The Obturator Nerve: When “Groin Strain” Isn’t a Muscle Problem
Persistent groin or inner-thigh pain is often labelled as an adductor strain or a hip issue. But when symptoms linger despite appropriate strengthening and imaging is unremarkable, one frequently overlooked structure may be responsible: the obturator nerve.Understanding this nerve—and how it refers pain—can explain why some groin pain simply doesn’t behave like a muscle injury.
Why the Obturator Nerve Matters:
The obturator nerve originates from the L2–L4 nerve roots and travels deep through the pelvis before supplying:
Motor control to the hip adductors
Sensation to the medial (inner) thigh
Dynamic hip stability during walking, single-leg stance, and directional changes
Because of its deep course and close relationship with the adductors and hip joint, irritation of this nerve often feels muscular, even when it is not.
The Typical (and Misleading) Pain Pattern
Obturator nerve–related pain is often described as:
Deep groin or inner-thigh pain
Poorly localized and difficult to pinpoint
Worse with walking distance, standing, or sustained load
Reproduced with resisted adduction or long-lever positions
Unlike many nerve conditions, symptoms are not always sharp, burning, or tingling, which is why this presentation is commonly misdiagnosed as a recurrent muscle strain.
Why It’s Often Missed
Imaging is frequently normal, and isolated adductor strengthening may improve strength without resolving symptoms. In these cases, the issue is rarely a lack of muscle strength—it is inefficient load sharing across the pelvis and hip, leading to repeated irritation of the nerve.
Evidence-Informed Physiotherapy Management
Successful treatment focuses on reducing nerve irritation while restoring efficient movement and load tolerance.
1. Load Management
Aggravating activities such as prolonged walking, cutting, skating, or sustained single-leg loading are temporarily reduced. Progression is guided primarily by next-day symptoms rather than pain experienced during activity.
2. Progressive Adductor Loading
The adductors are not avoided. Instead, they are gradually reloaded using pain-limited isometrics and short-range strengthening before progressing to functional and lengthened positions. Complete rest is avoided, as it often reduces tissue tolerance.
3. Pelvic and Trunk Control
Improving lumbopelvic stability reduces excessive reliance on the adductors and improves force distribution during gait, work tasks, and sport.
4. Hip Mechanics and Movement Quality
Optimizing hip rotation, frontal-plane control, and task-specific mechanics reduces repeated stress on the medial thigh and pelvic structures.
Should We Stretch or “Floss” the Obturator Nerve?
In most cases, aggressive nerve tensioning or flossing is not recommended, particularly in the early or irritable phase. Obturator nerve symptoms are usually driven by load sensitivity, not true mechanical restriction. Gentle neural mobility may be introduced later—only if symptoms are settling and movements are clearly non-provocative—but it is not a primary treatment strategy.
What to Avoid
Aggressive adductor stretching during painful phases
Early return to high-volume lateral or cutting activities
Treating the condition as “just weak muscles”
Ignoring trunk, pelvic, and movement contributors
Key Takeaway
If groin or inner-thigh pain:
persists despite appropriate strengthening,
feels deep and poorly localized, or
worsens with walking and sustained load rather than sprinting,
the obturator nerve should be considered.
With thoughtful, evidence-informed physiotherapy focused on load management, movement quality, and gradual re-exposure, outcomes are typically very good.
References:
Bradshaw, C., Bundy, M., & Falvey, É. (2008). The diagnosis of longstanding groin pain: A prospective clinical cohort study. British Journal of Sports Medicine, 42(10), 851–854.
Hölmich, P., Thorborg, K., Dehlendorff, C., Krogsgaard, K., & Gluud, C. (2014). Incidence and prevalence of groin injuries in sub-elite male soccer players. American Journal of Sports Medicine, 42(8), 1849–1854.
Moore, K. L., Dalley, A. F., & Agur, A. M. R. (2018). Clinically oriented anatomy (7th ed.). Wolters Kluwer.
