Groin Pain That Will Not Settle: Adductor Tendinopathy, Osteitis Pubis and What PRP Can and Cannot Offer
Groin pain is one of the most mislabelled problems in sport. The Doha agreement, an international consensus on groin pain terminology published in the British Journal of Sports Medicine in 2015, exists precisely because "groin strain" had become a bucket for at least four different problems: adductor-related groin pain, iliopsoas-related pain, inguinal disruption (the so-called sports hernia) and hip-joint-related pain. Each needs different treatment, so the diagnosis comes before any discussion of injections.
The good news: the most common of these, adductor-related groin pain, has the strongest conservative-treatment evidence in sports medicine. The honest news about PRP in the groin is below. Assessment first, always. Where PRP is justified, joint and tendon PRP is £750 a session.
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The four problems hiding inside "a groin strain"
Adductor-related groin pain. Pain at the adductor longus origin, reproduced by squeezing the knees together against resistance. This is the most common athletic groin problem and the one with the best evidence: a landmark randomised trial (Hölmich and colleagues, Lancet, 1999) showed a structured active exercise programme outperformed passive treatment for long-standing adductor-related groin pain.
Iliopsoas-related pain. Felt deeper, often with a snap or catch on hip flexion.
Inguinal disruption. Pain with coughing, sprinting and sit-ups, tenderness over the superficial inguinal ring. This is the group where surgery is sometimes the answer.
Hip-joint-related pain. Groin pain that is actually the hip: femoroacetabular impingement, labral problems or early arthritis. A stress fracture of the femoral neck is the rare cause that must never be missed.
Where PRP fits, honestly stated
The published evidence for PRP in groin pain is limited to small case series without control groups, mainly around adductor longus enthesopathy and osteitis pubis. There are no large randomised trials. What those series suggest is that some people with chronic adductor tendon pain that has failed a proper exercise programme improve after ultrasound-guided PRP. That is a reasonable basis to offer it as a next step after the proven treatment has been done properly, not a basis to offer it first. If someone offers you an injection for groin pain before anyone has run you through the Hölmich-style exercise evidence, the order is wrong.
Send us how long it has been there and what provokes it | or call 020 3951 3429
What an assessment involves
The examination maps your pain onto the Doha categories: where it hurts, what provokes it, the squeeze test, the hip screen. Where the category is uncertain, imaging settles it: ultrasound for the adductor origin, MRI for the joint, the pubic bone and the fracture that must not be missed. Then the plan. For adductor-related pain, that is a progressive loading programme with real evidence behind it. For the tendon that remains stubborn after that work, PRP is a defensible next step, ultrasound-guided, £750, with expectations set by the honest state of the evidence.
Free checklist: get the diagnosis right the first time
Note exactly where the pain is: crease of the groin, deep in the hip, or over the pubic bone in the middle.
Test the triggers yourself: squeezing a ball between the knees, a sit-up, a cough, a sprint.
Night pain or pain at complete rest is not typical tendon behaviour and deserves prompt assessment.
Bring any previous scan reports. They change what imaging, if any, is actually needed.
Ask whoever you see which Doha category your pain fits. If they cannot answer, get a second opinion.
When it is not us
Groin pain with a visible lump that comes and goes can be a true hernia and needs a surgical opinion. Groin pain in a runner who has recently increased load, with night pain or pain on standing on one leg, needs a stress fracture excluded urgently. Both routes are referrals we arrange the same day.
Ready when you are: WhatsApp, call 020 3951 3429, or email team@thewellnesslondon.com
Frequently asked questions
Q: Does PRP work for groin pain?
A: The honest answer is that evidence in the groin is limited to small case series without control groups, unlike the elbow or knee. It is a reasonable next step for chronic adductor tendon pain that has failed a proper exercise programme, not a first treatment.
Q: What is the best-evidenced treatment for adductor-related groin pain?
A: A structured active exercise programme. The Hölmich randomised trial in the Lancet (1999) showed active training outperformed passive treatment for long-standing adductor-related groin pain.
Q: How much does PRP for groin pain cost?
A: Where it is justified, joint and tendon PRP is £750 a session at The London PRP Clinic. The assessment determines whether your problem is one the evidence supports treating this way.
Q: Could my groin pain actually be my hip?
A: Yes, and commonly is. The Doha agreement (British Journal of Sports Medicine, 2015) separates hip-joint-related groin pain from adductor, iliopsoas and inguinal causes because they need entirely different treatment.
References
Weir A, et al. Doha agreement meeting on terminology and definitions in groin pain in athletes. British Journal of Sports Medicine, 2015.
Hölmich P, et al. Effectiveness of active physical training as treatment for long-standing adductor-related groin pain in athletes: randomised trial. Lancet, 1999.
Reviewed by The Wellness Clinical Team. Last updated 18 October 2026.