The Copenhagen Hip and Groin Outcome Score, or HAGOS, is a 37-item patient-reported outcome measure designed for young to middle-aged physically active people with hip and/or groin pain. It includes six separately scored subscales covering pain, symptoms, daily function, sport and recreation, participation in physical activities, and hip/groin-related quality of life. HAGOS can support monitoring and progress tracking, but it does not diagnose a condition or clear someone for sport on its own.
Hip and groin pain can affect sprinting, kicking, cutting, change of direction, running, gym training, sport participation, daily activity and confidence with movement.
The Copenhagen Hip and Groin Outcome Score, commonly called HAGOS, is a patient-reported outcome measure developed to assess the client’s own perception of hip and/or groin disability and related problems.
It is commonly used for:
athletic groin pain
hip-related pain in active people
adductor-related groin pain monitoring
hip and groin rehabilitation tracking
return-to-running and return-to-sport monitoring
long-term sport participation tracking
research and clinical outcome reporting
HAGOS was developed and validated according to COSMIN recommendations for young to middle-aged physically active people with long-standing hip and/or groin pain. It includes six subscales: Pain, Symptoms, Physical Function in Daily Living, Physical Function in Sport and Recreation, Participation in Physical Activities, and hip/groin-related Quality of Life.
Outcome measure: Copenhagen Hip and Groin Outcome Score
Abbreviation: HAGOS
Body region: Hip and groin
Type: Patient-reported outcome measure
Number of items: 37
Subscales: Pain, Symptoms, ADL, Sport/Recreation, Participation, Quality of Life
Score range: 0–100 for each subscale
Higher score means: Better perceived hip and groin status
Lower score means: More pain, symptoms, limitation, reduced participation or quality-of-life impact
Best used for: Physically active people with hip and/or groin symptoms
Key limitation: HAGOS does not diagnose a hip or groin condition or determine return-to-sport readiness on its own
The HAGOS is a hip- and groin-specific patient-reported outcome measure.
It was developed to provide a quantitative measure of hip and groin disability across different levels of the International Classification of Functioning framework. The official HAGOS resource describes it as an instrument for assessing the client’s perception of hip and/or groin disability and associated problems.
HAGOS includes six separately scored subscales:
Pain
Symptoms
Physical Function in Daily Living
Physical Function in Sport and Recreation
Participation in Physical Activities
Hip and/or Groin-Related Quality of Life
The HAGOS is especially relevant when the client is physically active and the assessment needs to capture sport, participation and quality-of-life impact, not only pain.
The HAGOS is used because hip and groin symptoms can affect more than pain intensity.
A client may have improving strength or range of motion but still report:
pain during kicking
pain during cutting or change of direction
reduced sprint confidence
reduced training participation
symptoms after sport
difficulty with stretching or long strides
reduced confidence returning to competition
frustration with recurrent groin symptoms
The HAGOS may help professionals:
establish a baseline
identify which domains are most affected
monitor symptom and function change over time
support goal-setting conversations
track sport and participation impact
combine client-reported outcomes with physical testing
improve Measurz reporting quality
The HAGOS should support assessment reasoning and progress tracking. It should not be used as a stand-alone diagnostic or clearance tool.
The Pain subscale captures hip and/or groin pain related to activity and daily tasks.
It may provide context around:
pain during sport
pain during daily movement
pain during loading
pain after activity
pain irritability
The Symptoms subscale captures hip and/or groin symptoms beyond pain.
This may include:
discomfort
clicking or noise
restricted movement
difficulty stretching
sudden twinges or stabbing sensations
This subscale captures everyday function.
It may include tasks such as:
walking
getting in and out of positions
basic mobility
daily activities
movement confidence
This subscale captures higher-demand sport and recreation activity.
It may include:
running
sprinting
twisting
kicking
changing direction
recreational activity
gym or field sport demands
This subscale captures the degree to which hip or groin symptoms affect participation.
It may provide insight into:
reduced training involvement
modified sessions
avoidance of sport
limited competition exposure
reduced recreational participation
This subscale captures broader personal impact.
It may include:
frustration
confidence
awareness of symptoms
concerns about recurrence
lifestyle restriction
perceived long-term impact
The HAGOS may be useful for:
exercise professionals
rehabilitation practitioners
strength and conditioning coaches
performance coaches
allied health support teams
movement assessment professionals
students learning outcome measures
professionals using Measurz or MAT for structured progress tracking
It may be relevant for clients with:
athletic groin pain
adductor-related groin pain
iliopsoas-related groin symptoms
pubic-related groin symptoms
hip-related groin symptoms
femoroacetabular impingement-related symptoms
long-standing hip or groin pain
recurrent sport-related groin symptoms
reduced confidence with sprinting, kicking or cutting
The original validation population included physically active patients with long-standing hip and/or groin pain, with a mean age of 36 years and age range of 18–63 years.
Use the HAGOS when you want to understand how hip or groin symptoms affect the client’s pain, function, sport participation and quality of life.
It may be useful at:
initial assessment
onboarding
reassessment
groin pain monitoring
hip pain monitoring
return-to-running planning
return-to-sport planning
in-season athlete monitoring
discharge or progress review
The HAGOS is especially useful when sport participation and higher-level physical activity matter to the client.
Use caution when:
the client is not physically active and sport items are not relevant
the client cannot complete the questionnaire independently
language or literacy affects responses
the wrong language version is used
multiple body regions are driving limitation
many items are missing
the score is being used as a pass/fail decision
the result is interpreted without physical assessment context
The HAGOS should not be used to:
diagnose a hip or groin condition
confirm adductor injury
confirm hip joint pathology
determine tissue healing
explain symptoms on its own
clear someone for sport
replace physical assessment
replace professional judgement
HAGOS questionnaire
Official scoring guide or validated calculator
Measurz recording workflow
Baseline and retest dates
Client-reported symptom notes
Optional related physical tests, such as:
hip range of motion
adductor squeeze test
hip adduction strength
hip abduction strength
FADIR or FABER where appropriate
single-leg squat
change-of-direction testing
running or sprint assessment
sport exposure tracking
Explain the purpose of the questionnaire before the client completes it.
Example wording:
“This questionnaire helps us understand how your hip or groin symptoms are affecting pain, daily function, sport, participation and quality of life. It does not diagnose the condition on its own, but it helps us monitor change over time.”
The HAGOS can be completed:
on paper
digitally
independently
with assistance
before a session
during reassessment
as part of a Measurz workflow
Ask the client to:
answer based on their hip and/or groin problem
answer based on the stated recall period in the questionnaire
choose the response that best matches their experience
answer every item where possible
avoid overthinking each question
ask for clarification if they do not understand the wording
complete the same version at each retest
Record whether the HAGOS was completed:
independently
digitally
on paper
verbally
with assistance
This supports repeatability and helps interpret changes over time.
If assistance is needed:
explain instructions without leading the answer
avoid telling the client which response to choose
record that assistance was provided
use the same assistance approach at retest where possible
Do not guess missing responses.
Use the official scoring guidance for the version being used. If too many items are missing for a subscale, record that subscale as incomplete rather than creating an unreliable result.
Each item is scored, then each subscale is transformed to a 0–100 score.
General scoring direction:
100: no hip or groin problems
0: extreme hip or groin problems
The six subscales should be interpreted separately rather than combined into one unsupported total score.
Retest at meaningful time points, such as:
baseline
after a rehabilitation block
after return-to-running progression
after return-to-kicking progression
during in-season monitoring
after symptom flare-up
before return-to-competition decisions
discharge or progress review
For consistency, record:
date
current training exposure
recent flare-ups
recent match or competition load
current running, kicking or cutting exposure
any changes in training modification
The HAGOS is a self-report questionnaire, so it does not create physical testing risk.
However, worsening scores may support further assessment when the client reports:
increasing pain
reduced participation
worsening quality of life
inability to train
new or changing symptoms
major confidence reduction
The HAGOS has six separate subscale scores.
Each subscale ranges from 0 to 100.
Higher scores indicate better perceived hip and groin status.
Lower scores indicate greater symptoms, limitation, participation restriction or quality-of-life impact.
Pain: 0–100
Symptoms: 0–100
Physical Function in Daily Living: 0–100
Physical Function in Sport and Recreation: 0–100
Participation in Physical Activities: 0–100
Quality of Life: 0–100
A higher score may suggest:
less pain
fewer symptoms
better daily function
better sport and recreation function
better physical activity participation
better hip/groin-related quality of life
improved confidence with activity
A lower score may suggest:
more pain
more symptoms
reduced daily function
reduced sport or recreation capacity
reduced training participation
reduced confidence
greater quality-of-life impact
A HAGOS score does not prove:
the diagnosis
the tissue source of symptoms
adductor injury
hip joint pathology
pubic-related pathology
readiness to return to sport
whether imaging is required
whether one intervention caused the change
Example wording:
“Your HAGOS results show that daily activities are improving, but sport participation and quality of life are still affected. This does not tell us exactly what structure is causing symptoms, but it helps us understand how your hip or groin problem is affecting the activities that matter to you.”
For general fitness clients, HAGOS may help show how hip or groin symptoms affect:
walking
gym training
lunging
squatting
running
recreational activity
Interpretation cautions:
sport participation items may be less relevant
recent activity can influence responses
symptoms from the lower back, abdomen or pelvis may affect answers
For athletes, HAGOS is especially useful because it includes sport and participation subscales.
It may help monitor:
sprinting confidence
kicking tolerance
cutting and change-of-direction confidence
training modification
participation restriction
quality-of-life impact
Interpretation should include sport-specific testing. A high HAGOS score should not be treated as clearance on its own.
HAGOS was developed for young to middle-aged physically active people, so interpretation in older adults should be cautious.
For older adults, consider:
whether the sport and participation items are relevant
whether HOOS may be more appropriate for hip osteoarthritis contexts
whether comorbidities influence scores
whether general strength, balance or mobility affects responses
For youth clients, consider:
reading level
comprehension
parent or guardian assistance
sport exposure
whether the measure version is appropriate
If assistance is provided, record it clearly.
HAGOS is highly relevant for athletic groin pain because it captures sport, participation and quality-of-life domains.
Interpretation should include:
adductor squeeze test
hip and groin strength testing
range of motion
sport-specific symptom behaviour
training load
running, kicking and cutting exposure
For hip-related groin symptoms, HAGOS may help monitor pain, sport function and participation.
Interpretation should also consider:
hip range of motion
symptom provocation tests where appropriate
strength testing
sport or occupational demands
imaging or medical information where available
For persistent symptoms, HAGOS can help monitor broader impact beyond pain.
Scores may be influenced by:
fear of recurrence
reduced confidence
modified training
frustration
symptom flare-ups
changes in sport participation
Meaningful change helps determine whether a score change is likely to matter.
Key terms:
MCID / MIC: the smallest change that may be meaningful to clients or professionals, depending on the method used
MDC: the amount of change likely needed to exceed measurement error
SEM: the estimated measurement error around a score
Responsiveness: the ability of the measure to detect change over time
In the original HAGOS development and validation study, HAGOS was evaluated for validity, reliability and responsiveness in 101 physically active patients with hip and/or groin pain. Test-retest reliability was substantial, with ICC values reported between 0.82 and 0.91 across subscales.
High-quality, universally applicable MCID, MDC or SEM values for every HAGOS subscale and every hip/groin population appear limited.
This means meaningful change should be interpreted by combining:
baseline comparison
repeated testing
subscale pattern
client-reported change
sport exposure
symptom response
related physical testing
training participation
When interpreting HAGOS change:
compare each subscale to baseline
avoid relying on one subscale alone
look for consistent improvement across relevant domains
consider whether activity exposure has increased
interpret sport and participation changes alongside actual training load
combine score change with pain, strength, ROM and sport-specific tests
Reported meaningful change values may vary by:
condition
sport
language version
scoring method
baseline severity
follow-up timeframe
intervention type
Where no matching MCID, MDC or SEM value exists, interpretation should rely more heavily on:
repeated measurement
client goals
symptom change
function change
training participation
related physical assessment findings
professional judgement
Broad general-population HAGOS normative data appear limited because HAGOS was developed mainly for young to middle-aged physically active people with hip and/or groin pain.
However, sport-specific comparative data are available.
A 2021 study in professional male football investigated normal values for hip/groin strength and self-reported hip and groin function using HAGOS across a season. The study aimed to identify normal values and seasonal changes in professional football players, making it useful as a sport-specific comparison context rather than a universal benchmark.
Practical comparison guidance:
Use the client’s own baseline as the primary comparison.
Compare subscales separately rather than using one total score.
Interpret sport and participation scores in relation to actual training exposure.
Use professional athlete values only for similar athletic populations.
Avoid applying football-specific values to general population clients.
Combine HAGOS scores with physical tests and goals.
Comparison values should be interpreted with caution because scores may differ by:
sport
sex
age
training level
injury history
current participation
symptom duration
season phase
cultural or language version
The original HAGOS study was developed according to COSMIN recommendations and evaluated validity, reliability and responsiveness in young to middle-aged physically active people with long-standing hip and/or groin pain.
Key reported measurement findings include:
six separately scored subscales
substantial test-retest reliability
ICC values reported from 0.82 to 0.91
evaluation of validity and responsiveness in a physically active hip/groin pain population
A Dutch validation study reported that HAGOS was developed to assess disease-specific consequences in young to middle-aged physically active hip and/or groin patients, and evaluated validity and reliability of the Dutch version in people with hip pathology.
A 2022 validation study using modern test theory in Danish, Norwegian and English-speaking male football players further examined HAGOS measurement properties in athletic populations.
Reliability and validity are stronger when:
the correct version is used
the same language version is repeated
all relevant items are completed
subscales are interpreted separately
the client is similar to the validation population
retesting occurs at meaningful time points
results are interpreted alongside physical and sport-specific assessment
Interpret cautiously when:
many items are missing
the client has not attempted sport or training
the client is outside the intended population
symptoms involve multiple regions
the score is used without activity exposure context
the score is used as a stand-alone return-to-sport decision
Common errors include:
treating HAGOS as a diagnosis
using one subscale as a clearance measure
combining subscales into an unsupported total score
ignoring missing items
not recording the language or version used
comparing scores without considering training exposure
using professional athlete comparisons for non-athletes
over-interpreting small changes
ignoring participation and quality-of-life domains
failing to pair HAGOS with physical testing
Limitations include:
developed mainly for young to middle-aged physically active people
less directly applicable to sedentary or older adult populations
self-report can be influenced by expectations, mood and recent activity
sport items may be misleading if the client has not returned to sport
broad normative data are limited
MCID, MDC and SEM values may not be available for every population
does not identify the exact cause of hip or groin symptoms
The HAGOS may help professionals:
document baseline hip/groin status
identify whether pain, sport, participation or quality of life are most affected
monitor athletic groin pain over time
track return-to-running and return-to-sport progress
support training modification discussions
improve client education
communicate progress with coaches or support teams
strengthen Measurz reports
For athletes, HAGOS can help identify whether participation and sport confidence are still limited even when pain has improved.
For general fitness clients, HAGOS can help track how hip or groin symptoms affect training, walking, running and daily activity.
For persistent symptoms, it can show whether the condition is affecting confidence, lifestyle and activity choices.
For Measurz users, HAGOS is most useful when combined with objective measures such as:
adductor squeeze test
hip adduction strength
hip abduction strength
hip range of motion
single-leg squat
change-of-direction testing
running or sprint exposure
pain with sport-specific tasks
Record:
outcome measure name: Copenhagen Hip and Groin Outcome Score / HAGOS
version used
language/version used
date completed
completion method: paper, digital, interview or assisted
condition or presentation being tracked
side involved: left, right or bilateral
Pain subscale score
Symptoms subscale score
ADL subscale score
Sport/Recreation subscale score
Participation subscale score
Quality of Life subscale score
score range: 0–100
direction of scoring: higher score indicates better status
missing items, if any
assistance provided, if any
current pain score, if relevant
current symptoms
current sport or training exposure
key functional limitations
participation goals
confidence notes
baseline comparison
meaningful change comparison where supported
related physical assessment findings
interpretation notes
retest date
referral or further assessment notes where appropriate
Record whether the main limitation appears to be:
pain dominant
symptom dominant
daily function limitation
sport/recreation limitation
participation limitation
quality-of-life limitation
mixed presentation
unclear due to incomplete responses
This improves:
repeatability
communication
client education
assessment reasoning
monitoring over time
team consistency
reporting quality
The HAGOS measures self-reported hip and groin pain, symptoms, daily function, sport and recreation function, participation in physical activities, and hip/groin-related quality of life.
The HAGOS has 37 items across six subscales.
Each subscale is converted to a 0–100 score. A higher score indicates better perceived hip and groin status.
HAGOS is usually interpreted using six separate subscale scores rather than one combined total score.
No. HAGOS does not diagnose adductor, hip joint, pubic or iliopsoas-related groin pain. It measures the client’s perceived symptoms, function, participation and quality-of-life impact.
HAGOS was designed for young to middle-aged physically active people with hip and/or groin pain, so it is especially relevant for active and athletic populations.
HAGOS can support return-to-sport reasoning, especially the Sport/Recreation and Participation subscales, but it should not be the only clearance measure.
It can be repeated at baseline, reassessment, after a training or rehabilitation phase, during in-season monitoring and at key return-to-activity milestones.
HAGOS is a hip and groin patient-reported outcome measure.
It was designed for young to middle-aged physically active people with hip and/or groin pain.
It includes six subscales: Pain, Symptoms, ADL, Sport/Recreation, Participation and Quality of Life.
Each subscale is scored from 0 to 100.
Higher scores indicate better perceived hip and groin status.
HAGOS does not diagnose a condition or clear a client for sport.
Reliability and validity are strongest when used in populations similar to the validation group.
Measurz should record each subscale, version, language, completion method, sport exposure, baseline comparison, related findings and retest plan.
Bourne, M. N., Williams, M., Jackson, J., Williams, K. L., Timmins, R. G., Pizzari, T., & Opar, D. A. (2020). Preseason hip/groin strength and HAGOS scores are associated with subsequent injury in professional male soccer players. Journal of Orthopaedic & Sports Physical Therapy, 50(5), 234–242. https://doi.org/10.2519/jospt.2020.9022
Christensen, K. B., et al. (2022). Validation of the Copenhagen Hip and Groin Outcome Score (HAGOS) using modern test theory across different cultures and languages: A cross-sectional study of 452 male football players with groin pain. British Journal of Sports Medicine. https://doi.org/10.1136/bjsports-2021-104412
Giezen, H., Stevens, M., van den Akker-Scheek, I., & Reininga, I. H. F. (2017). Validity and reliability of the Dutch version of the Copenhagen Hip and Groin Outcome Score (HAGOS-NL) in patients with hip pathology. PLOS ONE, 12(10), e0186064. https://doi.org/10.1371/journal.pone.0186064
Thorborg, K., Hölmich, P., Christensen, R., Petersen, J., & Roos, E. M. (2011). The Copenhagen Hip and Groin Outcome Score (HAGOS): Development and validation according to the COSMIN checklist. British Journal of Sports Medicine, 45(6), 478–491. https://doi.org/10.1136/bjsm.2010.080937
Walden, M., et al. (2021). Do hip and groin muscle strength and symptoms change throughout a football season in professional male football players? Journal of Science and Medicine in Sport. https://doi.org/10.1016/j.jsams.2021.03.008
