The anatomy of the pubic region revisited: implications for the pathogenesis and clinical management of chronic groin pain in athletes.

Chronic groin pain is a common complaint for athletes participating in sports that involve repetitive sprinting, kicking or twisting movements, such as Australian Rules football, soccer and ice hockey. It is frequently a multifactorial condition that presents a considerable challenge for the treating sports medicine practitioner. To better understand the pathogenesis of chronic groin pain in athletes, a precise anatomical knowledge of the pubic symphysis and surrounding soft tissues is required. Several alternative descriptions of pubic region structures have been proposed. Traditionally, chronic groin pain in athletes has been described in terms of discrete pathology requiring specific intervention. While this clinical reasoning may apply in some cases, a review of anatomical findings indicates the possibility of multiple pathologies coexisting in athletes with chronic groin pain. An appreciation of these alternative descriptions may assist sports medicine practitioners with diagnostic and clinical decision-making processes. The purpose of this literature review is to reappraise the anatomy of the pubic region, considering findings from cadaveric dissection and histology studies, as well as those from diagnostic imaging studies in athletes.