summary Athletic Pubalgia is a clinical entity characterized by anterior pelvic/groin pain, commonly referred to as "sports hernia," thought to occur as a result of an adductor muscle strain due to direct trauma or overuse microtrauma. Diagnosis is made clinically by tenderness over the adductor longus and groin pain that worsens with sitting up or valsalva maneuvers. Treatment is nonoperative with rest and physical therapy. Epidemiology Demographics males > females common in hockey players and soccer players Anatomic location muscles of abdominal wall or adductor longus Etiology Pathophysiology mechanism of injury may be caused by acute trauma or microtrauma caused by overuse thought to be caused by abdominal hyperextension and thigh abduction specific injury to the common aponeurosis between the rectus abdominis and adductor longus is thought to be source of pain Presentation Symptoms lower abdominal pain and inguinal pain at extremes of exertion Physical exam inspection tenderness to adductor longus provocative tests pain with valsalva and situps Imaging Obtain radiographs, MRI, and bone scan to rule out other cause of symptoms Differential Must be differentiated from subtle true inguinal hernia Treatment Nonoperative rest and physical therapy for 6-8 weeks indications first line of treatment Operative pelvic floor repair (hernia operation) vs. adductor / rectus recession indications after extensive nonoperative treatment fails decompression of the genital branch of the genitofemoral nerve indications after extensive nonoperative treatment fails