Thigh and groin overuse injuries

Abstract

Overuse injuries affecting the hip, groin, and thigh represent a significant burden in both endurance and field sport athletes. This narrative review examines the anatomy, biomechanics, and imaging manifestations of the common overuse injuries in these regions, with particular emphasis on magnetic resonance imaging (MRI) findings and their clinical correlation. We systematize injuries within the Doha classification framework, discussing adductor-related pain, pubic-related pain, iliopsoas-related pain, and inguinal-related pain, along with thigh-based pathology including proximal hamstring tendinopathy, rectus femoris injuries, femoral stress fractures, and greater trochanteric pain syndrome. Contemporary 3T MRI protocols, which offer advantages in spatial and contrast resolution, are reviewed; well-optimized 1.5T protocols also provide adequate assessment for most indications, alongside the complementary roles of ultrasound and radiography. The progression of muscle healing is detailed with implications for return-to-play assessment. Understanding the correlation between imaging findings and clinical presentation remains essential for accurate diagnosis and appropriate management guidance to sports medicine practitioners and surgeons.