Persistent gross pain.

? I am a 48-year-old male who typically runs about 30 miles a week. I also play basketball twice a week. I have recently felt pain in my right groin area while exercising. Two years ago I had an inguinal hernia, in that same area, which required surgery. My surgeon told me I do not have a recurring hernia, but possibly a groin injury, scar tissue or just symptoms of overuse. He did notice that the area was generally weak. Cutting back on exercise, complete rest and taking aspirin and ibuprofen have not helped. Are there any specific exercises to strengthen the groin, and/or a recommended schedule of rest and exercise that I should follow? What about other medication?

Len DiGregorio, Hackettstown, NJ

This can be a difficult problem to treat. Often athletes may suffer from groin pain and have difficulty returning to their sport for months or years despite rest and treatment. The key to recovering is a correct diagnosis, as symptoms of groin pain can arise from numerous causes, sports-related and otherwise. Groin injuries are a diagnostic and therapeutic challenge, even to the most skilled clinician. The anatomy of the area is complex and the symptoms are often the result of multiple pathologies. If you have recurring pain without a recurring inguinal hernia, I suspect some other etiology for your groin pain; some of the most common in athletes are muscle strains of the thigh or rectus abdominus, as well as stress fractures of the femur or pelvis. Nighttime pain is a key symptom that would suggest a stress fracture. A bone scan would help diagnosis this. Treatment is complete rest from running for 8 to 12 weeks.

An often unrecognized cause of groin pain is a condition called a sports hernia. It is caused by a tear of the transversus abdominus muscle and differs from the inguinal hernia in that it does not involve a clinically detectable hernia. Sometimes surgery is performed for an inguinal hernia which does not correct the sports hernia.

After you obtain an accurate diagnosis, there are numerous stretching and strengthening exercises that will help in the long run. Each day, stretch for 20 to 30 seconds with 4 to 6 repeats the hip adductors and flexors, the iliotibial band and the hamstrings. Perform strengthening exercises 3 to 4 times weekly. Focus on the hip adductor, abductor, flexor and external rotator muscles. Try 3 sets of 15 repetitions, using an exercise band for resistance. Consult a local sports trainer or therapist to ensure proper form when learning these specific exercises.

Troy Smurawa, MD, Akron, OH

Here are a few brief descriptions of the most common exercises used to stretch and strengthen the groin.

Stretching

Flexor stretch. Lie on your back on your bed with both legs over the end of the bed. Bring one leg up to your chest and allow the other leg to stretch down to the floor.

Adductor stretch. Sit on the floor in the position known as "Taylor sitting": hips rotated out, with knees bent and sneakers sole-to-sole. Grip your ankles and push both knees to the floor with your elbows.

Strengthening

Straight leg raises in all four planes: Flexion. Lie on your back and bend one knee while raising the other leg up.

Abductors. Lie on your side and bend the lower leg while lifting the other leg up.

Extensors. Lie on your stomach and lift one leg up.

Adductors. Lie on your side and bend the upper leg while lifting the lower leg up.

Carol Zehnacker, MS, PT, OCS, Frederick, MD

Please note that Clinic responses frequently appear as excerpts of longer answers, especially when the inclusion of two full answers would result in redundant information.

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