Risk factors associated with groin pain in athletes : a systematic review

Abstract

Groin pain is a common and multifactorial condition in athletes, leading to performance impairment and a reduction in participation in sports. This systematic review aimed to identify and synthesise risk factors for groin pain in athletes. A comprehensive search of PubMed, Embase, Web of Science, Scopus, and SPORTDiscus was conducted from inception to May 2025. Observational studies were included, and the risk of bias was assessed using the ROBINS-E tool. Due to heterogeneity across studies, a narrative synthesis was performed. Eight retrospective cohort studies comprising 4249 male athletes from various sports met the inclusion criteria. The most consistent risk factors were a previous history of groin injury, reduced eccentric hip adduction strength, limited hip rotation, and inadequate preseason conditioning. Additional contributors included participation in Olympic weightlifting as part of sport-specific conditioning, playing in skill-specific positions, and the presence of subclinical symptoms, with associations ranging from moderate to high. The overall quality of evidence was low to moderate, with confounding and outcome measurement being the most frequent sources of bias. These findings highlight the multifactorial nature of groin pain and underscore the need for individualised screening, early detection, and preventive approaches. Future research should prioritise prospective designs, standardised diagnostic criteria, and inclusion of female athletes to improve clinical applicability.