After a comprehensive Physical Examination to exclude other unrelated causes for persistent pain ( including, but not limited to Genitourinary Disease, Gynecologic Disorders, Musculoskeletal Problems etc), the following Physical Therapy exercises may be recommended to our patients who have developed Post-Herniorrhaphy Pain Syndrome or "Inguinodynia" This is a condition of chronic, and at times debilitating or severe pain in and around the region of a prior Inguinal or Femoral Hernia repair.
These activities are designed to both increase the flexibility in and around the region, and at the same time loosen potentially problem-causing scar tissue. Although some patients are not benefited from these activities, many patients do improve slowly and gradually with this program. Response is enhanced when accompanied by the judicious use of mild analgesia (such as Ibuprofen, with or without Prescription Medication such as Neurontin® or Elavil® etc.). Importantly, weight reduction when indicated is also appropriate and in fact necessary in treating this problem.
These Physical Therapy activities are recommended only after a comprehensive evaluation and physical examination to exclude other potential causes for the pain. Such activity should only be continued under the supervision of a licensed Physician or a Certified Physical Therapist. If these activities cause increase in the discomfort, they should be discontinued.
LEG/HIP EXTENSION ACTIVITY
This activity is designed to increase the flexibility and ability of the leg/hip to extend backwards.
Starting position: It is best performed lying face-down (may use pillow with face turned to the side), on a soft carpet or firm mattress. Arms should be extended to the side, straight out, with palms facing down. Deep Breathe.
Action #1:Slowly raise one (1) leg (affected side of discomfort first) upwards, moving heel towards the ceiling and keeping knee straight). Raise only to point of tightness or mild stretching. Hold in this position for 10 seconds (breathe deeply), then slowly lower back down. Rest briefly then do other side (always do both sides regardless of side of discomfort). Repeat both sides, alternating separately 10-15 times depending on ability and discomfort. Perform this activity 3-4 times daily if possible.
Action #2:Repeat as above, but this time bend knee somewhat, raising leg such that bottom of foot moves upwards towards the ceiling. Repeat both sides as above.
As an Alternative or for those unable to safely or comfortably lie on their abdomen face-down, this activity can be performed standing, holding onto the back of a chair for support. Extend the leg backwards and hold as described below, keeping upper body straight and vertical.
Starting position: Stand with one arm holding onto a chair or wall (Fig. 1A').
Action: With the free hand, grasp the instep of the foot and pull the heel behind you toward your buttocks. KEEP YOUR KNEE BACK (Fig. 1B'). Do not let it come forward.
Note: You should be standing erect throughout the entire stretch. DO NOT LEAN FORWARD. If you can touch your heel to your buttocks, slightly extend your back while doing this exercise.
LEG/HIP ADDUCTION ACTIVITY
Starting position: Sit on the front half in a firm yet comfortable chair (ie: Dining Room Chair), with your back erect and not against the chair back. Separate feet slightly wider than hip width and place your feet flat on the floor. Place a partially deflated basketball (or similar ball), or a very firm pillow between your knees.
Action:Slowly press your knees together, pressing inwards against the ball or pillow. Hold for 10-15 seconds and slowly release and relax, deep breathe, and then repeat 15 times. Perform this activity 3-4 times daily if possible.
LEG/HIP ABDUCTION ACTIVITY
Starting position: Using the same chair as described above, place chair directly beside a wall. Again sit on the front half of the chair (ie: Dining Room Chair), with your back erect and not against the chair back. Separate feet slightly wider than hip width and place your feet flat on the floor. The side of your knee should be touching the wall at this point.
Action:Slowly press your knee firmly outwards against the wall (hold seat of chair with opposite hand). Hold for 10-15 seconds and slowly relax, deep breathe, and then repeat 10 times. Turn chair around and repeat using the other leg. Perform this activity 3-4 times daily if possible.
LEG/HIP FLEXION ACTIVITY This activity is designed to increase the strength and flexibility of the region enhancing your ability of the leg/hip to extend forwards.
Starting Position: Lie on back, left knee bent. Tighten abdominals and buttocks, keeping back in a neutral position.
1. Raise right leg 12 inches, knee straight (Fig. 4A).
2. Hold 3 counts
3. Lower leg slowly.
Repeat 10 times.
4. Repeat with left leg
LEG/HIP ROTATION EXERCISE
Starting Position: Sit on the floor. Place the soles of your feet together and bring them about two feet away from your body (Fig. 5A).
Action: Place your hands on your knees and gently push downward toward the floor. SLOWLY bend forward, trying to touch your nose to your feet (Fig. 5B).