Lower Abdominal & Groin Pain

When imaging looks “normal” but the pain keeps showing up with walking, running, or sitting, the driver is often mechanical, myofascial, or nerve-related.

The Clinical Reality

Lower abdominal and groin pain is often less about a single structure and more about load transfer across the trunk, pelvis, and hip. The lower abdominal wall, hip flexors, adductors, inguinal region, and pelvic floor share fascial connections and overlapping nerve supply. When one region becomes guarded or overloaded, the brain can interpret the signal as coming from a different area. This is why symptoms can alternate between lower abs, inner thigh, pubic bone, or the front of the hip.

Common functional patterns include increased tone in the iliopsoas or adductors, abdominal wall trigger points, pelvic floor overactivity, and nerve sensitivity involving the ilioinguinal, genitofemoral, or obturator nerve pathways. These patterns are frequently influenced by gait changes, recent training increases, prolonged sitting, post-surgical guarding, or a prior hip or low back irritation that changed movement strategy.

Why Standard Care Fails

Standard care often looks for a structural diagnosis that “explains everything” (hernia, labral tear, ovarian or urologic pathology). When those are ruled out or treated but symptoms persist, the functional drivers can be missed. Medications may reduce pain sensitivity but do not restore coordination or tissue tolerance. Imaging can identify certain injuries, yet it often does not show myofascial trigger points, protective muscle tone, nerve irritability, or compensatory gait. If the plan does not include hands-on differentiation of abdominal wall, hip, adductors, and pelvic floor contributions, patients are left cycling through rest, stretching, and generalized strengthening without a clear target.

Signs & Symptoms

Do any of these sound familiar?

Deep ache or pressure near the pubic bone or inguinal crease

Often worse after prolonged sitting, hip flexion, or transitions from sit-to-stand. Can feel “inside the pelvis” even when the driver is superficial abdominal wall or adductor tissue.

Sharp pinch with cutting, sprinting, or lateral movement

Frequently linked to adductor or hip flexor load intolerance and reduced pelvic control. May reproduce with resisted adduction, hip flexion, or single-leg stance.

Burning, tingling, or hypersensitivity in the groin or upper inner thigh

Can reflect nerve irritation along ilioinguinal, genitofemoral, or obturator pathways. Symptoms may be position-dependent and sensitive to pressure from waistbands or seated posture.

Lower abdominal wall pain with coughing, bracing, or core training

May be related to rectus abdominis, oblique, or transversalis fascial irritation and trigger points. Palpation often reveals a discrete tender band that refers pain toward the groin.

Discomfort with certain positions during sex or pelvic floor engagement

Not always a weakness problem. Often reflects pelvic floor overactivity or guarding that refers to the groin, pubic region, or lower abdomen, especially under stress or after flare cycles.

Root Cause Contributors

The mechanical drivers behind your symptoms

Adductor Complex Load Intolerance

Trigger points and tendon-adjacent sensitivity near the pubic attachment can refer pain into the groin and mimic a persistent “strain,” especially with lateral agility and sprint mechanics.

Iliopsoas and Hip Flexor Hypertonicity

Protective tone can compress tissue planes at the front of the hip and refer into the lower abdomen or groin, commonly aggravated by prolonged sitting and uphill running.

Abdominal Wall Myofascial Referral

Rectus abdominis, obliques, and transversalis fascia can generate focal tenderness with referred pain toward the inguinal region, particularly with bracing, coughing, or heavy lifting.

Pelvic Floor Overactivity and Myofascial Guarding

Elevated resting tone and coordination loss can refer to the pubic bone, groin, or inner thigh and often coexists with hip and abdominal wall compensation.

Peripheral Nerve Irritability (Ilioinguinal, Genitofemoral, Obturator)

Nerve sensitivity can create burning, buzzing, or sharp pain patterns that do not match imaging findings and may worsen with hip extension, compression, or sustained sitting.

What to Expect

Your roadmap to recovery
Week 1 to 2
Clearer identification of the primary driver and referral pattern. Many patients notice improved predictability with specific positions or movements and less post-activity “mystery” pain.
Weeks 3 to 6
Meaningful reduction in symptom intensity or frequency for common triggers such as walking pace, stairs, sitting tolerance, or gym movements. Improved control during single-leg tasks and reduced guarding on palpation.
Weeks 6 to 10
Expanded capacity for higher demand activity (running progression, lateral drills, heavier lifting, longer sitting or travel) with fewer flares and a more reliable recovery curve after training.

Frequently Asked Questions

Get answers to common questions

No. Many common drivers of groin and lower abdominal pain are functional and do not appear clearly on imaging, including trigger points, protective muscle tone, tendon-adjacent sensitivity, and nerve irritability. A hands-on exam and movement testing can often localize the primary contributor even when imaging is unremarkable.

A hernia is a medical diagnosis and should be assessed by an MD when suspected. Some abdominal wall and adductor referral patterns can mimic hernia symptoms. If you have a new or enlarging bulge, escalating pain, or symptoms that feel acute and unusual, medical evaluation is appropriate. Our role is to address functional drivers when medical causes are ruled out or adequately managed.

When the exam suggests pelvic floor overactivity or referral, yes. Pelvic floor dysfunction is often elevated tone and guarding rather than weakness. Treatment may include pelvic floor dry needling to relevant myofascial structures alongside hip and abdominal wall work, based on what reproduces and reduces your symptoms on assessment.

It varies with duration, irritability, and training load. Many patients start with 1 to 2 sessions per week for a short period to calm sensitivity and identify the driver, then taper as capacity improves. The plan is reassessed each visit based on movement tests and palpation findings.

Post-treatment soreness can happen, especially in reactive adductors, hip flexors, or abdominal wall tissue. The approach is dosed to your presentation, with a focus on improving function and tolerance rather than chasing intensity. You will receive guidance on training modifications and recovery for the first 24 to 48 hours.

Often, yes. The goal is usually load management, not full rest. We adjust volume, intensity, and specific movements (cutting, sprint starts, heavy adduction work, aggressive core bracing) while rebuilding capacity. If a movement repeatedly produces sharp pain or lingering flare, it is typically scaled until tolerance improves.

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118 W. 72nd, Rear Lobby, Upper West Side, NY 10023 Evidence-based acupuncture and dry needling on the Upper West Side, NYC. From chronic pain, headaches, and pelvic floor dysfunction, Dr. Jordan Barber integrates the highest level of training with compassionate care to help you thrive. Disclaimer: This site does not provide medical advice. Always consult a qualified healthcare professional before making changes to your health. Read our full disclaimer

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