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Sports Hernia / Athletic Pubalgia

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Introduction

Sports hernias were first described in the early 1980s, and are an increasingly recognised as a cause of chronic groin pain. Injury to a number of high profile athletes has raised the public awareness of this condition. Typically occurring in young athletic males, sports hernias usually present with gradual onset exercise-related groin pain. However, ‘sports hernia’ has been so widely popularised by the media that it is now commonly used by the medical profession, media, and public alike. It is also referred to, and synonymous with, sportsman’s hernia, athletic pubalgia, and Gilmore’s groin. Essentially, sports hernias involve a set of injuries to the area where the abdominal and groin musculature meet known as the inguinal region where the inguinal ligament is located.

Signs & Symptoms

The symptoms of sports hernias are quite consistent and patients will usually present with a combination of:

 

  • Vague unilateral or bilateral groin pain, difficult to localise, but above the inguinal ligament (line between the tip of the pelvic bone and the pubic bone).
  • Dull/burning in nature.
  • Pain radiates towards the scrotum and inner thigh and can cross mid-line of the body.

 

Patients complain that the pain occurs on exertion, in particular sprinting, cutting or twisting, side-stepping, kicking, or sitting up. Pain can last for varying periods of time following exertion (ranging from days to weeks). These symptoms tend to be disabling and patients will report that they have had to reduce or cease their participation in sport altogether. Patients will often be unable to recall the exact onset of the pain.

Causes

This condition is seen most in sports that involve repeated, explosive change of direction movements such as rugby, football, hockey, lacrosse, netball and basketball. This can lead to a breakdown or a strength imbalance between the abdominal and groin muscles which connect to the pelvis.

Prevalence

Sports hernias typically affect young males who actively participate in sport. Females are affected, but much less commonly than males, comprising just 3–15% of all sports hernia referrals. It is rare in children and older people. It presents more in patients who actively engage in sport (particularly elite athletes), but it can occur in those that do not. It is more common in patients that participate in football, hockey, and athletics which involve explosive, dynamic movements.

Assessment & Diagnosis

Your Physio will ask for a history of your symptoms proceeded by carrying out a clinical examination so that a precise and timely diagnosis can be given to ensure the most effective treatment can be put in place immediately.

 

Imaging is useful in patients presenting with chronic groin pain as it can be used to both exclude other pathologies and assist in the diagnosis of sports hernia. The main two imaging modalities used to assist in the diagnosis of sports hernia are MRI and ultrasound.

 

Your Physiotherapist will work closely with you to set individualised treatment goals for you to aim at and will regularly re-assess you to measure your progress and make any necessary modifications in your treatment.

 

Self-Management

Your Physiotherapist will educate you on your injury so that you can understand how to help support your recovery. They will advise that you have a rest period and will discuss Non-steroidal anti-inflammatory drugs (NSAIDs) to allow your symptoms to settle. Your Physio will also recommend strategies for maintaining function in ways that avoid aggravating your symptoms.

 

Physiotherapy

Your Physiotherapist at Pure will be able to provide you with a personalised rehabilitation plan to strengthen your lower abdominal and pelvic floor muscles. This can accelerate your return to participation in sports and prevent further problems.

 

Physiotherapy treatment could also include:

  • Mobilisation.
  • Core Exercises.
  • Soft Tissue Treatment.
  • Hydrotherapy pool exercises.

 

All our Physiotherapists are highly skilled in providing complimentary hands on treatment and will work with you to develop a bespoke treatment plan to help you recover and return to the activities which are important to you. Regular re-assessment will ensure you are making progress as anticipated and can allow changes to your exercises to be made. You will be given ongoing support and advice so that you can continue to self-manage and prevent further complications.

Escalation of Treatment

When the patient is pain free, following this they should attempt to return to sport; if this is unsuccessful, operative management should be considered.

 

Operative management primarily involves reinforcement of the posterior abdominal wall, which can either be performed open or laparoscopically. Post-operative management includes analgesia and Physiotherapy. Patients can expect to return to full activity between 6 and 12 weeks.

References

Garvey, J. F. W., Read, J. W., & Turner, A. (2010). Sportsman hernia: what can we do?. Hernia14(1), 17-25.

 

Meyers, W. C., McKechnie, A., Philippon, M. J., Horner, M. A., Zoga, A. C., & Devon, O. N. (2008). Experience with “sports hernia” spanning two decades. Annals of surgery248(4), 656-665.

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