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Groin Pain Pathway

Operational clinical pathway page linking assessment, imaging decisions, treatment sequencing and escalation.

Purpose of this pathway

Groin Pain Pathway is designed to reduce inconsistency and make the clinical sequence visible: assess, classify, identify red flags, decide whether imaging changes anything, start the most appropriate active care, and escalate only when that sequence indicates it. The value of a pathway is not bureaucracy; it is better decisions made more reliably.

Stepwise structure

  1. Clarify the diagnosis and irritability profile.
  2. Screen for urgent or medical red flags.
  3. Assess movement, strength and function relevant to the patient’s goals.
  4. Decide whether imaging changes management.
  5. Build the initial rehabilitation block and education messages.
  6. Review response and escalate only if needed.

Operational note

Pathways work best when they include exit points for improvement and escalation points for lack of progress, rather than defaulting everybody to the same next step.

FAQs

What is the aim of a clinical pathway?

A pathway standardises useful decision points while still allowing for individual variation in diagnosis, irritability and patient goals.

Should pathways replace judgement?

No. They support judgement by reducing omissions and keeping the most important sequencing decisions visible.

References

  1. National Institute for Health and Care Excellence (2022) Osteoarthritis in over 16s: diagnosis and management. NICE guideline NG226.
  2. National Institute for Health and Care Excellence (2021) Chronic pain in over 16s: assessment and management. NICE guideline NG193.
  3. Hunter, D.J. and Bierma-Zeinstra, S. (2019) Osteoarthritis. Lancet, 393(10182), pp.1745–1759.
  4. Kolasinski, S.L. et al. (2020) 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis. Arthritis Care & Research, 72(2), pp.149–162.
  5. Bannuru, R.R. et al. (2019) OARSI guidelines for the non-surgical management of knee, hip and polyarticular osteoarthritis. Osteoarthritis and Cartilage, 27(11), pp.1578–1589.
  6. Crossley, K.M. et al. (2016) Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat. British Journal of Sports Medicine, 50(14), pp.842–850.
  7. Collins, N.J. et al. (2018) Consensus recommendations on exercise therapy and physical interventions for patellofemoral pain. British Journal of Sports Medicine, 52(18), pp.1170–1178.

Reasoning framework

Groin Pain Pathway should begin with pattern recognition and then move quickly into decisions that change management: high irritability versus low irritability, tendon versus joint versus bursal behaviour, traumatic versus gradual onset, and whether diagnostic ultrasound is likely to clarify the next step. That approach keeps the pathway practical and avoids over-investigation.