Sports Hernia

What is sports hernia?

Summary

A sports hernia is a painful, injury of the soft tissue that occurs in the groin area. It most often happens in people who play sports that require sudden changes of direction or intense twisting movements such as soccer, basketball, or wrestling.

Symptoms include severe pain, tenderness, and swelling in the groin area that appears immediately with an injury. The pain may improve with rest but flare up again with resumed activity. A visible bulge may or may not be present.

Treatment is necessary in order to return to sporting activities and to avoid chronic, disabling pain. You may receive non-surgical and surgical treatment depending on the severity of your injury.

Recommended care

You should visit your primary care physician within the next 24 hours. This condition should be promptly evaluated and treated with rest, physical therapy, and anti-inflammatory medications. Without treatment, this injury will result in chronic pain that could prevent you from returning to sports.

Sports hernia symptoms

Main symptoms

A sports hernia usually causes severe pain, tenderness and swelling in the groin area immediately at the time of injury. The quality of the pain and other symptoms can evolve in the following manner:

• Resumes with activity: The pain can improve with rest but may return when you go back to your usual sports activity, especially if it involves twisting movements.
• No visible bulge may be present: However, over time a sports hernia may cause a bulge by weakening the soft tissues around it to form a visible bulge.

Complications

Without treatment, this injury can result in chronic, disabling pain that prevents you from resuming sports activities.

Sports hernia causes

The soft tissues most often affected by sports hernia are the oblique muscles in the lower abdomen.

Variance from an abdominal hernia

It is important to note that even though a sports hernia may lead to a traditional, abdominal hernia, it is a different injury. An abdominal hernia specifically occurs when parts of the intestine push through weakened parts of the abdominal wall to cause a bulge. A sports hernia is a strain or tear of any soft tissue (muscle, tendon, ligament) in the lower abdomen or groin area.

Further identification

Because different tissues may be affected, and a traditional hernia may not exist, your physician may refer to your injury as an "athletic pubalgia." However, the general public and media are more familiar with the term "sports hernia."

Structural causes in the lower abdomen

The tendons that attach the oblique muscles to the pubic bone are especially vulnerable to this type of injury. Furthermore, in many cases of sports hernias, the tendons that attach the thigh muscles to the pubic bone (known as adductors) can also be stretched or torn. See this image here for a visual representation of this anatomy.

Forceful, twisting movements

Anything that causes twisting of the lower abdomen or groin with maximum exertion can cause a tear in the soft tissues. Sports are the biggest culprit; however, any condition that results in this type of movement can result in a sports hernia such as motor vehicle accidents or trauma.

Treatment options and prevention for sports hernia

Treatment is focused on providing rest and stability to the soft-tissues of the lower abdomen in order to give them proper time to heal. Treatment can be divided into nonsurgical and surgical options.

Non-surgical treatments

Nonsurgical treatment outcomes are favorable on their own. Treatments include:

• Rest: The RICE (Rest, Ice, Compress, Elevate) mnemonic is an often-used, easy to remember guide for treating a sports hernia. Try to lay down as much as possible. Put an ice pack over your lower abdomen every 15 minutes in order to reduce swelling. Elevation may be difficult, but try your best to keep the area raised while you rest. If you have a bulge in the groin, a compression wrap may help relieve some pain you are experiencing.
• Physical therapy: Your physician may prescribe a physical therapy/rehabilitation program to help you restore strength and flexibility in your abdominal muscles and inner thigh muscles.
• Pain management: Your physician may recommend non-steroidal anti-inflammatory medicines (ibuprofen or naproxen) to reduce swelling and pain. If your symptoms persist over a prolonged period, your physician may suggest a cortisone injection, which is a very effective steroid anti-inflammatory medicine.

Surgical treatments

However, if your pain continues or recurs when you go back to sports activities despite the above nonsurgical treatments, your physician may consider surgery to repair the injured tissues. Surgical treatment includes:

• Surgery types: A traditional, open procedure or a non-invasive, endoscopic procedure that allows the surgeon to see inside the abdomen may be performed. The end results of traditional and endoscopic procedures are the same. Your physician will discuss the details of the best surgical option for your specific needs.
• Surgical rehabilitation: Your physician will develop a rehabilitation plan to help you regain strength and endurance. Most athletes are able to return to sports six to 12 weeks after surgery.
• Additional surgery: In some cases of sports hernias, pain in the inner thigh continues even after the first surgical procedure. Your physician may suggest an additional surgery, called an adductor tenotomy, to address the continued pain. In this procedure, the tendon that attaches the inner thigh muscles to the pubis is cut. This causes the tendon to heal at a greater length, which releases tension and gives you a greater range of motion.

More than 90 percent of people who have a need for both nonsurgical treatment followed by surgery can return to normal sports activity relatively soon. However, in people who have tissue that re-tears, the surgical repair will need to be repeated with the adductor tenotomy.

When to seek further consultation for sports hernia

Make an appointment with your physician as soon as you experience symptoms, especially if the pain recurs when you attempt to go back to physical activity.

If you have persistent pain after treatment

If you receive surgery and rehabilitation but continue to experience pain, make a prompt appointment with your doctor in order to get the appropriate follow-up.