Management of severe lower abdominal or inguinal pain in high-performance athletes. PAIN (Performing Athletes with Abdominal or Inguinal Neuromuscular Pain Study Group)

Am J Sports Med. 2000 Jan-Feb;28(1):2-8. doi: 10.1177/03635465000280011501.


The purpose of this study was to gain insight into the pathophysiologic processes of severe lower-abdominal or inguinal pain in high-performance athletes. We evaluated 276 patients; 175 underwent pelvic floor repairs. Of the 157 athletes who had not undergone previous surgery, 124 (79%) participated at a professional or other highly competitive level, and 138 patients (88%) had adductor pain that accompanied the lower-abdominal or inguinal pain. More patients underwent related adductor releases during the later operative period in the series. Evaluation revealed 38 other abnormalities, including severe hip problems and malignancies. There were 152 athletes (97%) who returned to previous levels of performance. The syndrome was uncommon in women and the results were less predictable in nonathletes. A distinct syndrome of lower-abdominal/adductor pain in male athletes appears correctable by a procedure designed to strengthen the anterior pelvic floor. The location and pattern of pain and the operative success suggest the cause to be a combination of abdominal hyperextension and thigh hyperabduction, with the pivot point being the pubic symphysis. Diagnosis of "athletic pubalgia" and surgery should be limited to a select group of high-performance athletes. The consideration of other causes of groin pain in the patient is critical.

MeSH terms

  • Abdominal Pain / etiology*
  • Abdominal Pain / pathology
  • Abdominal Pain / surgery
  • Adult
  • Athletic Injuries / physiopathology*
  • Female
  • Humans
  • Inguinal Canal / pathology
  • Male
  • Muscle, Skeletal / pathology
  • Pelvic Floor / pathology
  • Pelvic Floor / surgery
  • Pelvic Pain / etiology*
  • Pelvic Pain / pathology
  • Pelvic Pain / surgery
  • Physical Therapy Modalities
  • Syndrome