Pubalgia exercises: this is one of the most frequent searches among people with groin pain who can no longer run, kick or change direction. The honest answer is that exercises really are the approach with the most evidence in their favour, but that this evidence is more fragile than it is usually told: no study justifies promising a certain recovery within a precise number of weeks.
This guide does something different from the others: it tells you what holds up under scrutiny and what does not. You will see why the word "pubalgia" is not a diagnosis, which exercises have actually been tested and on whom, how much the numbers quoted for treatment and prevention are really worth, and how to build a sensible progression from there anyway.
⚠ Important: read this before continuing
The exercises and advice in this article are general guidance and may not suit your situation. Every person has a unique clinical history: what works for others could be counterproductive for you.
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First of all: when groin pain should not be trained
Groin pain is a border zone. Underneath it run the hip joint, the abdominal wall, the bowel, the urinary and genital systems: the international classification therefore has a separate category for "other causes" of groin pain in athletes, precisely because not everything is muscular. That document, the Doha international agreement I come back to shortly, contains a table headed "do not miss", which lists inguinal or femoral hernia, nerve entrapment, pain referred from the lower back and sacroiliac joint, apophyseal avulsions and stress fractures (femoral neck, pubic ramus, acetabulum), hip problems during growth, reactive or infectious arthritis, intra-abdominal and urological conditions, gynaecological conditions, spondyloarthropathies and tumours (testicle, bone, prostate). Before attributing everything to pubalgia and starting any exercise, rule out these signs.
- Fever, general malaise or chills together with the pain.
- Night pain that does not depend on position or movement, that wakes you up, or pain that does not change in any way with what you do.
- Inability to put weight on the leg after an injury, or groin pain that appears in someone who has suddenly increased running or jumping: this is the typical presentation of a stress fracture of the femoral neck, which can be subtle and which, if ignored, risks serious complications. An X-ray is needed, and if it is negative but the suspicion remains, an MRI.
- Pain, swelling or a lump in the testicle, or pain radiating there in a new and persistent way.
- A swelling in the groin that appears or grows when coughing, under effort or standing: it needs to be assessed for a hernia.
- Unexplained weight loss, night sweats, history of cancer.
- An adolescent who feels a snap during a sprint or a kick and then can no longer bear weight: at growing ages the growth centres of the pelvis can separate.
- Associated urinary, bowel or gynaecological symptoms, ongoing pregnancy, or pain that appeared after childbirth.
In all these cases the first step is the doctor, not the mat. And this holds generally, in the words of the authors of that document: to recognise other possible causes, an accurate history and clinical examination that do not stop at the musculoskeletal system are decisive, plus investigations or referral to a specialist when they are needed.
The full list of signs that should be seen by a doctor before a physiotherapist is in urgent care.
"Pubalgia" is not a diagnosis: it is the name of an area that hurts
This is the point that changes everything else. In 2014 twenty-four experts from fourteen countries met in Doha precisely to bring order to the confusion of terms, and in the document that came out of it "athletic pubalgia" is not a diagnosis: it appears instead in the explicit list of terms the group chose not to recommend, together with "pubic osteitis", "sports hernia", "Gilmore's groin" and others, because of their lack of specificity and the highly variable way they have been used. The shared classification distinguishes four defined clinical entities (groin pain related to the adductors, to the iliopsoas, to the inguinal region and to the pubis), plus pain related to the hip and the category of other causes.
This is not terminological pedantry. In Italy "pubalgia" is used as if it were a disease in its own right, and as a result people look for "exercises for pubalgia" as if there were a single list valid for everyone. But the entities above have different treatments: pain related to the hip, for example from femoroacetabular impingement, does not respond to the same programme as an adductor problem, and pain related to the inguinal region first requires ruling out a hernia component.
Keep this in mind when you read the rest: almost everything we know about exercises has been studied on adductor-related pain, and it is to that entity, not to "pubalgia" in general, that the numbers below refer.
What the studies really say
The reference study dates from 1999, published in Lancet. It involved 68 athletes with long-standing adductor-related groin pain (median duration of symptoms: 40 weeks), randomly assigned either to an active training programme or to physiotherapy treatment without active training. The treatment lasted 8-12 weeks and the follow-up was done 4 months after it ended, by a doctor who did not know who had received what. Result: 23 athletes in the active training group returned to sport without groin pain, against 4 in the other group (odds ratio 12.7; 95% confidence interval: 3.4-47.2). The effective programme focused on strength and coordination of the muscles acting on the pelvis, particularly the adductors.
It is an important result, and it is the reason why today, faced with pubalgia, exercises are recommended. But it should be read for what it is: 68 people, one type of groin pain, more than twenty-five years ago. It should also be read with a detail that is almost always lost along the way: the Doha document, summarising the literature on treatment, speaks of moderate evidence in favour of supervised active training compared with passive therapies. What worked was not a list of exercises downloaded from the internet: it was a programme followed by someone.
And the rest of the literature? A systematic review published in 2023 (search conducted in March 2020) looked for all the randomised trials on non-surgical treatments for long-standing groin pain in athletes: it found seven, most classified at unclear risk of bias, with data too heterogeneous to be pooled in a meta-analysis. All showed positive effects, but the overall certainty of the evidence was judged low. The authors' conclusion is measured and also serves as the conclusion of this article: non-surgical treatment should probably be the first approach, and better studies are needed to say which is the most effective.
In short: exercises for pubalgia are the most sensible thing to try first, not a proven cure. Anyone who promises you a percentage of recovery or a precise date for returning is going beyond what the data allow. If you are interested in the general picture of what rehabilitation can and cannot promise, we covered it in this article on the effectiveness of physiotherapy.
The Copenhagen: the best evidence concerns preventing, not treating
The Copenhagen adduction is presented everywhere as "the gold standard exercise for pubalgia". Its best evidence, however, concerns something else.
In the cluster-randomised study published in 2019, 35 Norwegian semi-professional football teams were drawn by lot: 18 teams (339 players) in the group that performed the programme, 17 teams (313 players) as controls. The programme was a single exercise with three levels of progression, three times a week during pre-season (6-8 weeks) and once a week during the 28 weeks of the championship. The average prevalence of groin problems during the season was 13.5% in the training group against 21.3% in the control group, with a risk of reporting groin problems 41% lower (odds ratio 0.59; 0.40-0.86).
Here too honesty is needed about what was measured, because it is a point almost nobody reports. The outcome was not certified injuries with time off training, but self-reported groin problems collected every week with a questionnaire, in semi-professional male footballers. And until shortly before, the evidence on prevention was much less rosy: the meta-analysis summarised in the Doha document had pooled seven randomised prevention studies (4,191 participants, 157 injuries) and had found no statistically significant effect (relative risk 0.81; 95% confidence interval: 0.60-1.09), that is, a 19% reduction that may be relevant but is not demonstrated. The Norwegian study of 2019 came after, and it is the single most solid result we have, not a consolidated certainty.
With this caveat, the numbers remain remarkable. But they describe healthy players who stay healthy. As a treatment for pain that is already present, the evidence on the Copenhagen is much smaller: a randomised trial from 2024 on 30 footballers (15 per group, eight weeks, two sessions a week) added the exercise to a rehabilitation programme and found more eccentric adduction strength and less pain compared with the programme without it: an encouraging result, on a tiny sample.
The practical consequence is clear: in pubalgia the Copenhagen is not the starting point when the groin hurts, it is a point of arrival, and afterwards it becomes maintenance. Putting it in on the first day is one of the most common ways of making things worse.
An important point: before trying these exercises, make sure you have received a correct diagnosis. People often assume they have one problem, but the real cause of the pain is something else. Doing the wrong exercises can make things worse instead of better.
Progression, phase by phase
What follows is not a protocol to apply blindly: it is the order in which, in practice, load is built in adductor-related pubalgia. The criterion for moving on is not the calendar but the response: a discomfort that is tolerable during the exercise is acceptable, pain that the next morning is worse than the day before tells you that you have asked for too much.
Phase 1: Isometrics, loading without moving
These are the first building block because they allow tension to be placed on the adductors with minimal joint movement.
- Isometric squeeze: lying on your back, knees bent, a ball or cushion between the knees. Squeeze and hold for 10 seconds, 10 repetitions for 3 sets. Adjust the intensity of the push, not the number: start from a contraction you feel clearly but that does not cause pain. The same movement also serves as a thermometer: if the strength of the squeeze improves week after week, you are heading in the right direction.
- Glute bridge: lying on your back, knees bent, lift the pelvis. 15 repetitions.
- Short plank and dead bug: the plank held for 20-30 seconds with the body aligned; the dead bug lying on your back, arms towards the ceiling and hips at 90 degrees, extending the opposite arm and leg, 10 repetitions per side, keeping the lower back in contact with the floor.
Phase 2: Strengthening with movement
When the isometrics are painless, movement against resistance is introduced.
- Side-lying adduction: lying on one side, lower leg straight and upper leg bent in front; lift the lower leg upwards. 15 repetitions per side.
- Band adduction: standing, a band around the ankle anchored to the side, bring the leg across towards the other one against resistance. 15 repetitions. It is the variant that is easiest to dose, because you only need to change the band or the distance from the anchor point.
- Short Copenhagen: lying on your side, the knee of the upper leg resting on a bench or sofa; lift the pelvis and lower leg. 8-12 repetitions per side. It is the version to start with: the lever is short, so the load on the adductors is much lower.
- Pelvic stability: side plank 20-30 seconds per side, bird dog 10 repetitions per side, clamshell 20 per side, standing hip hike on a step 15 per side.
Phase 3: High load
- Long Copenhagen: as above but with the upper leg straight and the ankle on the support. Much more demanding: you move to it only when the short version is painless and controlled.
- Sumo squat (wide feet, toes turned out, knees in line with the feet) and lunges, first bodyweight then loaded.
- Single-leg bridge, 10 repetitions per side.
- Pallof press with a band, 10 repetitions per side, and hollow hold for 20-30 seconds: they work the anti-rotational control of the trunk, which is the natural complement to the adductor work. If you want to go deeper into this part, you will find further progressions in core exercises.
Phase 4: Return to sport
The return happens in steps, and each step must be passed without pain and without a reaction the next day: straight-line running → wide, slow changes of direction → tight, quick changes → sprinting → light kicking → full sporting movement.
Reasonable criteria for considering the path complete are three: the isometric squeeze produces similar strength on both sides, the long Copenhagen is performed without pain, and the most demanding session leaves no after-effects in the following 24 hours. After that the exercises are not abandoned: this is exactly where the programme changes from "treatment" to "prevention", that is, the use in which the most solid single study saw it working.
Stretching: useful, but not the engine
In the popular imagination pubalgia is treated by stretching the adductors, and indeed it is the first thing almost everyone tries on their own. The data, however, do not say this. The programme that worked in the 1999 study was built on strength and coordination, and the comparison group, which received physiotherapy without active training, did clearly worse.
This does not mean throwing stretching away. It means putting it in its place: it serves comfort and hip mobility, not to repair tissue that is suffering. Moreover, aggressive stretching of the adductors during an irritable phase is one of the most reliable ways to worsen symptoms: if it pulls and burns, you have overdone it.
- Butterfly: seated, soles of the feet together, let the knees drop without pushing. 30 seconds.
- Lunge for the iliopsoas: knee on the floor, pelvis moving forward. 30 seconds per side. Useful especially when the dominant component is anterior.
- 90/90 for rotational hip mobility: seated with both legs bent at 90 degrees, rotate the hips by bringing the knees from one side to the other, without forcing.
If the pain radiates behind, towards the buttock, the picture may not be that of the adductors at all: it is worth reading about piriformis syndrome too.
Why "rest and that's it" is not a plan
The comparison group in the 1999 study was not entirely still: it still received physiotherapy, simply without the active part. And it got much less. The message, for anyone with pubalgia, is that removing the painful stimulus is necessary but not sufficient: the part that changes the outcome is the one that gradually puts load back on the tissue.
In practice this means relative rest: you stop the movements that set off the pain (fast running, changes of direction, kicking) and keep everything else, adding the specific work. Another detail from the same study deserves attention: the athletes enrolled had had pain for a median of 40 weeks before starting serious treatment. Waiting for it to pass on its own is the strategy those people had already tried.
Imaging and diagnosis: be careful not to treat the picture
Here there is a trap worth knowing about before booking tests. A prospective study lasting four years followed 34 young professional footballers (average age 16.5) with symptom questionnaires, and repeated ultrasound and MRI of the anterior pelvis; over the four years the group shrank from 34 to 22 participants, none of them however because of a groin injury. The conclusion: bone oedema of the pubis, the secondary cleft, capsular and tendon oedema on MRI and the "ballooning" of the inguinal canal on ultrasound were frequently found in athletes without symptoms, and did not predict either the onset of injuries or the onset of symptoms.
A report that mentions oedema of the pubis, therefore, is not in itself proof that your pubalgia comes from there. The diagnosis remains clinical: history, location, movements that provoke the pain, strength tests and palpation. Imaging serves to answer precise questions: to rule out a stress fracture, a hernia, a hip condition. X-rays and MRI are excellent tools when you know what you are looking for, and misleading when you hope they will find the problem for you.
How long it takes, honestly
The figures that circulate on recovery times for pubalgia, "mild cases in 4-8 weeks, severe ones in 4-6 months", do not come from any study: they are numbers copied from one site to another. What can be said with a source behind it is this:
- in the reference study the programme lasted 8-12 weeks and the outcome was assessed 4 months after the end of treatment;
- those athletes had had symptoms for a median of 40 weeks, that is, they were long-standing cases;
- even in the arm that worked best, not everyone returned to sport without pain.
For groin pain that has lasted for months, then, the realistic horizon is measured in months, not weeks, and nobody can give you a date. What you can monitor are the intermediate indicators: the strength of the squeeze, the level of Copenhagen you tolerate, the running distance without a reaction the next day.
If you are not a male footballer
It is worth saying this explicitly, because it is the biggest limitation of all this literature: the studies cited were conducted almost entirely on male athletes, largely footballers. Pubalgia also affects runners, hockey players and rugby players, but also women, sedentary people who have suddenly increased their activity, and those with pelvic pain after pregnancy, a picture that has its own rules during pregnancy, collected in pubalgia in pregnancy.
For these groups the principles (gradual progression, strengthening before stretching, respecting the response at 24 hours) are reasonably transferable, but the numbers are not. And in pelvic pain linked to pregnancy or postpartum the picture is different and must be assessed separately: it is not the same condition as the footballer's adductors. If the pain is right on the pubis and has remained after childbirth, how much passes on its own and what distinguishes the minority in whom it persists is covered in pubic pain that does not go away after childbirth.
How we handle it in tele-rehabilitation
The difficult part of a pubalgia programme is not knowing the exercises: you have just read them all. It is understanding which of the clinical entities you are dealing with, dosing the load and knowing when to move on. It is exactly the kind of work that is also done well at a distance: guided assessment by video call, correct execution checked live, progression updated on your indicators. Ri-Hub's online physiotherapy sessions cost 29,90 € and the programme is rebuilt session after session based on your response.
In short
Exercises for pubalgia remain the first thing to do, but with three corrections to how they are usually presented. First: "pubalgia" is not a diagnosis, and without knowing which structure is involved the programme is a shot in the dark. Second: the evidence on treatment exists but is limited, seven randomised trials with low certainty, and the single most solid result concerns prevention in healthy footballers, where moreover the earlier meta-analyses had not found a significant effect. Third: no number of weeks is guaranteed, and anyone who promises you one is making it up.
The good news is that none of this takes anything practical away from someone with pubalgia. The progression stays the same (isometrics, then strengthening, then high load, then return in steps), and maintenance after recovery remains a sensible investment. What changes is the expectation with which you face it.
Sources
- Doha agreement meeting on terminology and definitions in groin pain in athletes, British Journal of Sports Medicine, 2015
- Effectiveness of active physical training as treatment for long-standing adductor-related groin pain in athletes: randomised trial, The Lancet, 1999
- Nonsurgical Interventions for the Management of Long-Standing Groin Pain in Athletes: A Systematic Review of Randomized Controlled Trials, Cureus, 2023
- The Adductor Strengthening Programme prevents groin problems among male football players: a cluster-randomised controlled trial, British Journal of Sports Medicine, 2019
- The effectiveness of the Copenhagen adduction exercise on improving eccentric hip adduction strength among soccer players with groin injury: a randomized controlled trial, The Physician and Sportsmedicine, 2024
- Do MRI and ultrasound of the anterior pelvis correlate with, or predict, young football players' clinical findings? A 4-year prospective study of elite academy soccer players, British Journal of Sports Medicine, 2015
Last source check: August 2026.
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