# Groin pain at 14: why it is almost never «a pulled muscle»

> In women's football, hip and groin problems reach a 60.7% seasonal prevalence — yet only 11.1% of them cost a single training session. It is the injury that never makes it into the records, because almost nobody stops. And in a growing body the chain does not break where it would break in an adult: between 13 and 17 the weak link is not the muscle, it is the apophysis. The data, the limits of the data, and the two signals not worth waiting on.

**In short:** In a growing body the weak link in the groin is not the muscle belly but the apophysis, the growth centre the tendon attaches to: across pelvic avulsion series mean ages run from 13.6 to 16.8 years, and the commonest sites are the anterior superior iliac spine (37%), the anterior inferior iliac spine (31%) and the ischial tuberosity (14%) (Di Maria et al., 2022; sample 82% male). That is why the adult 'adductor strain' model describes what happens at 14 rather badly.

- Page: https://www.babsport.com/en/blog/dolore-inguine-giovani-atlete
- Markdown source: https://www.babsport.com/en/blog/dolore-inguine-giovani-atlete.md
- Published: 2026-08-21
- Updated: 2026-08-21
- Author: Sajid Hossain
- Publisher: BAB — Breaking All Barriers (https://www.babsport.com/)
- Tag: groin-pain, apophysis, apophyseal-avulsion, scfe, overuse, load-management
- How to cite: BAB — Breaking All Barriers, "Groin pain at 14: why it is almost never «a pulled muscle»", https://www.babsport.com/en/blog/dolore-inguine-giovani-atlete
- Note: educational content, not medical advice. Every health claim is anchored to a source listed under "Sources"; where a study was run on adults, the text says so.

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There is a region of the body where sports medicine learned nearly everything it knows by studying adult men — and where that knowledge fits worst the people who are 14. The groin. In women footballers followed across a full season, hip and groin problems reach **60.7%** of the squad, yet only **11.1%** of those problems cost even one training session. It is the injury that never makes it into any register, because almost nobody stops.

And there is a second difference, less intuitive. In a body that is still growing, when the chain breaks it does not break where it would break in an adult.

> **In short**
> - Across pelvic apophyseal avulsion series, sample mean ages run from **13.6 to 16.8 years**: commonest sites anterior superior iliac spine **37%**, anterior inferior iliac spine **31%**, ischial tuberosity **14%** (Di Maria et al., 2022; sample **82% male**).
> - Among **105 youth footballers aged 11-15** (47 girls), **21.9%** reported hip or groin pain in one season; male sex was associated with pain (OR **5.71**) (Schoffl et al., 2021).
> - In **adult** Swiss Super League women footballers seasonal prevalence is **60.7%**, but only **11.1%** of problems cost any training time (Reichmann et al., 2025).
> - In **slipped capital femoral epiphysis** the pain is in the knee in **26.2%** of cases and in the groin in **13.9%**; **49%** have more than one visit before diagnosis (Uvodich et al., 2019).
> - The adductor programme that cut prevalence from 21.3% to **13.5%** was tested in **adult men** playing semi-professionally (Harøy et al., 2019).

## How many young female athletes have groin pain?

**One in five over a season, in the only population of that age that has been measured directly.** A prospective study of **105 elite youth football players aged 11-15** — 58 boys and 47 girls, mean age 12.7, all in one Australian club academy — found that **23 of them (21.9%)** reported at least one episode of hip or groin pain during the season, and that **18.1%** had already had an episode in the past ([Schoffl et al., 2021](https://doi.org/10.1186/s40798-021-00392-w)).

Move up in age and level and the numbers grow sharply. In a **Swiss Women's Super League** squad followed for a full season, average two-weekly prevalence of hip and groin problems was **14.2%** and seasonal prevalence **60.7%**: of 61 players, 37 had at least one problem, 45 episodes in total ([Reichmann et al., 2025](https://doi.org/10.1016/j.smhs.2025.04.005)). These are **adult athletes**, and the jump from 21.9% in young teenagers to 60.7% in professionals does not describe a deterioration with age: it describes two different populations, with different loads and different measurement methods.

So the number worth carrying away is not the prevalence. It is the ratio between the players in pain and the players who stop.

## Why doesn't groin pain show up in the injury list?

**Because registers count who misses training, and with the groin almost nobody does.** In that same Super League season, of the 45 hip and groin problems recorded only **5 — 11.1%** — involved time loss, a time-loss incidence of **0.5 per 1,000 hours** of exposure ([Reichmann et al., 2025](https://doi.org/10.1016/j.smhs.2025.04.005)). Look only at "real" injuries, the ones that cost availability, and this whole chapter shrinks to one line.

The same pattern repeats at a completely different level. Among **383 Dutch amateur women footballers** from 35 teams, prevalence of groin injury **without** time loss was **22%** (95% CI 18-26) versus **7%** (95% CI 5-10) with time loss; 21% reported pain with normal performance and 16% pain with reduced performance ([Langhout and Tak, 2019](https://doi.org/10.1016/j.ptsp.2019.09.013)). Again: **adult** athletes.

Two independent studies, two very distant contexts, the same conclusion. Groin pain is by definition the symptom you carry onto the pitch. Which is exactly what makes it invisible to whoever plans the load.

## Why is it almost never «a pulled muscle» at 14?

**Because the weakest point in the chain is not the muscle: it is the bone the muscle pulls on.** Apophyses are the growth centres tendons insert onto; they stay cartilaginous until they fuse, which around the pelvis happens in mid-to-late adolescence. While that point is cartilaginous, in an explosive movement it gives way before the tendon does.

The result has a name: **apophyseal avulsion**. A scoping review of 18 studies and **453 adolescent patients** found sample mean ages between **13.6 and 16.8 years**, with this distribution of sites ([Di Maria et al., 2022](https://doi.org/10.3389/fped.2022.947463)):

| Site | Share |
| --- | --- |
| Anterior superior iliac spine | 37% |
| Anterior inferior iliac spine | 31% |
| Ischial tuberosity | 14% |
| Lesser trochanter | 9% |
| Iliac crest | 8% |
| Superior corner of the pubic symphysis | 1% |

One caveat is part of the data: that sample is **82% male**. It holds across the literature on this topic, and it is why this article cannot tell girls how often it happens *to them*.

Some sex-specific signal does exist, though. In a series of **242 adolescents** with pelvic avulsion collected over 19 years, **football** was the commonest sport at the time of injury and **running or sprinting** the commonest mechanism; boys were about 67% of cases and older at presentation, and the distribution of sites differed by sex: **girls more often had iliac crest avulsions**, boys anterior inferior iliac spine avulsions ([Moeller and Galasso, 2022](https://doi.org/10.1097/JSM.0000000000000866)).

The practical point is a single one: if the pain appeared suddenly, during a sprint, a mistimed kick or a split, and the body is mid-growth, "adductor strain" is a hypothesis borrowed from an adult athlete. It is not the most likely one at that age.

## Do girls get more groin pain than boys?

**No — and it is worth saying so precisely here, where BAB could comfortably say the opposite.** In the study of 11-15 year-olds, of the 23 players with in-season pain **18 were boys and 5 were girls**; in the multivariate model **male sex** was associated with pain at an odds ratio of **5.71**, and **higher BMI** at an OR of 1.32 ([Schoffl et al., 2021](https://doi.org/10.1186/s40798-021-00392-w)). That is the reverse of what happens with the [ACL](/en/blog/crociato-giovani-atlete) and the [ankle](/en/blog/distorsione-caviglia-giovani-atlete), where the risk is higher in girls.

The limitation deserves as much weight as the result: one study, one academy, 105 participants, one sport. It is not a law of nature.

And the operating conclusion does not change at all. If a 14-year-old girl has groin pain, the statistic does not explain her case — if anything it makes it less expected, and therefore easier to wave away. It is the mechanism this site meets in every article: [the symptom that doesn't fit the script](/en/blog/dolore-in-puberta-neuroscienza) is the one at risk of being heard least.

## Which two signals are not worth waiting on?

**The first is pain that appeared suddenly in an explosive movement; the second is knee pain that has nothing to do with the knee.**

On the second, the literature is clear. In **slipped capital femoral epiphysis** — the slipping of the femoral head's growth plate relative to the neck, typical of puberty — pain often presents away from the hip. In a prospective study of **107 patients (122 hips)** operated on between 2009 and 2015, the site of pain was the hip in **57.4%** of cases, the thigh or leg in **35.2%**, the **knee in 26.2%**, the groin in **13.9%**, posterolateral in 10.7%, and combined zones in 39.3%; **49%** had more than one visit before diagnosis, and less typical presentations were associated with significantly longer symptom duration (p=0.04) and more healthcare visits (p=0.04) ([Uvodich et al., 2019](https://doi.org/10.1016/j.jpeds.2018.10.050)).

Two necessary qualifications, because the number alone isn't enough: SCFE is **more common in boys and with higher body weight**, and that study includes both sexes. So it is not a condition "of female athletes". But it is the reason why, in a growing body, knee pain with no injury and no swelling or local tenderness is a good reason for someone to **look at the hip as well** — and that is a clinical assessment, not a coach's job.

## Can it be prevented?

**The best evidence concerns the adductors, but it was produced in adult men — and that has to be said before promising it to a 13-year-old.** A cluster-randomised trial across **35 Norwegian semi-professional teams** (18 intervention teams with 339 players, 17 control teams with 313) tested a programme built around a single exercise, the **Copenhagen adduction**: average seasonal prevalence of groin problems was **13.5%** (95% CI 12.3-14.7) in the intervention group versus **21.3%** (95% CI 20.0-22.6) in the control group ([Harøy et al., 2019](https://doi.org/10.1136/bjsports-2017-098937)). The sample was **entirely male and adult**.

Pulling the other way is the datum closest to girls: in the study of 11-15 year-olds, **preseason adductor and abductor strength did not predict** the following season's hip and groin pain, and neither did HAGOS questionnaire scores ([Schoffl et al., 2021](https://doi.org/10.1186/s40798-021-00392-w)).

The honest summary is this: strengthening the adductors is low-risk, consistent with what we know about [progressive loading during the growing years](/en/blog/forza-ragazze-adolescenti), and has solid proof in a population other than the one we are discussing. It is not a guarantee, and nobody should sell it as one.

## What can a coach do without medicalising anything?

Three things, none of which requires clinical skills.

**Ask rather than wait.** The figure that opens this article — only 11.1% of hip and groin problems lead to missing anything ([Reichmann et al., 2025](https://doi.org/10.1016/j.smhs.2025.04.005)) — means the spontaneous channel does not work: the player in pain keeps playing, so she doesn't mention it. One direct question during a lap of the pitch is worth more than an open door.

**Distinguish how it started.** Pain that came on gradually over weeks of sprints and changes of direction, and pain that appeared suddenly mid-sprint, are two different stories: the second one, in a growing body, is a scenario to get looked at.

**Don't use one label as a container.** The **Doha agreement**, signed by 24 experts from 14 countries, tidied up the terminology into three groups: the defined clinical entities (**adductor-**, **iliopsoas-**, **inguinal-** and **pubic-related** groin pain), **hip-related** groin pain, and other causes ([Weir et al., 2015](https://doi.org/10.1136/bjsports-2015-094869)). Different names mean different pathways: calling them all the same thing is the first step towards treating them all the same way, which is to say badly.

And a fourth, which holds all season: during the weeks of the [growth spurt](/en/blog/picco-di-crescita-giovani-atlete) the pelvic apophyses are an open building site. That is not the moment to add maximal sprints and new loads all at once.

## Frequently asked questions

### Is groin pain in a 14-year-old girl a pulled muscle?

That can't be settled without an assessment, but the adult model describes that age badly. In a growing body the weak link in the chain is not the muscle belly: it is the apophysis, the growth centre the tendon inserts onto, which stays cartilaginous until it fuses. In a scoping review of 18 studies and 453 adolescents with pelvic apophyseal avulsion, sample mean ages ranged from 13.6 to 16.8 years, and the commonest sites were the anterior superior iliac spine (37%), the anterior inferior iliac spine (31%) and the ischial tuberosity (14%) (Di Maria et al., 2022). It should be said that this sample was 82% male: the numbers for girls are much weaker.

### How many young female athletes get hip or groin pain?

In the only study to measure that age group directly, among 105 elite youth football players aged 11-15 (58 boys and 47 girls, mean age 12.7), 21.9% reported at least one episode of hip or groin pain over a season and 18.1% had a prior history (Schoffl et al., 2021). In adult women footballers the figures are far higher: in a Swiss Women's Super League squad followed for a full season, seasonal prevalence of hip and groin problems was 60.7%, with an average two-weekly prevalence of 14.2% (Reichmann et al., 2025). Those are ADULT athletes, not young teenagers: the comparison shows where load leads, it does not transfer the number.

### Why does groin pain almost never show up in injury statistics?

Because almost nobody stops, and injury records count the people who stop. In the Swiss Super League study, of 45 hip and groin problems recorded across a season only 5 — 11.1% — involved any time loss, a time-loss incidence of just 0.5 per 1,000 hours (Reichmann et al., 2025). The same pattern appears in amateur women's football: among 383 Dutch players, non-time-loss groin injury prevalence was 22% versus 7% for time-loss injury (Langhout and Tak, 2019). Count only missed sessions and three quarters of the problem becomes invisible. Both studies are in ADULT athletes.

### Do girls get more groin pain than boys?

No — and this is one of the few chapters where the data point the opposite way to ACL and ankle injuries. In the study of 105 players aged 11-15, of the 23 who reported in-season pain 18 were boys and 5 were girls, and in the multivariate model male sex was associated with in-season pain at an odds ratio of 5.71, alongside higher BMI (OR 1.32) (Schoffl et al., 2021). The limitation is large: a single study, a single academy, 105 participants. The useful reading is not 'it doesn't happen to girls', but this: when it does happen to a girl, being a girl does not explain it — it deserves the same attention.

### What is a pelvic apophyseal avulsion?

It is the separation of a bone fragment at the point where a tendon inserts onto a growth centre that is still cartilaginous. It typically happens in a single powerful movement — a sprint start, a kick, a split — rather than through accumulation. In a series of 242 adolescents collected over 19 years, football was the commonest sport at the time of injury and running or sprinting the commonest mechanism; about 67% of cases were male, and girls more often had iliac crest avulsions while boys more often had anterior inferior iliac spine avulsions (Moeller and Galasso, 2022). In most cases the treatment described is conservative.

### Does an apophyseal avulsion need surgery?

In most cases described in the literature, no — but that decision is clinical and is not made by reading an article. In the scoping review of 453 adolescent patients, 79% of those treated conservatively returned to their previous activity level versus 95% of those operated on, and the fragment displacement thresholds used to indicate surgery varied between 15 and 20 mm across studies (Di Maria et al., 2022). In the series of 242 cases, every patient managed conservatively was cleared to return to sport (Moeller and Galasso, 2022). The practical message is a different one: these are bone injuries of the growing skeleton, and they need to be seen by a healthcare professional rather than managed like a strain.

### Can knee pain come from the hip?

Yes, and that is why it is worth knowing about. In slipped capital femoral epiphysis — the slipping of the femoral head growth plate, typical of puberty — the pain often presents away from the hip. In a prospective study of 107 boys and girls who underwent surgery (122 hips), pain was reported in the hip in 57.4% of cases, but in the thigh or leg in 35.2%, in the knee in 26.2% and in the groin in 13.9%; 49% had more than one visit before diagnosis, and the less typical presentations were associated with longer symptom duration and more healthcare visits (Uvodich et al., 2019). It should be said that SCFE is more common in boys and with higher body weight. Knee pain with no injury and no local signs, in a growing body, is a good reason for someone to look at the hip too.

### Can groin pain be prevented with adductor exercises?

The best evidence exists, but it is not in girls. A cluster-randomised trial across 35 Norwegian semi-professional teams tested a single-exercise programme, the Copenhagen adduction: average seasonal prevalence of groin problems was 13.5% in the intervention group versus 21.3% in the control group (Harøy et al., 2019). That sample, however, was entirely adult men. Pulling the other way, in the study of 11-15 year-olds preseason adductor and abductor strength did not predict the following season's pain (Schoffl et al., 2021). Translated: strengthening the adductors is reasonable and low-risk, but nobody can promise a 13-year-old the result obtained in adult men.

### What should a coach do if an athlete reports groin pain?

Three things, none of which is a diagnosis. First: take it seriously even though she is still training — in women's football only 11.1% of hip and groin problems lead to missing anything (Reichmann et al., 2025), so 'she plays anyway' is not reassuring information. Second: ask how it started, because pain that appeared suddenly during a sprint or a kick, in a growing body, is a scenario to get looked at rather than iced. Third: don't use one word as a container for everything. The Doha agreement, signed by 24 experts from 14 countries, separates the defined clinical entities (adductor-, iliopsoas-, inguinal- and pubic-related), hip-related groin pain, and other causes: different names, different pathways (Weir et al., 2015).

### How long does it take to get back on the pitch?

It depends on the injury, and this article cannot establish that. For a sense of scale: the scoping review on pelvic avulsions reports a study in which full return to sport after a conservatively treated anterior inferior iliac spine avulsion occurred at 10 weeks post-injury, and overall 79% of those treated conservatively returned to their previous level (Di Maria et al., 2022). Weeks, not days: and for a 14-year-old the hard part is not the bone, it is staying part of the team while everyone else plays.

## Sources

- Schoffl J., Dooley K., Miller P., Miller J., Snodgrass S.J. **Factors Associated with Hip and Groin Pain in Elite Youth Football Players: A Cohort Study.** *Sports Medicine - Open*, 2021;7:97. (105 elite youth football players aged 11-15, mean age 12.7 ± 1.0; **58 boys and 47 girls**; 23 players — 21.9% — with at least one episode of hip or groin pain in season, 18 boys and 5 girls; prior history in 18.1%; preseason adductor and abductor strength and HAGOS scores **not predictive**; predictors in the model: BMI OR 1.32 and male sex OR 5.71; **single club, single sport**) [doi:10.1186/s40798-021-00392-w](https://doi.org/10.1186/s40798-021-00392-w)
- Reichmann F., Stadelmann J.D., Mosler A.B., Maffiuletti N.A., Franceschini-Brunner R., Bizzini M. **Epidemiology and intrinsic risk markers of hip and groin problems in Swiss Women's Super League football: a full-season prospective cohort study.** *Sports Medicine and Health Science*, 2025. (61 **ADULT** Super League women footballers; 45 hip and groin problems in 37 players; average two-weekly prevalence 14.2% and seasonal prevalence 60.7%; only 5 problems — 11.1% — with time loss; time-loss incidence 0.5 per 1,000 hours; age as a risk marker, OR 1.14 per year) [doi:10.1016/j.smhs.2025.04.005](https://doi.org/10.1016/j.smhs.2025.04.005)
- Langhout R.R.F.H., Tak I.J.R. **Including performance level lowers prevalence of non-timeloss groin injury: a cross-sectional study in 383 female amateur football players.** *Physical Therapy in Sport*, 2019. (383 Dutch **ADULT** amateur women footballers, 35 teams, cross-sectional survey; non-time-loss groin injury 22%, 95% CI 18-26; time-loss 7%, 95% CI 5-10; pain with normal performance 21%, pain with reduced performance 16%) [doi:10.1016/j.ptsp.2019.09.013](https://doi.org/10.1016/j.ptsp.2019.09.013)
- Di Maria F., Testa G., Sammartino F., Sorrentino M., Petrantoni V., Pavone V. **Treatment of avulsion fractures of the pelvis in adolescent athletes: a scoping literature review.** *Frontiers in Pediatrics*, 2022;10:947463. (**scoping** review, 18 studies, 453 patients, **82% male and 18% female**, sample mean ages 13.6-16.8 years; sites: anterior superior iliac spine 37%, anterior inferior iliac spine 31%, ischial tuberosity 14%, lesser trochanter 9%, iliac crest 8%, superior corner of the pubic symphysis 1%; return to pre-injury level 79% with conservative treatment and 95% with surgery — **non-randomised comparison, non-equivalent populations**; displacement thresholds for surgical indication varying between 15 and 20 mm) [doi:10.3389/fped.2022.947463](https://doi.org/10.3389/fped.2022.947463)
- Moeller J.L., Galasso L. **Pelvic Region Avulsion Fractures in Adolescent Athletes: A Series of 242 Cases.** *Clinical Journal of Sport Medicine*, 2022. (**retrospective** series of 242 adolescents collected over 19 years; football the commonest sport at the time of injury, running/sprinting the commonest mechanism; about 67% male and older at presentation; sex difference in site: **girls more often iliac crest**, boys more often anterior inferior iliac spine; conservative management with clearance to return to sport in all cases treated that way) [doi:10.1097/JSM.0000000000000866](https://doi.org/10.1097/JSM.0000000000000866)
- Uvodich M., Schwend R., Stevanovic O., Wurster W., Leamon J., Hermanson A. **Patterns of Pain in Adolescents with Slipped Capital Femoral Epiphysis.** *The Journal of Pediatrics*, 2019. (prospective study of 107 patients, 122 hips operated on between 2009 and 2015, **both sexes**; site of pain: hip 57.4%, thigh/leg 35.2%, knee 26.2%, groin 13.9%, posterolateral 10.7%, combined zones 39.3%; 49% with more than one visit before diagnosis; less typical presentations associated with longer symptom duration, p=0.04, and more visits, p=0.04) [doi:10.1016/j.jpeds.2018.10.050](https://doi.org/10.1016/j.jpeds.2018.10.050)
- Harøy J., Clarsen B., Wiger E.G., Øyen M.G., Serner A., Thorborg K., Hölmich P., Andersen T.E., Bahr R. **The Adductor Strengthening Programme prevents groin problems among male football players: a cluster-randomised controlled trial.** *British Journal of Sports Medicine*, 2019;53(3):150-157. (cluster-randomised trial across 35 Norwegian semi-professional teams, **entirely MALE and ADULT sample**: 18 intervention teams with 339 players, 17 control teams with 313; average seasonal prevalence of groin problems 13.5%, 95% CI 12.3-14.7, versus 21.3%, 95% CI 20.0-22.6; programme based on a single exercise, the Copenhagen adduction) [doi:10.1136/bjsports-2017-098937](https://doi.org/10.1136/bjsports-2017-098937)
- Weir A., Brukner P., Delahunt E., Ekstrand J., Griffin D., Khan K.M., et al. **Doha agreement meeting on terminology and definitions in groin pain in athletes.** *British Journal of Sports Medicine*, 2015;49(12):768-774. (**consensus document**, not a study: 24 experts from 14 countries meeting on 4 November 2014; three-group taxonomy — defined clinical entities with adductor-, iliopsoas-, inguinal- and pubic-related groin pain; hip-related groin pain; other causes) [doi:10.1136/bjsports-2015-094869](https://doi.org/10.1136/bjsports-2015-094869)

*This article is for information only and is not medical advice or a clinical assessment. Groin, hip or knee pain that appears suddenly during exertion, pain that does not improve within a few days, difficulty bearing weight or walking normally, or a foot that turns outwards, should be assessed by a healthcare professional.*