11 Dec Sports Hernia or ‘Athletic Pubalgia’
Some diagnoses are so unknown and rarely picked up by doctors that they warrant some good information out there on the web.
A sports hernia is a generic term for what has been called ‘athletic pubalgia’. Basically sports hernia symptoms are groin and pubic pain, sometime pain in front of the hip where your pocket sits and often also lower back.
On an MRI you may see ‘tendonitis’ or an increased signal over the adductor (groin) tendons, and sometimes a tear of one or some of these tendons, and often inflammation around the public bone is also found. There may also be swelling, ‘tendonitis’ around the insertion of the lower abdominals, and in extreme cases a tear of the abdominal muscle. However, you could see nothing at all.
This does not mean without MRI confirmation the problem does not exist. The physical exam is and should be the means by which we diagnose this condition. Generally the patient has pain in the front of the hip/ lower abdominal muscles where then insert into the pelvis; and often in the groin towards the public bone, or on the pubic bone itself.
This pain generally worsens with abdominal contractions like sit-ups or the sitting up positions. Often it will be painful during running due to the assymetric heel strike and groin/abdominal contraction during the weight acceptance phase of running. Any activity that uses these two muscle groups may cause pain.
The pain can be differentiated from regular hernia pain as sit-ups and abdominal contraction do not generally cause this kind of pain. In addition a regular hernia generally can be painful with coughing, sneezing and going to the bathroom./bearing down, while a sports hernia is generally not.
So in essence, a sports hernia is akin to a shin splint in the lower leg in that there are generally microtears of either the lower abdominals and/or groin muscles as they attach to the pelvis.
They can be caused by a number of factors, most being positional or postural in nature, causing biomechanical disruptions. For instance, a pelvic or leg length asymmetry can cause tightness in these muscles forcing them to fail over time. It can also be your position in sport and your specific body posture and biomechanics during movement.
What are treatment options?
Physical therapy is a great option for healing. A physical therapist can lessen the tightness of the groin and lower abdominals through massage, stretching and correcting the biomechanical factors or assymetries that exist in your anatomy. They can also teach you ways to lessen these pressures at home. This therapy combined with activity modification (staying away from activity that causes pain or uses your abdominals) will help you recover faster and not need therapy.
Surgery is an option, although in my practice I have never had a patient who required surgery. A good physical therapist who understands this condition and how to treat it should be all that is necessary. That and the patience to shut your sports down for awhile to let it heal. My advice is to let the pain be a guide of what you can and cant do and when you can make a gradual return. Any discomfort means the area is not healed.
It does take some patience on your part, but it is very fixable with the right therapist without surgery!