Background Sports hernia, or sportsman’s groin, is a complex and poorly understood cause of chronic groin pain in athletes, characterized by weakness or injury to the posterior inguinal wall without the presence of a true hernia. Proper evaluation and treatment are challenging due to varied presentations and a broad differential diagnosis. Objective This chapter provides a comprehensive overview of the pathophysiology, diagnosis, and management of sports hernia, focusing on the integration of advanced diagnostic techniques and tailored therapeutic approaches. Methods A multidisciplinary approach to evaluation includes clinical history, physical examination, and imaging modalities, such as dynamic ultrasound and MRI. The novel Sheen Paajanen grOin Recommended Treatment (SPoRT) score standardizes assessment and guides treatment decisions. Nonoperative management emphasizes physiotherapy and injection therapies, while surgical interventions range from minimal repair to laparoscopic mesh reinforcement. Results The SPoRT score demonstrates high sensitivity and specificity in identifying cases requiring surgical intervention, aiding timely return to sport. Conservative therapies, including the Hölmich and modified Hölmich protocols, improve outcomes in adductor-related pain. For refractory cases, surgical repair achieves high success rates, with laparoscopic techniques offering broader reinforcement and quicker recovery compared to open methods. Conclusions The multidisciplinary management of sports hernia requires precise diagnosis and individualized treatment plans. Incorporating scoring systems, advanced imaging, and minimally invasive surgical options can optimize outcomes, enabling athletes to return to performance swiftly and effectively. Further research is needed to refine techniques and expand evidence-based treatment protocols.