Abstract: Two studies, involving a total of 122 participants who had experienced adductor-related groin pain for at least two months, were included in this review. All but one of the participants were male athletes aged between 18 and 50 years old. Both studies were assessed as 'high risk of bias' for at least one source of bias domain. The 'successful treatment' outcome reported in both studies was based primarily on pain measures. One study, based on an intention-to-treat analysis, found a significant difference favouring exercise therapy (strengthening with an emphasis on the adductor and abdominal muscles and training muscular co-ordination) compared with 'conventional' physiotherapy (stretching exercises, electrotherapy and transverse friction massage) in successful treatment at 16-week follow-up (25/34 (74%) versus 10/34 (29%); risk ratio (RR) 2.50, 95% CI 1.43 to 4.37, P = 0.001). Similarly, of those followed-up significantly more athletes treated by exercise therapy returned to sport at the same level (23/29 (79%) versus 4/30 (13%); RR 5.95, 95% CI 2.34 to 15.09, P = 0.0002). Although still favouring the exercise group, the differences between the two groups in patients' subjective global assessment at 16 weeks and successful treatment at 8 to 12 years follow-up were not statistically significant. The second study (54 participants) found no significant differences at 16-week follow-up between a multi-modal treatment (heat, manual therapy and stretching) and exercise therapy (the same intervention as in the above study) for the outcomes of successful treatment (14/26 (54%) versus 12/22 (55%); RR 0.99, 95% CI 0.59 to 1.66, P = 0.96) and return to full sports participation (13/26 (50%) versus 12/22 (55%); RR 0.92, 95% CI 0.53 to 1.58, P = 0.75). Those returning to full sports participation returned on average 4.5 weeks earlier after receiving multi-modal therapy (mean difference -4.50 weeks, 95% CI -8.60 to -0.40, P = 0.03) than those in the exercise therapy group. This study reported that there were no complications or side effects found in either intervention group. The available evidence from the randomized trials is insufficient to advise on any specific conservative modality for treating exercise-related groin pain. While still low quality, the best evidence is from one trial which found that exercise therapy (strengthening of hip and abdominal muscles) in athletes improves short-term outcomes (based primarily on pain measures) and return to sports compared with physiotherapy consisting of passive modalities. Given the low quality of the available evidence from both included trials, further randomized trials are necessary to reinforce their findings.

Plain-language summary: Two randomized controlled trials, involving a total of 122 athletes with exercise-related groin pain, were included in this review. Participants were aged between 18 and 50 years and all but one were male. They had had groin pain for at least two months. One trial demonstrated positive results in athletes treated by exercise therapy (strengthening of hip and abdominal muscles, and training muscular co-ordination) in comparison with 'conventional' physiotherapy consisting of passive modalities (stretching exercises, electrotherapy and transverse friction massage) 16 weeks after the end of treatment, for 'successful treatment' (based primarily on pain measures) and for the rate of return to sports at the same level without groin pain. The second study compared multi-modal treatment (heat, manual therapy and stretching) with exercise therapy and found no significant difference between groups for 'successful treatment' and return to sports, but did show an earlier return to sport for those athletes who achieved this outcome following the multi-modal treatment. The available evidence is exclusively related to athletes and is limited because of the low number of studies and low number of participants for each outcome. Further randomized controlled trials are needed to ratify these results.