Groin complaints may lead to surgical consultation, especially when ultrasound has diagnosed a groin hernia in the outpatient setting. However, a hernia is not necessarily the cause of the problem. In this clinical lesson, we present three patients (an 80-year-old woman, a 46-year-old man and 65-year-old woman). Severe inguinal pain was the presenting symptom in all cases. The diagnosis 'inguinal hernia' was confirmed with ultrasound in all cases. Based on the new guideline, physical examination is decisive for the diagnosis 'inguinal hernia'. A combination with ultrasound is not recommended, although often performed. We discuss why ultrasound can be helpful but also misleading. For the treatment of inguinal pain, we advocate lessons learned in sports medicine.