Pain Sensitivity, Psychological Factors, and Muscle Function in Male Athletes With Long-Standing Groin Pain and Matched Controls

Long-standing groin pain in athletes is often managed as a localized musculoskeletal tissue injury. Treatment-resistant symptoms and disability after return to sport suggest that other factors may also contribute. This study compared pain sensitivity, psychological factors, and muscle function between male athletes with long-standing groin pain (N = 20) and sex-, age-, and sports-matched controls (N = 20). Pressure-pain thresholds were assessed with a handheld algometer at the adductor longus muscle and origin, iliopsoas tendon, pubic bone, pubic symphysis, gluteus maximus muscle, and elbow. Pain detection and tolerance thresholds, temporal summation of pain, and conditioned pain modulation were assessed at the lower leg with cuff-pressure algometry. Catastrophizing, fear of movement, pain self-efficacy, depression, anxiety, stress, loneliness, and sleep were assessed. Maximal and explosive hip-adduction and -abduction strength were assessed. Between-group effects were expressed as Cohen's d or rank-biserial correlation r. Athletes with long-standing groin pain showed lower pressure-pain thresholds on the most painful side (d = 0.7-1.2), and lower pain detection threshold (d = 0.7). They reported more pain catastrophizing (r = 0.6), fear of movement (r = 0.4-0.5), depressive symptoms (r = 0.3-0.4), and lower pain self-efficacy (r = 0.6). Explosive strength was lower during both hip-adduction (d = 0.8) and hip-abduction (d = 0.7-0.9). At the group level, male athletes with long-standing groin pain showed altered pain sensitivity, adverse psychological factors, and lower explosive hip strength, despite inter-individual heterogeneity in these factors. Athletes with these characteristics may require a more biopsychosocial management than the traditional approach.