[Pubalgia: from diagnosis to return to the sports field]

To review reports of the diagnosis and treatment of groin pain (pubalgia) on the basis of anatomical considerations, epidemiology and pathogenicity.

We searched the Medline database using the key words groin injury, groin pain, and symphisis syndrome for information on groin pain.

Despite the limitations of this study, athletic pubalgia appears to be a real diagnosis, with a long duration of symptoms and a therapeutic challenge. The pathophysiologic processes of this lower abdominal pain resulting from over use is unclear, but muscular imbalance might be involved in the pathogenicity. There is no consensus on the diagnostic criteria and the role of imaging (magnetic resonance imaging). Physicians should eliminate the diagnosis of hip and groin injuries in athletes. Specific rehabilitation should include eliminating the pain-triggering factors, increasing the limited flexibility, and strengthening the abdominal muscles and adductor muscles. The multidisciplinary team's goal is to restore function and prevent recurrence. Successful surgical repair is predictable in well-selected patients.

Further studies are required for better assessment of incidence, the natural course of groin pain, and optimal clinical evaluation in screening patients. Overall, a large prospective randomized study of athletes with groin pain would help determine optimal treatment.