Gilmore’s groin is a term for chronic groin pain in athletes caused by damage to the muscles and tendons of the lower abdominal wall, not by a true hernia. Named after British surgeon Jerry Gilmore, who described the condition and its surgical repair in the 1980s and 1990s, it remains one of the most confusing diagnoses in sports medicine, partly because it goes by at least half a dozen names and partly because the anatomy involved is genuinely complicated. The condition is most common in sports involving kicking, twisting, and rapid direction changes, and it can sideline athletes for months if it is not recognized and managed properly.
What the Condition Actually Is
Gilmore’s groin refers to a pattern of injury in the inguinal region, the crease where your lower abdomen meets your thigh. The damage involves tearing, stretching, or degeneration of the muscles and tendons that anchor to the pubic bone, particularly where the rectus abdominis (the “six-pack” muscle) meets the adductor longus (one of the inner-thigh muscles that pulls your leg inward). Repetitive high-impact activities generate shear forces across the pubic symphysis, the joint at the front of the pelvis. Over time, microtears accumulate, leading to inflammation, swelling, and sometimes nerve irritation behind the inguinal ligament.1PubMed Central. Narrative Review and Clinical Recommendations for Sportsman’s Hernia and Athletic Pubalgia Based on 30 Years of Expert Experience The posterior wall of the inguinal canal weakens, which can produce a subtle bulge under strain, but there is no discrete sac of tissue poking through a hole the way a conventional hernia presents.
The crucial anatomical detail is how tightly packed the structures are around the pubic symphysis. Cadaveric studies show that the adductor longus tendon sits less than a centimeter from the rectus abdominis attachment, and the adductor longus communicates with the opposite side’s rectus sheath, the pubic symphysis capsule, and the inguinal ligament.2PubMed. Anatomical and mechanical relationship between the proximal attachment of adductor longus and the distal rectus sheath This web of connections acts as a force highway. When an athlete sprints, pivots, or kicks, enormous loads travel through this junction. If one element weakens, neighboring structures pick up the slack and can fail in turn.
Why It Has So Many Names
Few injuries in sports medicine have generated as much terminological chaos. The same condition has been called Gilmore’s groin, sportsman’s hernia, sports hernia, athletic pubalgia, inguinal disruption, and core muscle injury. A systematic review found that “athletic pubalgia” was the most commonly used term in the literature, followed by “sports hernia.”3PubMed. A Systematic Review Shows High Variation in Terminology, Surgical Techniques, Preoperative Diagnostic Measures, and Geographic Differences in the Treatment of Athletic Pubalgia/Sports Hernia/Core Muscle Injury/Inguinal Disruption The British Hernia Society weighed in on this mess in 2014, recommending “inguinal disruption” as the preferred name and explicitly rejecting “sportsman’s hernia” on the grounds that no true hernia exists.4British Journal of Sports Medicine. ‘Treatment of the Sportsman’s groin’: British Hernia Society’s 2014 position statement based on the Manchester Consensus Conference
This naming tangle is not just academic pedantry. It causes real problems for athletes trying to get a diagnosis. A player told they have a “sports hernia” may end up in front of a general surgeon who looks for a conventional hernia, finds nothing, and sends them home. A player told they have “athletic pubalgia” may see a different specialist entirely. The inconsistency also makes research harder to compare across studies, because different groups may be studying overlapping but not identical patient populations. If you are dealing with chronic groin pain and getting conflicting opinions, understanding that these names all describe variants of the same family of injuries can save you months of diagnostic limbo.
Who Gets It and Why
The condition is most common in athletes who play sports requiring sudden acceleration, deceleration, twisting, and kicking. Soccer and rugby players are the classic cases, though ice hockey, Australian rules football, and American football players are also frequently affected.5Clinical Orthopaedics and Related Research. The Athletic Hernia The common thread is repetitive, high-energy rotational loading through the pelvis.
The injury develops from the accumulation of microtrauma rather than a single dramatic event. An athlete might notice a vague ache in the groin after training that gradually becomes sharper and more persistent over weeks or months. Eventually, the pain limits the ability to sprint, change direction, or kick at full force. Twisting movements tend to be the worst provocation, because they generate shearing forces across the pubic symphysis while the abdominal and adductor muscles are simultaneously pulling in opposite directions.6PubMed Central. The recognition and evaluation of patterns of compensatory injury in patients with mechanical hip pain
Men are diagnosed far more often than women, which likely reflects both the demographics of the highest-risk sports and genuine anatomical differences. An MRI study comparing male and female athletes with groin pain found that women were significantly less likely to have injuries at the rectus abdominis-adductor longus junction or in the short adductor muscles. Women were, however, much more likely to show degenerative changes in the pubic bone itself.7PubMed Central. Imaging of groin pain in athletes: patterns of injury at MRI and gender differences therein The wider female pelvis distributes forces differently, which may protect the soft-tissue attachments but load the bony structures in other ways.
How It Is Diagnosed
There is no single test that clinches the diagnosis, which is part of what makes this condition frustrating for athletes and clinicians alike. Diagnosis relies on a combination of history, physical examination, and imaging.
The typical story is an athlete with gradually worsening groin pain, worse with activity and often radiating into the inner thigh, lower abdomen, or perineum. On examination, tenderness is commonly found over the pubic tubercle, the pubic symphysis, or the adductor muscle origins. One study reported that about a third of athletes with athletic pubalgia have adductor tenderness, while pain with resisted adduction (squeezing your legs together against resistance) was present in the vast majority of cases.8PubMed Central. Primary Care Sports Hernia/Athletic Pubalgia Evaluation and Management Specific provocation tests, such as the cross-body sit-up test, are very good at detecting the condition when it is present but poor at ruling out other causes, meaning they catch almost everyone who has the injury but also flag people who do not.9PubMed. Diagnostic Accuracy of Physical Examination Tests in Core Muscle Injury
MRI is the imaging workhorse. A combination of a wide-field pelvic survey and high-resolution imaging focused on the pubic symphysis can reveal the location and severity of injury to the muscles, tendons, and bone marrow in the region.10PubMed. Athletic pubalgia and “sports hernia”: optimal MR imaging technique and findings Dynamic ultrasound, performed while the patient strains or coughs, can detect subtle bulging of the posterior inguinal wall that would not show up on a static scan.11PubMed Central. Diagnosis of Groin Pain Associated With Sports Hernia Using Dynamic Ultrasound and Physical Examination: A Case Report Ultrasound is also useful for identifying frank hernias where bowel or omental tissue moves anterior to the inferior epigastric vessels during a Valsalva maneuver, helping distinguish a true inguinal hernia from the soft-tissue disruption of Gilmore’s groin.12PubMed Central. Inguinal Hernia in Athletes: Role of Dynamic Ultrasound
The Hip Connection
One of the more important discoveries in recent years is how often Gilmore’s groin coexists with hip joint problems, particularly femoroacetabular impingement (FAI), a condition where the shape of the hip joint causes abnormal contact between the ball and socket. A systematic review found that FAI has been reported in anywhere from about 12% to 94% of patients with sports hernias or athletic pubalgia, a strikingly wide range that reflects differences in how aggressively clinicians look for it.13PubMed Central. Sports hernia and femoroacetabular impingement in athletes: A systematic review The proposed mechanism is that a hip that cannot rotate normally forces the pelvis to compensate by moving more during athletic activities, which increases the shearing load across the pubic symphysis and overloads the abdominal and adductor attachments.
This relationship matters clinically because repairing the groin without addressing a stiff or impinging hip may set the athlete up for recurrence. If your hip cannot move freely, the forces that caused the original injury will keep hammering the repair. Athletes with persistent or recurrent groin pain after surgery should have their hips evaluated if this was not done during the initial workup.
Osteitis Pubis and Overlapping Conditions
Groin pain in athletes rarely comes from a single tidy pathology. Osteitis pubis, an overuse syndrome characterized by inflammation and pain at the pubic symphysis itself, shares many of the same risk factors and mechanisms. It is caused by repetitive muscle strains pulling on the pubic bones during kicking, twisting, and cutting movements.14PubMed Central. Osteitis pubis in elite athletes: Diagnostic and therapeutic approach On imaging, MRI changes consistent with osteitis pubis can be present in a large proportion of elite athletes, including many who have no symptoms at all, which complicates the picture further. A scan showing bone marrow edema at the pubic symphysis does not automatically mean that is the source of the pain.
Other conditions that mimic or overlap with Gilmore’s groin include adductor strains, hip labral tears, stress fractures of the pubic ramus, obturator nerve entrapment, and even referred pain from the lumbar spine. This is why specialists in the area often describe athletic groin pain as a syndrome rather than a single diagnosis. The examination room detective work involves teasing apart which structures are contributing and how much each one matters.
Conservative Treatment
Not every case of Gilmore’s groin requires surgery. A structured rehabilitation program is typically the first line of treatment, especially in athletes who are caught relatively early. The most effective conservative approaches focus on progressive strengthening of the abdominal and adductor muscles, core stability work, and gradual return to sport-specific movements. A randomized controlled trial comparing an active rehabilitation program to a passive treatment regimen found that the active group had roughly double the pain reduction and a far higher rate of return to sport without groin pain: 13 of the actively rehabilitated athletes returned, compared with only 3 in the passive group.15Annals of Rehabilitation Medicine. Effectiveness of Active Rehabilitation Program on Sports Hernia: Randomized Control Trial
Case reports exist of professional athletes returning to full competition within weeks through manual therapy and targeted exercise. One NHL player completed his recovery and returned to play seven weeks after injury with a conservative approach and was still competing seven years later.16PubMed Central. Non-surgical treatment of a professional hockey player with the signs and symptoms of sports hernia: a case report That said, case reports represent best-case scenarios. The evidence taken together suggests that surgery tends to be more effective than conservative treatment for athletes who have failed a reasonable rehabilitation trial, and that laparoscopic techniques generally allow a quicker return to play than open procedures.17British Journal of Sports Medicine. Sports hernias: a systematic literature review
Surgical Options and Outcomes
When conservative treatment fails, surgery aims to reinforce or repair the weakened posterior wall of the inguinal canal and reattach damaged muscle and tendon to the pubic bone. The original Gilmore repair involved open surgical reconstruction without mesh, directly suturing the torn structures. In a series of 100 consecutive groin repairs using this approach, 96% of athletes returned to competitive sport within 15 weeks.18PubMed. Gilmore’s groin repair in athletes
Since then, a range of surgical techniques have been developed. Open repairs with or without mesh, laparoscopic repairs, and conjoint tendon repairs are all in use. A long-term follow-up study tracked 100 patients for an average of 13 years and found a combined success rate of 94% for both conservative and surgical treatment.19PubMed. Sports hernia or groin disruption injury? Chronic athletic groin pain: a retrospective study of 100 patients with long-term follow-up The variation in techniques is partly regional and partly a matter of surgeon preference, with no single approach emerging as definitively superior across all studies.
When adductor pathology is a major contributor to the pain, surgeons sometimes combine inguinal repair with an adductor longus tenotomy, a procedure that partially releases the adductor tendon from its attachment to the pubic bone. A study of 32 elite athletes who underwent adductor release, 20 of whom also had a concomitant sports hernia repair, found no significant difference in performance scores between those who had the combined procedure and those who had the adductor release alone.20PubMed Central. Surgical Release of the Adductor Longus With or Without Sports Hernia Repair Is a Useful Treatment for Recalcitrant Groin Strains in the Elite Athlete A separate series using laparoscopic inguinal repair with adductor tenotomy reported that most athletes returned to full activity within about four weeks, though some experienced a return of symptoms on the opposite side.21PubMed. Total extraperitoneal laparoscopic inguinal hernia repair with adductor tenotomy: a 10-year experience in the treatment of athletic pubalgia
The Nerve Component
Pain from Gilmore’s groin is not purely musculoskeletal. In many cases, the genital branch of the genitofemoral nerve runs through or near the damaged area, and the weakened posterior wall of the inguinal canal can compress it as it bulges under load.22Sports Health / Sage Journals. Sportsmen’s Groin-Diagnostic Approach and Treatment With the Minimal Repair Technique: A Single-Center Uncontrolled Clinical Review This nerve irritation can produce burning or shooting pain that radiates into the scrotum, inner thigh, or perineum, which is why some athletes describe symptoms that do not sound like a typical muscle injury.
There is also emerging evidence that long-standing groin pain changes the way the nervous system processes pain signals more broadly. A study comparing athletes with chronic groin pain to matched pain-free controls found that the symptomatic athletes had lower pressure pain thresholds not just in the groin area but across multiple sites, suggesting a generalized increase in pain sensitivity.23PubMed Central. Pain Sensitivity, Psychological Factors, and Muscle Function in Male Athletes With Long‐Standing Groin Pain and Matched Controls Athletes with bilateral groin pain showed the largest drops in pain thresholds. This central sensitization phenomenon, where the nervous system amplifies pain signals in response to chronic input, helps explain why some athletes continue to experience disproportionate pain even after their structural problem has been addressed. It also underscores the importance of not letting the condition drag on for years before seeking treatment.
Contralateral Recurrence
One pattern that catches athletes off guard is developing the same problem on the opposite side after successful treatment. The laparoscopic repair series mentioned earlier specifically noted that when symptoms recurred, they frequently appeared on the contralateral side rather than at the original repair site.24PubMed. Total extraperitoneal laparoscopic inguinal hernia repair with adductor tenotomy: a 10-year experience in the treatment of athletic pubalgia This makes sense biomechanically. The forces that caused the original injury are not a fluke; they reflect the athlete’s sport, movement patterns, and pelvic mechanics. Repairing one side may shift compensatory loading to the other. Any postoperative rehabilitation program should address bilateral strength and stability, not just the surgical side, to reduce this risk.
Recurrence risk also ties back to the hip connection. If restricted hip motion was a contributing factor and goes unaddressed, the athlete returns to the same biomechanical environment that created the problem. Comprehensive management means looking beyond the groin itself and treating the entire kinetic chain, from the hip joint through the pelvis and core. Some surgeons now routinely screen for FAI before performing groin surgery and stage the procedures if both problems are present.
What Recreational Athletes Should Know
Most of the published research on Gilmore’s groin comes from elite and professional athletes, which can make it seem like a condition that only affects people playing at the highest level. In reality, recreational athletes who play in adult leagues, especially in soccer, hockey, and rugby, are also at risk. The same kicking and pivoting motions that injure a professional midfielder can injure a weekend player. The difference is that recreational athletes are less likely to have access to sports medicine specialists, and their symptoms may be attributed to a generic groin strain for much longer before the underlying cause is identified.
If you have had groin pain for more than six to eight weeks that is clearly linked to twisting or kicking movements and has not responded to rest, it is worth pushing for a more thorough evaluation. Ask specifically about athletic pubalgia or inguinal disruption. A standard hernia examination at your GP’s office may not detect the subtle posterior wall weakness that defines this condition. Dynamic ultrasound or MRI with protocols specifically designed for the pubic symphysis region offer much better diagnostic sensitivity than a routine physical exam.