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I've been training for a triathlon for three months now. All of a sudden, I've pulled up lame with groin pain. Can I safely work through the pain? If I keep training, how do I modify my workouts?

There are different problems that can cause groin pain. Before making a decision about your training regimen, see a sports medicine specialist for an examination and diagnosis. If you have a simple tendon strain, the treatment approach is very different from a sports hernia or stress reaction (fracture). An X-ray can rule out (or confirm) the presence of any bone fractures. Stress reactions are not visible for six to weeks after the damage has been done, so there may be a lag time before this diagnosis can be made. Another imaging study that might offer some useful information is a contrast MRI. A dye is injected that is taken up by the tendon where it inserts into the bone. Damage to the tendon fibrils leave the soft tissue edges open so that the dye seeps into the area. Not all tendon problems show up on MRIs, so this test is not 100 per cent accurate. There are some simple clinical tests the physician can use to pinpoint the problem. Reproducing your pain by pressing on the adductor longus, the most common tendon involved in groin pain, is a sure sign that the problem is extra-articular. Extra-articular means the pain is coming from outside the hip joint. Two other tests are helpful: resisting movement of the adductor muscles and assuming a position that stretches the muscles. Pain with either of these tests helps confirm the adductor muscle as the most likely cause. Once the diagnosis has been made, then your physician can advise you as to the best treatment or management approach. This could involve a period of rest and avoidance of weight-bearing activities. Or it could mean a change in your training protocol. Depending on how far away the triathlon is, you may still be on target after rest and recovery. Continuing to repeatedly stress the area is usually not advised.

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