HERNIA INSTITUTE OF PENNSYLVANIA

Sports Hernia

Athletic Pubalgia

Although occurring in the same general area (the groin region) as that of an inguinal hernia, a sports hernia is not a true hernia. Instead of a hole or defect in the abdominal wall, the over-diagnosed, and misnamed “sports hernia” is simply a strain, stretching or weakness in one of the three muscles (internal and external obliques mostly) or the transversalis fascia of the abdominal wall, or an avulsion of one of these muscles or their tendons from their attachment to the pelvic bone. Therefore, with a Sports Hernia, also known as athletic pubalgia, there is no visible swelling or bulge. Also, there is no bulge palpable by the physician on examination. This means making a definitive sports hernia diagnosis is difficult. Imaging studies, such as CT Scans and MRIs are valuable in excluding other causes of groin or pelvic pain, but are not of value, and are often normal in patients with Athletic Pubalgia.

A Sports Hernia is unfortunately one of the least understood of all the injuries of the groin, and one that predominantly involves professional level and collegiate level athletes. Sports hernias occur most commonly among professional athletes, specifically football, hockey, soccer and tennis players. However, recreational athletes making extreme and repeated twisting-and-turning movements may also be susceptible to a these injuries. Sports hernias result from extreme, forceful, repetitive, twisting movements, as may occur in high level athletes in sports such as soccer, football and hockey. It is far more common in professional athletes and is very rare among recreational athletes. Actually, it is also quite rare among heavy-duty athletes, with documentation being relatively uncommon in these high-level professionals. This is why I believe it is often an over-diagnosed problem.

Symptoms

A sports hernia typically has a slow onset of pain in the lower abdominal region, made worse with activity and improving with rest. Symptoms may include: Pain in the lower abdomen, Pain in the groin, Pain in the testicle (in males). The symptoms are often quite similar to those of an inguinal hernia, and include sharp pain in the groin or lower abdomen, which are worsened with physical exertion, straining, sneezing or coughing. Tenderness to pressure in the area, similar to that with ‘real’ hernias may also occur.

Diagnosis

The diagnosis of a sports hernia is based on the combination of the patient's history, and a complete and comprehensive physical examination by a skilled and knowledgable physician. Diagnostic tests such as CT Scans and MRI studies are primarily used to exclude other causes of groin pain.

Treatment

Comprehensive evaluation by a physician is necessary before initiating any treatment to exclude other potentially more serious causes for pelvic pain .The initial and most appropriate treatment for a sports hernia is conservative and non-surgical. This includes rest, including complete avoidance of the initiating sports or physical activity. Healing will obviously be prolonged and/or incomplete if one continues to participate in these activities. This often requires several weeks to months for symptoms to resolve. Over-the-counter, anti-inflammatory medicines (e.g., ibuprofen) if tolerated, and the use of ice will decrease the level of acute discomfort. Physical therapy should only be initiated when all signs of discomfort are resolved, and then only under the supervision of a physician. This includes exercises that strengthen the abdominal muscles and increase their flexibility.

Only when rest and physical therapy do not relieve symptoms should surgery be recommended. We rarely recommend surgery for individuals who are not high-level professional athletes unless a true Inguinal Hernia is identified, or pain persists for 3-4 months despite appropriate rest. When the injury occurs in the region of the Myopectineal Orifice, a mesh reinforcement similar to that used for Inguinal Hernias may be recommended. This is our approach in high-level athletes. Unfortunately, while most athletes can resume their sport after a period of post-operative physical therapy, some patients who have had sports hernias continue to have persistent lower abdominal muscle pain and groin pain. However, some studies have shown between 65% and 90% of athletes can effectively return to their sport after surgery. Rehabilitation after surgery for a sports hernia usually takes about eight weeks, which is much longer that recovery following a routine Inguinal Hernia Repair.