How should I manage left inguinal region pain that started after running?

Management of Left Inguinal Ligament Pain After Running

Continue modified running activity while initiating a physiotherapist-led hip strengthening program rather than resting completely. 1

Immediate Management Approach

Do Not Stop Running Completely

• Maintain modified physical activity throughout treatment rather than prescribing complete rest, as this preserves cardiovascular fitness and prevents deconditioning. 1
• Complete rest should only be considered if a stress fracture is suspected. 1

Initial Assessment Focus

• Evaluate hip range of motion and movement quality during functional tasks such as single-leg squats to identify deficits contributing to pain. 1
• Examine for pain with palpation over the pubic symphysis or surrounding structures, as the pubis acts as a pivot point between abdominal musculature and lower-extremity adductors. 2
• Test for pain reproduction during resisted sit-up or with forced cough/sneeze, which suggests athletic pubalgia (sports hernia). 2
• Assess for coexisting hip pathology, particularly femoroacetabular impingement, which can produce transfer stress to the pubic region and manifest as inguinal pain. 3

Core Treatment Protocol

Physiotherapy Program (First-Line Treatment)

Implement a structured program emphasizing:

• Progressive hip-muscle strengthening targeting abductors and flexors using adequate load, frequency, and progression principles. 1
• Dynamic balance and single-leg control exercises to improve neuromuscular stability of the lower limb. 1
• This approach is supported by consensus guidelines and should be attempted before considering surgical options. 1, 2

Graduated Return-to-Running Protocol

Follow a three-phase progression that is symptom-guided:

1. Initial phase: Focus on strength building, cardiovascular conditioning, basic athletic movements, and load tolerance. 1
2. Progressive phase: Introduce sport-specific tasks with incremental increases in running speed. 1
3. Advanced phase: Add high-speed running, twisting, turning, and provocative positions at speed. 1

Monitoring Progress

• Use validated outcome measures such as the Copenhagen Hip and Groin Outcome Score (HAGOS) or International Hip Outcome Tool (IHOT) to track functional recovery. 1
• Complement patient-reported outcomes with objective measures including hip range of motion, hip-muscle strength, and functional task performance. 1

When Conservative Treatment Fails

Consider Athletic Pubalgia (Sports Hernia)

If symptoms persist despite 6-12 weeks of focused physical therapy and anti-inflammatories:

• Magnetic resonance imaging can identify tears or strains of the rectus abdominis or adductor tendons and rule out other pathologies. 2
• Lidocaine injections can localize the pain source. 2
• Surgical options (open or laparoscopic) include reattachment of rectus abdominis, repair of abdominal musculature, and possible adductor tenotomy, with high rates of return to play reported. 2, 4

Common Pitfall

Do not overlook concurrent femoroacetabular impingement: Diagnosis and treatment of coexisting hip pathology are crucial to successful return to athletic activity, as constrained hip motion can produce pathologic transfer stress to the pubic symphysis. 2, 3