Sports Hernia
What is a Sports Hernia?
Athletic pubalgia, otherwise known as a sports hernia, is a soft tissue injury that manifests as intense pain in the lower abdomen or groin area. Sports hernias are typically caused by repetitive or explosive actions, especially those that require twisting of the pelvis such as in American football, hockey, soccer, rugby, wrestling, and soccer. The muscles, ligaments, and tendons involved in these movements are located in the lower abdomen and groin area, with the tendons that attach abdominal muscles to the pubic bone being particularly vulnerable. Frequently there are also coexisting injuries to tendons attaching thigh muscles, i.e., the adductors, to the pubic bone.
Sports Hernia – Symptoms
The most common symptom of a sports hernia is a pain in the groin that spreads to the lower abdomen and thigh. Intense pain in the groin usually occurs at the time of injury and improves with rest, but recurs when athletic activity is resumed. A sports hernia may even become an inguinal hernia if untreated, characterized by a soft bump or thickening in the groin region. Chronic pain may be so debilitating that it not only prevents athletes from returning to play but also keeps them from functioning in daily life. Seeking treatment is therefore critical to maximizing health outcomes.
Sports Hernia – Causes
The biggest risk factor is playing a competitive sport that requires athletes to firmly press their feet to the ground and make sudden, explosive twisting movements that can injure the soft tissue around the groin or lower abdomen. Other risk factors include:
- Previous trauma to the groin or lower abdomen
- Insufficient warmup before engaging in athletic activity
- Lack of exercise before initiating athletic activity, such as a sedentary lifestyle
Sports Hernia – Diagnosis
Diagnosing a sports hernia involves a physical examination by a physician during which athletes are asked to bend over, sometimes against resistance. Experiencing pain in the lower abdomen can confirm the presence of a sports hernia. In some cases, imaging tests, such as ultrasound, X-ray, or MRI are ordered to establish the diagnosis.
Sports Hernia – Treatment
Treatment of a sports hernia depends on the stage of the disease and the severity of the pain.
Conservative Treatment
- Avoid physical activity for 7-10 days after injury and apply ice packs as needed
- After 2 weeks, begin exercising to strengthen the abdominal and inner thigh muscles
- Non-steroidal anti-inflammatory drugs can be used to reduce swelling and pain. If the pain persists then a physician may administer cortisone, i.e., steroid injections
If pain persists 4-6 weeks after injury and especially if it recurs during athletic activity, surgical intervention may be necessary to repair the damaged tissues.
Surgical treatment
Surgical sports hernia repair may be done via the classical (open) method using one long incision, or with minimally invasive techniques such as laparoscopic or robotic surgery. Minimally invasive techniques avoid making a large incision in the skin. Instead, access is achieved using only 3-5 much smaller incisions, whose diameter is less than 1cm. These tiny openings serve as gates for all the surgical instruments, including an endoscopic camera to properly visualize the area.
Minimally invasive techniques are also highly recommended for inguinal neurectomies and adductor tenotomies in the treatment of persistent pain after the initial surgery.
- Inguinal neurectomy involves dissecting and cutting a sensory nerve in the groin, called the inguinal nerve, to relieve pain.
- Adductor tenotomy is indicated when adductor muscles of the thigh are shortened and constricted, applying painful tension to their attachment points on the pelvic bone. The procedure involves cutting the tendon and surgically lengthening it before reattaching. This reduces tension and improves the range of motion.
Minimally invasive techniques allow for better visualization of the surgical field, which results in greater precision and lower risk of unintentional nerve, blood vessel, and tissue damage. Minimally invasive surgery offers patients several key advantages over classic, open techniques. Namely, there is less intraoperative blood loss and a lower risk of surgical site infection. The postoperative recovery period is also shorter and less painful, allowing patients to return to their daily routines sooner. Finally, scars are often barely visible when healed, achieving a vastly superior cosmetic effect for patients as compared with classic, open surgery.
Sports Hernia – Recovery
Over 90% of patients with a sports hernia can expect to make a full recovery after conservative and surgical treatment. Rehabilitation after surgery lasts about 6-12 weeks, after which athletes can slowly begin exercising again. However, it is important to remember that intensive athletic activity may increase the risk of hernia recurrence and therefore another surgery.
Sports Hernia – Price
The price of a sports hernia repair depends on whether the surgery is done classically, laparoscopically, or robotically. All details of the operation and possible treatment options are always discussed together with the attending physician during the initial consultation where you are qualified for the procedure.
