Sports Hernia

A lot of sports can be physically demanding, which is why engaging in physically intense activities isn't uncommon. Sports hernias occur when abdominal and pubic tissues are torn or injured through repetitive and explosive motions.

Below, we take a look at what sports hernia is, its causes, and the treatment options available in detail. 

What Is Sports Hernia

Sports hernias are not actually hernias, despite their name. Sports hernias occur in the lower abdomen, pelvis, or groin area. The condition may also be referred to by other terms, such as athletic pubalgia, sportsman's hernia, Gilmore's groin, and incipient hernia.

It is most common for people who play sports that require sudden changes of direction or twisting movements to get a sports hernia, but it can occur to anyone.

Young males who participate in sports are most likely to develop this conditiom. Only 3–15% of all sports hernia referrals are female, which is much less than males. Most commonly, it affects patients who are active in sports (particularly elite athletes), but it can also affect people who do not engage in sports. It is more prevalent in athletes who play football or hockey.

What Causes Sports Hernia

Specifically, sports hernias occur when the pelvis twists repeatedly or explosively, such as in sports like football, hockey, soccer, and sometimes even running. These movements occur mainly in the lower abdomen and pubic area, where the soft tissues are more susceptible to injuries. In some cases, the tendons connecting the thigh muscles to the pubic bone can also stretch and tear apart. 

Typically, this affects the side muscles in the abdomen, tendons that connect the thigh muscles to the pubic bone, and tendons that connect the oblique muscles to the pubic bone. 

Symptoms

Sports hernias are usually characterized by severe shooting pain in the groin area when the injury occurs. Typically, the pain gets better after a while but reappears when the person attempts to engage in any physical activity.

Unlike other hernia types like umbilical hernia and spigelian hernia, sports hernia does not result in a visible bulge, which makes it a bit hard to diagnose. If a sports hernia is not treated correctly, it can lead to an inguinal hernia, where abdominal organs can press against the weak, soft tissues and form a bulge.

If the sports hernia is severe, then you may not be able to resume sports activities if you do not get treatment for this injury.

Diagnosis

Sports hernias can be identified using multiple diagnostic techniques, but most healthcare providers begin by investigating how they occurred. Your doctor will first conduct a physical examination. If the hernia is not diagnosed by the physical examination, you will be asked to get certain imaging tests done.

Physical Examination

In order to rule out a true hernia, a physical examination is necessary. Physical examinations include looking for injuries, palpating them, and testing motor strength and range of motion.

Imaging Techniques

When a physical examination does not reveal a sports hernia or the severity of the injury, an X-ray, ultrasound, CT, or MRI may be ordered to rule out injuries to the bones, nerves, and soft tissues. It is most effective to use MRI imaging to diagnose soft tissue tears, such as those in tendons, ligaments, and muscles. 

Imaging diagnostics are important because they allow doctors to see inside your body for clues about your health. Depending on your symptoms and the part of your body being examined, your doctor may use different types of imaging.

Treatment Options for Sports Hernia

Due to the fact that sports hernias are not exactly hernias, their treatment options may vary from case to case.

Nonsurgical Treatment

If you have a minor sports hernia, then your doctor may simply advise you to rest. It's best to rest and ice the injury in the first seven to ten days after it happens. Around 2 weeks after the injury, it is likely to be safe to move toward physical therapy, which will help you improve abdominal muscle strength.

Most athletes are able to return to sport after four to six weeks of physical therapy. However, if the pain returns when you resume sports activities, surgery may be necessary to repair the torn tissues.

You may also be prescribed non-steroidal anti-inflammatory drugs (NSAIDs) for swelling and pain reduction, such as ibuprofen or naproxen.

Surgical Treatment

In cases of severe sports hernia which cannot be treated through non-surgical options, your doctor will recommend surgery. Here are the different surgery options available:

• Open Repair Surgery - traditionally, this treatment involves making incisions in the groin area and repairing the defect through them. The abdominal muscles are strengthened with stitches and synthetic mesh. Recovery from an open repair surgery takes about three weeks. The patients will be able to resume regular physical activity in about six weeks.
• Endoscopy - It involves making several tiny incisions in the lower abdomen, through which a camera-equipped device called a laparoscope is inserted. In case of fully ruptured ligaments, the surgeon will reattach the tissue using synthetic mesh, sutures, and skin glue. As part of the surgery, the surgeon may also sever the pain-producing inguinal nerve that is located in the groin if it has been injured or scarred from physical activity.

It is possible that sports hernia pain continues after surgery in some patients. For this pain, another surgery might be recommended, called adductor tenotomy. It involves cutting the tendon that connects the inner thighs to the pubis. As the tendon heals, tension will be released, allowing the patient to move more freely.