What is the Inguinal Ligament and What Does it do?
The inguinal ligament is a flexible band of tough connective tissue that holds the pelvis to the spine (it connects the pubic tubercule to the super iliac spine).
It follows the curvature of your outer pelvis and attaches deep in the groin area where it forms at the base of the inguinal canal. Its job is to provide strength and support to the surrounding tissues and bones.
As a ligament, it is comprised of fibrous tissue and helps to connect bone and cartilage to muscle.
Inguinal Ligament Pain Symptoms and Diagnosis
According to a peer-reviewed report published in the Ochsner Journal and the National Institutes of Health, inguinal ligament pain has several possible diagnoses.
- Direct hernia where a bulge is able to be seen
- Indirect hernia where a bulge is not able to be seen (sports hernia or athletic pubalgia)
- Ligament and muscle strains affecting the adductors, lower abdominals, or ilipsoas muscles
- Nerve entrapment (one of the possible complications of a sports hernia)
- Hip joint issues
Furthermore, they provided an effective strategy to categorize and determine which of the above diagnoses you fall into.
By evaluating your symptoms, you can help to get an idea of the source of your pain.
- If you experience pain later in the day, after standing for a long time, or while straining using the restroom, you likely have a direct hernia that is treated with surgery; a bulge is almost always present in this case.
- If you experience pain as soon as you begin the day, while on light walks, or during any activity that involves intense straining, you likely have a muscle or ligament issue that can be treated with the rehab program below. It is also possible that you have a sports hernia that may require surgery (more explained below).
- If pain decreases with more activity, it is likely a muscle, ligament, or joint issue—and also treatable with the rehab plan.
Inguinal Ligament Pain Treatment
The ligament also helps to supports the iliopsoas muscles which includes the psoas major muscle that runs from your upper femur, through your pelvis, to your lower spine.
Because of its positioning, the ligament is responsible for helping to support the lower abdominal wall and prevent the groin from tearing.
When looking at muscle and ligament issues, there are two causes of the pain, and the first is much less serious.
- Groin Strain
- Sports Hernia
Treatment for Inguinal Ligament Pain if You Have a Groin Strain
A groin strain is a more common type of injury where the muscles of the groin become overstretched or tear slightly as a result of sudden movement, such as sprinting or a quick shift during a game of soccer or basketball.
Groin strain treatment is relatively straightforward and follows the 3-point physical therapy approach:
With just stretching and no mobility work or strengthening exercises, you will not see lasting flexibility and pain relief—it will be only transient and short-term right after you get done. With just physical therapy exercises and no mobility, you will be unable to get into the proper positioning. This leads to poor form and incorrect movement patterns—which is how you got injured in the first place. Bottom line, make sure you do all three.
The full lower-body stretching a mobility routine that goes with the strengthening protocol outlined below can be found here.
By following the 10-week groin pain treatment program, you will be able to restore strength and mobility to your hip and groin area.
With the exercises and movements outlined, you will regain balance and relieve pain permanently through proper movement.
- Abdominal vacuums
- Bosu ball crunches
- Hip bridges with dorsiflexion
- Dog legs
- Dirty dog legs
- Supine short levers
- Supine psoas holds
- Supine adduction against an exercise ball
- One-legged reaching deadlifts
- And more
While the video below is aimed at treating a sports hernia, the exercises are exactly the same and designed around the concept of strengthening your hips and groin while restoring mobility and balance.
Treatment for Inguinal Ligament Pain if You Have a Sports Hernia
On the flip side, if you make it to week six and you still don’t have any pain relief, it is likely that you have a sports hernia. Make sure by confirming your pain location.
Pain in the inguinal ligament is usually seen in athletes or those who are highly active. This is even more so the case when a sports hernia is present. In these situations, patients normally have a history that includes an insidious onset of pain associated with activity. In other words, it seemed to get worse with time.
The pain is described as “deep” that somewhat lessons with rest, but never truly goes away. While there are reported cases of females getting the injury, it occurs a majority of the time in men.
Most patients also experience symptoms of pain for months before a proper diagnosis, becoming frustrated with vague advice findings. This makes sense as the injury is relatively new in the medical community. The first major publication made its way into the British Journal of Medicine in March of 1993.
According to a publication in the National Institutes of Health, the average time until proper diagnosis is 9 months. However, this can be cut down dramatically by using the pubic probe method that helps to pinpoint the specific location pain is radiating from (explained in the video below).
While there is evidence that recovery without going under the knife is possible, the possibility that you will require recovery without surgery decreases exponentially as more time passes. The sooner you can get it diagnosed properly and begin the treatment plan, the better chance you have of alleviating your pain completely without an operation.
While sports hernia treatment without surgery is an effective option for some—namely those who begin rehab a.s.a.p. as described above—many will still require surgery to reach complete pain-free levels.
This isn’t the end of the world, unless you pick the wrong repair approach. A strong percentage of those who receive the mesh procedure experience permanent issues, so make sure you find someone trained in conducting the minimal approach.
This specialist should also be able to help confirm your diagnosis of a sports hernia by performing an ultrasound. However, you can also perform the pubic probe technique from anywhere using just your pinky.
Make no mistake…
The true source of inguinal ligament pain is likely years of failing to stretch and perform mobility, coupled with sub-optimal form and movement patterns during sports, lifting weights, or other repetitive physical activities.
While a certain game of football or twist while lifting may have caused the injury and triggered the pain, it is likely just the last straw that broke the camel’s back.
By using bad form and posture over a long enough period of time, your body begins to make permanent changes based on those negative movement patterns. This is seen in the form of muscular imbalances and uneven form when lifting or doing any other strenuous, repetitive physical motion. The repetitive nature of these movements push you to build up larger and larger imbalances and unevenness over time—unless you are using the 3-point approach listed above.
While inguinal ligament pain can be caused by a number of issues, if you are physically active and experiencing groin pain, your outcome for a full recovery is very strong by following the rehabilitation steps provided above.
If you are inactive and experiencing pain, it is likely that you have a more serious structural issue treatable only by a medical professional.