Athletic Pubalgia: Why the Pelvis Is the Missing Link in Chronic Groin Pain

In 2012, I experienced one of the most frustrating injuries of my career.

I tore my rectus abdominis off my pubic bone—an injury commonly referred to as a sports hernia, but more accurately known as athletic pubalgia.

The irony?

As a podiatrist and movement specialist, I understood biomechanics. Yet I still developed an injury that took more than a year to diagnose.

Why?

Because I didn't fit the profile.

I was a woman.

At the time, athletic pubalgia was considered a "male athlete's injury," most commonly seen in soccer and hockey players. Despite debilitating pain, specialist after specialist dismissed the diagnosis. I couldn't sit through dinner. Standing for more than a few minutes was miserable. The only position that gave me relief was lying flat on my back.

Eventually, I underwent surgery to reattach the torn tissue, followed by months of rehabilitation to restore stability throughout my pelvis, adductors, and deep core.

Looking back, that experience fundamentally changed how I evaluate chronic groin pain.

Today, I believe athletic pubalgia is one of the most underdiagnosed fascial injuries in sports medicine.

It's Not Just a Groin Injury

Athletic pubalgia isn't simply an adductor strain.

It's a failure of force transmission through the anterior pubic joint.

The injury occurs where the rectus abdominis attaches to the pubic bone, disrupting one of the body's most important fascial intersections.

That tear may only be a few centimeters, but fascia doesn't work in isolation.

Once that continuity is disrupted, the body begins compensating.

I've seen athletes spend months treating plantar fasciitis, Achilles tendinopathy, hip pain, or recurrent adductor strains without anyone recognizing that the dysfunction actually began at the pelvis.

The body doesn't care about anatomical regions.

It functions as one continuous fascial system.

Women Get This Injury Too

One of the biggest misconceptions is that athletic pubalgia only affects men.

It doesn't.

Women develop this injury as well, but because they don't fit the traditional profile, they're often diagnosed with:

• Hip labral pathology
• Hip flexor strain
• Chronic adductor tendinopathy
• Pelvic pain

While these diagnoses may coexist, I always ask myself:

Could the anterior pubic joint be driving the entire presentation?

Understanding the Fascial Connection

One of the concepts I teach repeatedly is that the pelvis isn't stabilized by bones.

It's stabilized by tension.

The rectus abdominis pulls superiorly.

The adductor longus pulls inferiorly.

Importantly, these muscles connect on the same side of the pelvis—not opposite sides, as many people assume.

Together, they create constant shear across the pubic symphysis.

Your body manages this shear through the deep stabilizing system:

• Transverse abdominis
• Internal obliques
• Pelvic floor

When these muscles lose their timing, the larger muscles begin compensating.

That's where problems begin.

The Injury Starts Long Before the Tear

In my case, I wasn't injured by one dramatic movement.

I created the perfect environment for injury.

Heavy cycling.

Aggressive hanging abdominal work.

Poor thoracic mobility.

Limited hip extension.

And, most importantly, a deep core that had stopped doing its job.

Instead of stabilizing through my transverse abdominis, I was generating force through my lats, chest, and superficial abdominal muscles.

The tear was simply the final event.

The dysfunction had been building for months.

Research now supports what many clinicians observe every day: athletes with chronic groin pain often demonstrate delayed activation of the transverse abdominis and reduced deep abdominal function.

The injury isn't simply about overuse.

It's about poor load management.

My Rehabilitation Philosophy

One lesson completely changed how I approach rehabilitation:

Local before global.

We live in a fitness culture obsessed with adding load.

I became obsessed with restoring stability.

Every rehabilitation program I build begins with what I call micro-stability.

That means restoring the deep stabilizers before challenging the larger movement system.

The progression is simple:

• Release excessive adductor tension
• Restore pelvic floor function
• Activate the transverse abdominis
• Maintain that baseline stability during movement
• Only then introduce larger movement patterns

If someone loses their deep abdominal control during an exercise, we regress.

Because movement quality always comes before movement quantity.

Why This Matters

Athletic pubalgia isn't simply an injury.

It's an example of what happens when the body's stabilizing system can no longer manage force.

When we focus only on the painful tissue, we miss the bigger picture.

When we restore the deep fascial system, the entire movement strategy changes.

That's why I no longer look at chronic groin pain as an isolated diagnosis.

I look at the sensory system.

I look at fascial continuity.

I look at breathing.

I look at foot function.

Because every one of those systems influences how force travels through the pelvis.

My Clinical Takeaways

• Athletic pubalgia is a fascial injury, not simply a muscle strain.
• Women experience this injury more often than many clinicians realize.
• Chronic groin pain should always include assessment of the anterior pubic joint.
• The pelvis depends on deep stabilizers—not just strong muscles.
• Rehabilitation should always progress local before global, restoring timing before loading.
• Lasting recovery requires addressing the entire movement system—not just the site of pain.

Final Thoughts

If there's one lesson this injury taught me, it's that our bodies rarely fail because they're weak.

They fail because they've lost their ability to organize force.

When we restore that organization—through breathing, deep core activation, sensory awareness, and progressive movement—we don't just heal an injury.

We create a body that moves with greater efficiency, resilience, and confidence.

Because movement isn't about producing more force.

It's about directing force where it belongs.