basically had extra bone of the ball of the femur, each hip, creating friction with every movement that mattered to his sport. And so his labrum was being damaged, but the core symptoms he was experiencing were downstream of that mechanical problem, not the primary source. Now, understandably, his parent was skeptical about surgery. And that's fine. And that is the right posture to have. You should be inquisitive. But what changed his mind wasn't my recommendation. It was the bilateral diagnostic hip injections we gave him because both his hips responded right after and they actually felt a lot better. So then we said the joint was confirmed as the primary on both sides. And so now there was no ambiguity about what needed to be treated. Ultimately, Alex underwent same-day bilateral hip arthroscopy. We addressed the impingement, the structural bone issue, and then repaired the laboral damage on both sides. At four and a half months, Alex returned to play and he was clear to compete. He had a high performing season. He earned a collar scholarship that allowed him to continue fulfilling his dream of playing soccer. Now, what I want you to take from that isn't that surgery was the answer. It's that getting the diagnosis right was the answer. Surgery was ultimately the treatment that followed, but the diagnosis was the thing that had been missing. Because when you treat the actual source, outcomes can be predictable. And when you treat the symptom, you stay stuck. The hip joint in a young athlete with FAI will keep creating mechanical irritation. It'll keep tearing the labrum and it'll keep generating progressive cartilage damage as long as the structural problem remains. Rest doesn't fix bone shapes that are abnormal, and strengthening doesn't fix impingement. Treating the right structure does. So think of it this way: you'd think about a training film. Before you can fix a technical problem, you need a footage film of what's actually happening in a sense. And what you're about to do is collect that footage. Specific, clear information about your pain that then changes how productive your next clinical conversation becomes. And so here are four concrete steps to take tonight before your next physio session. Number one, I want you to map exactly where your pain is. Use two fingers at most to locate the pain. Is it at the front of the groin, deep inside the joint, in the inner thigh, or across the lower abdomen near the pubic area? The location matters because hip joint pain typically sits deep in anterior, not at the surface of the muscles. Number two, list three movements that reliably reproduce your pain. Be specific. Is it kicking with a dominant leg, sitting longer than 30 minutes, getting out of a car, squatting below 90 degrees? Because if deep hip flexion is constantly on that list, you got to write that down. Number three, honestly, rate how much core focus rehab has moved the needle. So on a scale of one to 10, where one is no change and 10 is fully resolved, where are you, at least after six weeks of rehab? If you're below a six or seven and you've been consistent, that treatment target may be wrong. Point number four. Now bring one specific question to your next appointment. Has the hip joint been definitely ruled out as a primary pain source? And if not, is a diagnostic injection then appropriate for me? That question tells your clinician exactly where your thinking is, and it then opens the door that often stays closed. In conclusion, groin pain in soccer players is layered. And the most dangerous version of this injury isn't the one that hurts the most. It's the one that looks familiar enough to get a fast diagnosis that then stops the evaluation too early. The hip joint is the most commonly missed source in this presentation, not because it's rare, but because it mimics the more obvious diagnosis well enough that the evaluation never goes up one level deeper. And so what gives athletes the best outcomes isn't more rest or more exercises. It's an accurate diagnosis that identifies the actual source, confirms it with the right tools, and then builds a treatment plan around that specific structure. And that's what predictable recovery looks like. Now, if you haven't already, watch my recent video called After Performing Over 2,000 Hip Surgeries, I Stop Trusting MRI Results Alone. That video covers the diagnostic gap I see most often and why imaging alone isn't enough to confirm a diagnosis and what additional steps actually tell you what's driving the pain. Again, my name is Dr. Al Mastery. I'm an orthopedic surgeon, hip reservation, and sports medicine specialist. Thanks for listening.