Sports Hernias
Chris Epperson, ATC, CSCS
Hughston Athletic Training Fellowship
Groin and abdominal pain are commonly caused by strains of the muscles crossing the hip joint, but may also be related to abdominal wall abnormalities. A sports hernia is a tear, strain, or weakness in the muscles of the lower abdomen (pubic symphysis), thigh adductors, and hip flexors; causing pain to the lower abdomen or groin.
In addition to the term sports hernia, such injury may also be referred to as “athletic pubalgia,” “athletic hernia,” or “sportsman’s hernia.”
A hernia is the protrusion of a tissue through the wall which usually contains it. In the case of sports hernias, the abdominal wall or surrounding areas is weak and may or may not cause protrusion or bulging of the tissue. In most cases a sports hernia will not be palpable.
Sports hernias are typically caused from extreme, forceful, and repeated bending, stretching, twisting, or turning movements. Sports that are typically recognized for this type of injury are soccer, hockey and tennis, but certainly are not limited to only these activities. Symptoms usually present slowly, then progress to sharp pain and discomfort in the lower abdomen, groin and testicles (in males). Pain is intensified with activity, especially running, cutting, and twisting movements. Symptoms may also increase with coughing and sneezing.
Physicians diagnose sports hernias by taking a thorough history and performing a physical examination. Diagnostic imaging such as x-rays, MRIs, CT scans, and ultrasound may be used. These tests are not effective in diagnosing sports hernias; however, they are relied upon to exclude differential diagnoses. Differential diagnosis may include bone problems such as avulsion fractures or soft tissue injuries such as muscular strains.
Once a diagnosis is confirmed the initial treatment for all sports hernia injuries is rest. The injured athlete should discontinue all physical activity. Surgical and non-surgical options are available for treatment. The non-surgical option includes anti-inflammatory medications, cyrotherapy (ice treatments), and therapeutic exercise. Should this option fail the alternative surgical route is chosen. Minimally invasive laparoscopic or endoscopic herniorrhaphy are surgical procedures used to repair a sports hernia. Surgery will repair and reinforce the weakened or torn muscular wall. Following surgery rehabilitation is required for a full recovery; rehabilitation usually requires 6-12 weeks of therapy.
References
Johnson, J. D., & Briner, W. W. (2005). Primary chare of the sports hernia: Recognizing an often-overlooked cause of pain. The Physician and Sportsmedicine, 33, (2), 35-39.
Kemp, S., & Batt, M. E. (1998). The 'sports hernia': A common cause of groin pain. The Physician and Sportsmedicine, 26, (1), 36-44.
Meyers, W. C., Yoo, E., Devon, O. N., Jain, N., Horner, M., Lauencin, C., & Zoga, A. (2007). Understanding “sports hernia” (athletic pubalgia): The anatomic and pathophysiologic basis for abdominal and groin pain in athletes. Operative Techniques in Sports Medicine, 15, (4), 165-177.
Chris Epperson, ATC was a participant in the Hughston Athletic Training Fellowship Program, Columbus, Georgia in 2008. He received a Bachelor of Science Degree in Health Science with an emphasis in Athletic Training from Eastern Kentucky University in May of 2006. While at EKU, he worked with football and women’s basketball and also spent time with the Lexington Horsemen, a professional indoor football team. Chris is a Certified Strength and Conditioning Specialist (CSCS) and is an active member of the National Athletic Trainers Association (NATA), the Southeast Athletic Trainers Association (SEATA), Kentucky Athletic Trainers Society (KATS), and the National Strength and Conditioning Association (NSCA). He has been assigned to and will oversee the healthcare of the athletes at Chattahoochee Valley Community College in Phenix City, Alabama, as well as Chattahoochee County High School in Cusseta, Georgia.