Groin Pain: The DOHA hip Classification

Our groins are complex but strong structures that contain some of the most powerful muscles in our body. However, they are still prone to injury particularly for those that participate in team and cutting sports. The wide variety of probable causes for hip pain, given there are many different structures (e.g. muscles and tendons, ligaments, nerves, blood vessels), means an accurate diagnosis can be often difficult or missed.

In 2014, a group of 24 hip medical experts discussed groin pain in athletes to methodically categorise groin injuries in order to assist medical professionals in their accurate diagnoses, and therefore treatment, of groin injuries. This conference, known as the Doha Hip Agreement, categorises groin injuries into six sections with their own unique classification criteria:

Adductor Related Groin Pain: A positive test for this group results in pain felt in the adductor muscle group during resisted adduction testing and tenderness over the adductor group.

Iliopsoas Related Groin Pain: Pain reproduction with resisted hip flexion and hip-flexor stretching indicate a positive test. Palpation for this muscle is not possible due to its position deep in the hip.

Inguinal Related Groin Pain: Positive markers must include:

- Localised pain in the inguinal canal region

- Tenderness of the inguinal canal

- No palpable inguinal hernia present

- Pain with abdominal muscle resistance OR on pressure increase such as during

cough/sneeze

Pubic Related Groin Pain: Tenderness of the pubic symphysis with palpation indicates a positive test for pubic related groin pain.

Hip Related Groin Pain: The hip joint is important to consider as a possible cause for groin pain. Passive range of motion screening and special tests of the hip are mainly performed to exclude structures of the hip as a cause of groin pain.

Other Related Groin Pain: Other potential causes of groin pain can include orthopeadic, neurological, dermatological, and oncological causes. All of these should be screened for.

The rehabilitation process will we dependant on the clinical diagnosis made by your therapist. Physiotherapy management of groin pain should involve an individualised exercise program, education around return to

activity, and manual therapy.

If you are experiencing groin pain, you can book an appointment here.