Clinical examination tests for adductor- and pubic-related groin pain in athletes with longstanding groin pain: inter-examiner reliability and prevalence of positive tests

Review written by Dr Joshua Heerey info

Key Points

  1. The inter-examiner reliability of adductor and pubic symphysis palpation tests ranged from slight to substantial.
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Longstanding groin pain is common in athletes participating in change of direction sports (1,2). When present in athletes, groin pain can result in reduced performance, inability to train and altered quality of life (3). Adductor-related injuries account for nearly two of every three groin complaints in male football players (1). Whereas, Iliopsoas- (3 to 12%), inguinal- (4 and 8%) and pubic-related injuries (3 and 9%) are less prevalent (1,2).

Although common, groin pain is renowned as being difficult to diagnose and manage (4) as the overlap of bony, articular and muscular structures can result in confusion for clinicians (4). Adding to this misperception, is the heterogenous terminology used to classify groin pain. Over the last two decades, there has been considerable advances in the classification of groin pain. Pivotal to this progress was the Doha Agreement Meeting, where international experts developed a clinically based system (including patient history and specific physical examination findings) for classifying groin pain in athletes (5).

This study sought to determine the inter-examiner reliability of clinical pain provocation tests for the hip adductors and pubic symphysis, and the prevalence of positive tests in athletes with adductor- or pubic-related groin pain.

Groin pain can result in reduced performance, inability to train and altered quality of life.
Clinicians need to be cognizant that athletes may also report pain in other structures during resistance and stretch tests, highlighting the need to confirm the location of pain when conducting a clinical groin examination.


This study was nested within a larger reliability study investigating the inter-examiner reliability of clinical tests in athletes with longstanding groin pain. Male athletes with longstanding groin pain were prospectively recruited from a large sports medicine hospital in Doha (Qatar).

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