Sports Hernia

author : AMSSM

comments : 0

Recurrent injuries to the groin are slow to heal, easily re-injured, and will frustrate your training and competition plans. Learn about the diagnosis, anatomy and treatment of sports hernias.

Member Question

I've taken two weeks off completely.  In the past five days I have noticed considerable improvement.  I was under the impression that if it really is a sports hernia, it wasn't going to get better.  True or false?  I was going to try and take off some more time and really make sure this thing is behind me before I jump back (slowly) into things. BUT After 3+ weeks of rest, I attempted to run again.  Same pain, started immediately.  My doctor recommended physical therapy.  I'm going tomorrow, but hope to move this forward and get it diagnosed if it really is a sports hernia.  I've read countless articles describing sports hernia symptoms...it's as if I could have wrote them.

Answer from Ben Herring, MD
Member AMSSM 

Dear Triathlete, 

The issue you raise regarding sports hernia is complex.  Recurrent injuries to the groin are slow to heal, easily re-injured, and will frustrate your training and competition plans.  Sports hernia is essentially a syndrome of repetitive injury to the lower abdominal wall. It represents one of many possible injuries to the groin. 

Diagnosis

The complexity of the hip and groin region makes a diagnosis tricky. You describe your injury as recurrent and exacerbated by resuming running.  This may very well be a sports hernia, but many other possibilities exist and should be ruled out. Potential injuries with similar symptoms include: strain of hip flexors and adductors, injury to the hip itself such as a labral tear or stress fracture, nerve entrapment, or referred pain form lower back injury.  There are some medical conditions which can masquerade as musculo-skeletal injury such as prostatitis, urinary tract infection, avascular necrosis of the femoral head, and even tumors.

Anatomy of a hernia

The anatomy of the groin is complicated, formed by the confluence of the bony structures of the hip joint and pubic ring with the abdominal muscles, hip muscles, and the fascia (connective tissue) connecting these structures. To complicate the situation, there is a gap in the abdominal wall called the inguinal ring, through which nerves, blood vessels, and the spermatic cord pass. The inguinal ring and the surrounding fascia can be the site of a true inguinal hernia, which is a bulge where contents of the abdominal compartment have pushed through a defect.  The sports hernia is not a true hernia. It is however, a defect of the fascia or muscle at the junction of the abdomen and groin. The precise cause of sports hernia is open to debate. Likely causes include overuse, defects in the lower muscles, their attachments to the pubic bone, and tears of associated ligaments and tendons. These structures are very close to the site of true hernias, hence the name.  Sports hernia pain is usually associated with athletic activity and non-sporting sudden movement or increased intra-abdominal pressure (coughing, sneezing, straining, and sexual activity.) There may also be pain with pressure over the central pubic bone.

Sports hernia treatment

Treatment of groin injury varies by diagnosis. Most groin conditions are amenable to RICE (Rest, Ice, Compression, and Exercise). Exercise includes physical therapy to address core instability, muscle imbalance, and hip and lower back tension. Exercise also means a graduated return to training and competition. Training through groin injuries increases the risk of chronic injury or re-injury. Cross-training will help maintain fitness and strength during recovery. If diagnosed, a sports hernia does respond well to surgery.  Multiple surgical options exist, but some experts describe high rates of re-injury after the surgery. Surgery should be supplemented with intensive physical therapy and core strengthening. 

Studies of soccer and hockey players suggest reduced rates of groin injury among athletes with rigorous off season sport specific training, superior core strength, and absence of hip strength imbalances. Risk factors included previous groin injury, reduced hip flexibility, and increasing age. So prevention of groin injury should focus on developing core strength, hip and low back flexibility, and intense pre-season training regimens.

In your case Triathlete, I recommend that you meet with your physical therapist to work on flexibility, core strength and correcting muscle imbalances. Your physical therapist may also shed some light on the identity your injury. If running causes pain, get a float belt and log your miles in the pool. Concentrate on your swim and bike training if you can do so without pain. 

Ben Herring, MD

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date: September 20, 2012