Surgery for groin
pain and injury

Is surgery right for groin pain?

Surgery is rarely the first step for groin pain. Most people start with education, activity changes, and a structured strengthening program, and many get back to sport and daily life without an operation.¹ ⁵ ⁶

Doctors may begin to discuss surgery if:

• You have long lasting groin pain that has not improved with a good course of active rehabilitation
• Your pain is clearly linked to a structural problem, such as hip joint changes, inguinal disruption, or a high risk stress fracture
• Your symptoms are stopping you from walking, working, or playing sport despite careful, guided treatment

In athletes, groin pain often has more than one cause at the same time, for example adductor tendinopathy plus pubic bone irritation plus hip joint changes.¹ ¹⁵ This is one reason surgery is not automatic. Fixing one structure may not fully solve the problem if strength, control, and training loads are not also addressed.

Decisions about surgery are shared. Your doctor and physical therapist will look at:

• Your main diagnosis (for example, adductor related, pubic related, inguinal related, hip related, or bone stress)¹
• How long you have had symptoms
• What you have already tried
• Your sport or work demands and personal goals

For high risk problems, such as tension side femoral neck stress fractures or a trapped hernia (part of the bowel pushes through a weakened area of the abdominal wall and gets stuck), surgery can be urgent and is often needed to protect the hip or your general health.¹¹ ¹² ¹⁴ For most other groin pain, surgery is a considered choice, but not an emergency, and there is time to weigh options against less invasive alternatives.

Common surgical options for groin pain

Surgery for groin pain is tailored to the main pain source. You may hear about:

Hip surgery for femoroacetabular impingement or “FAI” (abnormal contact between deformed bones)

• It can be done by arthroscopy (through small cuts with a camera in the hip joint) or by mini open surgery
• Aims to reshape extra bone (cam or pincer) and repair or tidy the labrum and cartilage⁷ ⁸ ⁹
• Considered in people with clear FAI on scans and ongoing hip related groin pain after well structured conservative care

Surgical repair for inguinal disruption

• Reinforces the back wall of the inguinal canal (passage in the lower anterior abdominal wall) when there is weakness or tearing, but no classic hernia sac
• Can be done by open or keyhole (laparoscopic) methods in centers that specialise in athletic groin surgery¹³
• Considered when inguinal related pain limits sport and has not improved with focused rehab

Procedures for adductor or pubic related groin pain

• Options include adductor longus release (tenotomy) or operations around the pubic symphysis, such as curettage or stabilisation¹⁵ ¹⁷
• Usually reserved for athletes with long standing symptoms who have tried a high quality strengthening and load program first

Fixation of femoral neck stress fractures

• Uses screws or a plate to stabilise the top of the thigh bone
• Urgent for tension side or displaced femoral neck stress fractures to lower the risk of non union and damage to the blood supply of the femoral head¹¹ ¹²

Not everyone with these diagnoses will need an operation. Surgery is only one tool, and it almost always needs to be combined with a strong rehabilitation plan.¹ ⁵ ⁸

What to expect during recovery

Recovery after groin surgery varies by procedure, how long you have had symptoms, and your sport or work goals. There is no single timeline that fits everyone, but there are common patterns.

Early days to first few weeks

• Pain and swelling are common. You may use crutches for a short time after hip or femoral neck surgery.⁸ ¹¹ ¹²
• You will usually start gentle movements and basic muscle activation early, guided by your surgical team and physical therapist

First 6 to 12 weeks

• Focus is on restoring comfortable walking, hip and trunk range of motion, and early strength
• After hip arthroscopy, many people work through a staged program that includes gait training, hip and core strength, and gradual exposure to sitting, stairs, and light functional tasks⁸ ⁹
• After adductor or inguinal procedures, exercises aim to rebuild trunk and adductor strength and protect the repair as it heals⁵ ¹³ ¹⁵

3 to 6 months and beyond

• Higher level strength, power, and sport specific drills are added, such as cutting, sprinting, and kicking
• Return to sport is usually based on meeting clear criteria such as strength symmetry, hop or change of direction tests, and Copenhagen Hip and Groin Outcome Score (HAGOS) score improvements rather than on time alone⁴ ⁵ ⁶ ¹⁵
• For femoral neck stress fractures, return to impact may take several months and is guided by healing on imaging, pain free loading, and careful medical review¹¹ ¹²

Common challenges can include:

• Stiffness or weakness around the hip and groin
• Nerve type symptoms such as numbness or sensitivity in the groin area
• Flare ups when training loads rise too quickly
• Worry about re injury or loss of performance

Risks of surgery can include infection, bleeding, nerve irritation, blood clots, scar pain, or incomplete pain relief. There is also a small risk of non union or avascular necrosis with femoral neck surgery, which is why early diagnosis and the right operation are so important.¹¹ ¹²

A clear rehab plan, realistic expectations, and regular check ins with your care team can help you navigate these phases and adjust as needed.

Can surgery be avoided?

Often, yes. For many people with groin pain, especially adductor related or pubic related pain, a structured exercise program and smart load management are the main treatments and can match or outperform passive care.¹ ⁵ ¹⁵

• The classic Hölmich trial showed that athletes with long standing adductor related groin pain did better with an active strengthening program than with passive treatments alone⁵
• Team based adductor strengthening programs, such as the Copenhagen adduction exercise, have been shown to reduce groin problem rates in football when used regularly in warm ups⁶
• For hip related groin pain from femoroacetabular impingement, both physiotherapist led care and arthroscopic surgery improved symptoms. Surgery gave greater short term gains in selected patients, but not everyone needed an operation⁷ ⁸ ⁹

Surgery is hardest to avoid when:

• There is a high risk femoral neck stress fracture on the tension side or a displaced fracture¹¹ ¹²
• There is an incarcerated hernia that will not reduce or return to the abdomen¹⁴
• Conservative care has been properly tried and is still not enough to let you walk, work, or play sport

For most other groin pain, it is reasonable, and often wise, to do a full course of good rehabilitation before considering surgery.

How Sword can support you before and after surgery

Physical therapy can play an important role in preparing for surgery, supporting recovery, and, in some cases, helping people manage symptoms without surgery. Sword offers physical therapy programs designed to support you at different points along that journey.

Sword supports recovery before and after surgery, with care designed to fit into your life. You receive high-quality physical therapy at home, guided by licensed clinicians and supported by smart technology.

• Care that adapts as your body and recovery needs change
• Licensed physical therapists guiding your care at every stage
• Non-invasive, evidence-based physical therapy programs

Support for preparation, recovery, and long-term movement health

Clinical insight

Groin pain care starts with clear classification rather than a single label like “groin strain.” The Doha agreement encourages clinicians to describe groin pain as adductor related, pubic related, inguinal related, hip related, or other, based on history and examination.¹ This helps ensure that key diagnoses such as adductor tendinopathy, osteitis pubis, inguinal disruption, hip joint pathology, and nerve entrapments are considered, and that more serious causes like femoral neck stress fracture are not missed.¹ ¹⁰ ¹¹ ¹² ¹⁵