Runner's Groin Pain in : A Physiotherapy Approach
Updated: 6 days ago
From managing symptoms to rebuilding strength, sprint exposure and return-to-performance capacity. This article outlines a practical framework for approaching adductor-related groin pain in runners, from the initial management of symptoms through to return to performance.
Adductor-related groin pain is a common and often frustrating problem for running athletes. For sprinters, the challenge becomes even greater because the demands of acceleration, high-speed running, powerful hip movements, and repeated exposure to high forces can place substantial stress on the groin region.
For a 100 m or 400 m runner, being able to walk without pain—or even jog comfortably—does not necessarily mean they are ready to sprint.
The rehabilitation process therefore needs to go beyond simply reducing pain.
The athlete needs to progressively rebuild the capacity to tolerate strength, speed, acceleration, repeated high-intensity running, and eventually the demands of competition.
1. Why adductor pain can be difficult for sprinters ?
The adductor muscle group is located along the inner aspect of the thigh and includes the adductor longus, adductor brevis, adductor magnus, gracilis, and pectineus.
Although these muscles are commonly described as muscles that “pull the leg inward,” their role during running is considerably more complex.
The adductors contribute to controlling the position of the hip and pelvis and are involved in producing and absorbing force during dynamic movements.
For sprinters, this becomes particularly relevant during:
Acceleration
High-speed running
Rapid changes in limb position
Single-leg loading
Powerful hip movements
Repeated sprinting
Running under fatigue
An athlete may therefore feel comfortable during daily activities but experience symptoms when the intensity of running increases.
This is one reason why adductor-related groin pain can become persistent.
The athlete may feel that they are “almost recovered,” yet the symptoms return when they approach the speed or workload required for their event.
The gap between being comfortable in daily life and being capable of performing at competition intensity is where rehabilitation needs to be particularly thoughtful.
2. First: is this actually adductor-related groin pain?
Before designing rehabilitation, the first question should be whether the symptoms are actually coming from the adductors.
“Groin pain” is not a diagnosis.
Pain in the groin region can arise from several structures, including the adductor muscles and tendons, pubic region, hip joint, abdominal structures, or other surrounding tissues.
A thorough assessment should therefore consider:
Location and behaviour of symptoms
Mechanism of onset
Pain during resisted adduction
Pain during adductor stretching
Hip range of motion
Adductor strength
Hip and trunk function
Running and sprinting demands
Recent changes in training load
Previous injury history
The history of the injury is particularly important.
The objective is not simply to identify where it hurts, but to understand what loads reproduce the symptoms and what the athlete currently cannot tolerate.
3. Early rehabilitation: reduce irritability without unnecessary rest
The first goal is to reduce excessive irritation while maintaining as much useful activity as possible.
Complete rest is not automatically the best solution.
In many cases, the athlete can continue training around the problem while temporarily modifying activities that significantly aggravate symptoms.
For a sprinter, this may involve reducing or temporarily removing:
Maximal sprinting
Aggressive acceleration
High-volume plyometrics
Wide-stance or provocative movements
Heavy adductor loading
High-intensity change-of-direction work
The principle is simple:
Reduce the load that the athlete cannot currently tolerate while maintaining the load they can tolerate.
This helps avoid the common cycle of:
Pain → complete rest → feeling better → sudden return to full training → symptoms return.
4. Building adductor strength and load tolerance
Once symptoms are sufficiently controlled, progressive strengthening becomes a central component of rehabilitation.
Early loading may include exercises such as:
Isometric adduction
Ball or pad squeezes
Supported adduction exercises
Controlled hip adduction
Short-lever Copenhagen variations
These exercises can provide a relatively controlled way to introduce force into the adductor system.
As tolerance improves, the athlete can progress toward higher-load exercises such as:
Long-lever Copenhagen variations
Cable or band-resisted adduction
Split squats
Lunges
Lateral movements
Loaded single-leg exercises
Multi-planar strength exercises
Progression should reflect improvements in:
Load → range → control → speed → complexity → sport-specific demand.
The athlete should gradually become capable of producing and absorbing greater forces through the hip and groin region.
Strength is not just about the number on the exercise.
5. Why strengthening alone isn't enough ?
One of the most common rehabilitation mistakes is assuming that an athlete is ready to return to running because they can perform strengthening exercises without pain.
Strength training is essential.
But sprinting is not a gym exercise.
Running involves rapid force production, high rates of loading, single-leg support, coordination between the hip and pelvis, and repeated exposure to high-speed forces.
An athlete may therefore demonstrate good strength during a controlled exercise but still experience symptoms when running at higher speeds.
This is not necessarily a failure of rehabilitation.
It simply means that the athlete has developed capacity in one environment but has not yet transferred that capacity to the demands of running.
This is why rehabilitation should gradually move from:
Controlled strength → dynamic strength → running → acceleration → high-speed running → repeated sprint exposure → full training.
The gym builds capacity.
Running teaches the athlete to use that capacity at speed.
6. Reintroducing running
Returning to running should be considered a progression rather than a single event.
An athlete may begin with comfortable jogging before progressing toward faster running.
The exact progression depends on the injury, but the general principle is to gradually increase the demands placed on the athlete.
For example:
Walking → jogging → moderate running → faster running → controlled acceleration → faster acceleration → high-speed running
The athlete's response should be monitored during the session and after it.
Important questions include:
Did symptoms increase during the session?
Did running mechanics change?
Did the athlete begin protecting the painful side?
How did symptoms respond later that day?
How did the athlete feel the following morning?
Was the next training session affected?
The next-day response is particularly useful.
An athlete who feels comfortable during running but develops significantly increased pain or stiffness afterward may have exceeded their current capacity.
In that situation, the answer is not necessarily to stop rehabilitation.
It may mean that the previous progression was too aggressive and needs to be adjusted.
7. Acceleration and high-speed running
For sprinters, returning to jogging is only the beginning.
Acceleration and high-speed running represent substantially different demands.
The transition from running to sprinting should be progressive. Acceleration can be modified by changing:
Starting position
Distance
Intensity
Number of repetitions
Recovery period
Total session volume
For example, an athlete may initially perform controlled accelerations before progressing toward longer or faster efforts.
Eventually, the athlete needs exposure to higher running speeds.
A 100 m runner cannot be considered fully rehabilitated simply because they can jog pain-free.
They eventually need to demonstrate the ability to tolerate the high-speed demands of sprinting.
High-speed exposure should be earned progressively
There can be a large difference between:
“I can run.”
and
“I can run fast repeatedly without symptoms.”
8. The 400 m athlete: managing fatigue
The 400 m event introduces another layer of complexity.
A 400 m athlete needs to produce high levels of force and speed while progressively accumulating fatigue.
This means that an athlete may tolerate an isolated sprint when fresh but experience symptoms during repeated high-intensity efforts.
Fatigue can change movement strategy, force production, coordination, and the athlete's ability to control the pelvis and lower limb.
Therefore, rehabilitation should eventually include appropriately progressed exposure to fatigue.
This does not mean immediately reproducing a full 400 m training session.
Instead, fatigue-related demands can be introduced gradually through:
Increased repetitions
Reduced recovery
Longer running efforts
Progressive speed exposure
Event-specific conditioning
Gradual return to normal training sessions
The key question becomes:
Can the athlete maintain their movement and force-production capacity when fatigue begins to accumulate?
This is particularly important before competition.
A rehabilitation programme that prepares an athlete only for their first sprint repetition may not adequately prepare them for the demands of the final part of a 400 m race.
9. Return to sport vs Return to performance
Return to sport may mean that an athlete is able to participate in training.
Return to performance means they have developed the capacity to meet the demands required to perform effectively.
These are not always the same.
Before returning to competition, rehabilitation should consider:
Symptoms : Can the athlete train without significant or progressively worsening symptoms?
Strength : Can the adductors tolerate high levels of force through relevant ranges and positions?
Running : Can the athlete tolerate progressively faster running?
Acceleration : Can they accelerate without significant symptoms or protective movement?
High-speed exposure : Have they been progressively exposed to the speeds required by their event?
Training volume : Can they tolerate a meaningful amount of normal training?
Fatigue : Can they maintain performance when fatigue increases?
Confidence : Does the athlete trust the injured side during high-speed movements?
Return-to-performance is better understood as a progressive accumulation of evidence that the athlete can tolerate the demands of their sport.
10. Common rehabilitation mistakes
Mistake 1: Complete rest until pain disappears
An athlete may feel better after several days away from training while still being poorly prepared for high-speed loading.
Mistake 2: Returning to sprinting too quickly
Progressive exposure is usually more appropriate than an immediate return to full speed.
Mistake 3: Only strengthening in the gym
Gym strength is important, the athlete must eventually transfer strength into running-specific tasks.
Mistake 4: Treating every symptom with stretching
A sensation of tightness does not automatically mean that a muscle needs more stretching.
Repeated symptoms may instead indicate that the athlete needs improved load tolerance or a modification in training.
Mistake 5: Ignoring training load
If symptoms developed following a significant increase in sprint volume, intensity, strength training, or competition exposure, simply treating the painful area without addressing the training context may not solve the problem.
Mistake 6: Stopping rehabilitation once daily activities are pain-free
Walking, sitting, and climbing stairs represent only a small fraction of the demands placed on a competitive sprinter.
The final stages of rehabilitation need to reproduce the athlete's actual sporting demands.
11. A practical way to think about progression
Adductor rehabilitation can be viewed as a progression from capacity to performance.
A useful framework is:
1. Settle symptoms - Reduce activities that significantly aggravate the problem while maintaining appropriate general activity.
↓
2. Introduce loading - Begin controlled adductor loading and progressively increase force tolerance.
↓
3. Build strength - Develop strength through different ranges, positions, and loading conditions.
↓
4. Develop dynamic capacity - Introduce more complex, single-leg, multi-planar, and faster movements.
↓
5. Reintroduce running - Progress from comfortable running toward faster running.
↓
6. Introduce acceleration - Gradually increase acceleration intensity, distance, and repetition volume.
↓
7. Develop high-speed exposure - Progress toward the speeds required by the athlete's event.
↓
8. Add fatigue and training demands - Increase repetition, volume, and event-specific demands appropriately.
↓
9. Return to training - Reintegrate the athlete into progressively larger portions of normal training.
↓
10. Return to performance - Prepare the athlete to tolerate the demands required to compete at their previous or intended level.
The exact progression will vary between athletes.
A first-time injury, recurrent symptoms, acute muscle injury, and persistent groin pain should not all be managed using the same template.
The most useful rehabilitation programmes are therefore principle-based rather than exercise-based.
Final takeaway
Adductor-related groin pain in runners should not be viewed simply as a problem of pain in the inner thigh.
For a sprinter, the real rehabilitation challenge is rebuilding the capacity to tolerate progressively greater levels of force, speed, acceleration, repetition, and fatigue.
The athlete needs to move from symptom management to strength, from strength to running, and from running to sport-specific performance.
Being pain-free during everyday activities is an important milestone—but it is not necessarily the finish line.
For a runner, successful rehabilitation means being prepared for what happens when the athlete is asked to run fast, accelerate aggressively, repeat high-intensity efforts, and perform under fatigue.
The goal of rehabilitation is not simply to get the athlete back on the track. It is to prepare them to perform on it.
Nidhi Nadar (PT)
Sports Physiotherapist | Sports Rehabilitation & Performance
Comments