A sports hernia is an injury to the soft tissues of the groin. It typically occurs while playing sports requiring sudden sharp changes in running direction. In medical circles, the technical term for this injury is an “athletic pubalgia”. The trademark sign of a sports hernia injury is sudden groin pain. The pain is sometimes referred to the abdomen, testicle and occasionally to the contralateral side. The patient complains typically of a grumbling groin pain that improves or subsides with rest but recurs with physical activity. Often, there is tenderness over the pubic bone and the inguinal ring.
If you play basketball, football or rugby (to take a few examples) you may have experienced an injury of this type. The sudden directional changes required by these & some other sports activities require twisting of the pelvic muscles. The result of these movements is often tearing or other damage to the soft tissues of the groin area.The injury often consists of tears to the adductor muscles, often above the level of their attachment to the pubic bone.
Sports hernias should not be confused with traditional hernias. The latter are caused by an abnormal exit of an organ or tissue (typically the bowel) through a defect in the abdominal wall. Sports hernias, on the other hand, are tearing of soft tissues (often the adductor muscles) in the groin or lower abdomen area. They can exist in the absence of traditional hernias.
Sports hernias are similar to groin strains. However, care should be taken not to confuse these two groin injuries. Groin pain from a sports hernia tends to be more chronic in nature. In addition, sports hernias can cause pain not only in the groin but also in the lower abdomen.
In what follows below, we will consider the causes & symptoms of these injuries. We will then look at the most typical methods of treating these injuries. Finally, we will suggest ways to reduce the risk of incurring this painful and unpleasant injury.
As always, the contents of this article should not be regarded as a substitute for professional medical advice.
Anatomical Causes Of Sports Hernias
The twisting and turning movements demanded by sports like football and basketball place significant stresses on the oblique muscles located in the lower abdomen. These muscles and the tendons that attach them to the pubic bone, play a key role in turning the torso.. Sports hernia injuries usually involve tearing or stretching of these muscles and the associated tendons.
By contrast, most traditional hernias occur in the inguinal canal area above the oblique muscles. For this reason, these hernias are also referred to as inguinal hernias.
The main factor that increases the risk of this injury is extensive twisting of the torso , especially when keeping the feet planted in a fixed position. This type of movement is common to many sports; hence the classification of a sports hernia as a sports injury.
Symptoms Of A Sports Hernia Injury
The main symptom of a sports hernia is a sharp groin pain, starting at the time the injury occurs. As is common with many soft tissue injuries, the pain may recede after a rest period. However, if the damage is not fully repaired, the pain will resume as soon as physical activity restarts.
There are no visible signs associated with athletic pubalgia injuries. Unlike traditional hernias, victims of a sports hernia injury will not notice a bulge in the groin area. However, left untreated, a sports hernia injury may eventually give rise to a traditional hernia with its characteristic bulge in the groin.
Diagnosing A Sports Hernia Injury
To diagnose whether your injury is a sports hernia, doctors may interview you about when the injury started. They may also ask what you were doing at the time.
Most doctors will then conduct a physical examination to check for pain and tenderness in the groin or pelvic area.
One tell tale sign of a likely sports hernia injury is unusual pain when attempting a sit up exercise. Some doctors may ask you to attempt this type of exercise as part of the physical examination. You will then be asked to report any groin pain you experience.
In a few cases, you may be asked to undergo an imaging scan of the pelvic area to confirm the doctor’s findings. He or she may request an X ray or MRI scan for this purpose. An MRI scan of the pelvis and pubic symphysis can sometimes help to establish the cause of ‘athletic pubalgia’.
Treating A Sports Hernia Injury
The treatment plan for these injuries (in common with that of other soft tissue injuries) depends on its severity.
If the injury is mild, with only moderate stretching or slight tearing of the oblique muscles and tendons, a period of rest may be sufficient. Sometimes, gentle stretching exercises during the period of rest can be beneficial. To ease the pain, doctors may suggest cold therapy such as an ice pack (every few hours for 15-50 minutes).
If the pain is unusually severe, you may also be advised to use an over the counter anti inflammatory medication. A typical choice would be Advil (ibuprofen) .
Physical therapy (physiotherapy) to help rehabilitate the damaged muscles and tendons may also be suggested.
In the case of severely torn oblique muscles or tendons, home treatment will not be adequate. Your doctor will likely refer you to an orthopedic surgeon for further treatment.
Surgeons can use 2 approaches:
The traditional one involving a single long incision; or
Endoscopic surgery involving several small incisions and the use of a tiny camera to look inside the incisions and repair the damage.
After the surgery, you may be referred to a physiotherapist who can recommend exercises to help the damaged muscles recover fully. Following these exercises will help you to reduce the risk of recurrence of your sports hernia injury.
When treating this injury, it is important to consider and exclude other possible causes of the groin pain, especially if the response to the treatment intervention is not as would normally be expected.