By: Brian Schulz, MD
I was interviewed recently by a major news publication about a professional athlete who had sustained a common injury called a sports hernia. The reporter I spoke with had a variety of questions about this type of injury, and I had the opportunity to clarify some common misunderstandings about it. Given this interview, I thought sports hernia a fantastic topic to share in greater detail with the public. One of the most critical initial things to clear up about sports hernias is that they aren’t like other hernia types. In fact, in the case of this injury-type, no actual hernia or protrusion occurs.
Sports hernias are commonly referred to as a “groin pull” and can be accompanied by a strain of the adductor muscles. Caused by abnormal tension in the groin area, mainly concentrated around the inguinal ligament, a sports hernia results in a disruption in the oblique abdominal muscle at the pubic attachment. The strain results in small tears of the muscle and edema, or fluid build-up, in the surrounding tissue.
To best understand how sports hernias happen, a bit of an anatomy lesson is in order. The oblique abdominal muscle originates from the rib cage (ribs 5-12 to be precise) and attaches to the inguinal ligament. The oblique muscles are responsible for our ability to rotate and side-bend at the trunk. The adductor muscles are the muscles located on the inner thighs. They are responsible for bringing the leg close to the midline of the body and assisting with flexion of the hip. The adductors insert into the pubic body just below the pubic crest. Finally, the inguinal ligament runs from the ilium to the pubic bone.
As previously mentioned, sports hernias usually occur with a groin tear – often when the adductors and obliques are both activated and since they are both attached to the pelvis, indirectly pulling against each other. The adductor muscles are stronger and will “win” this tug-of-war, resulting in a tear of the oblique muscles. Sports hernias are frequently misdiagnosed and symptoms are attributed to hip injuries. They don’t present with a visible deformity, and there is no specific test to detect them.
Although sports hernias may be elusive to diagnosis, they can arise more often in athletes who engage in repetitive twisting, kicking, turning at high speeds, or from a traumatic contact occurrence. Symptoms of a sports hernia may include weakness and pain in the groin area as well as difficulty with kicking and running. Chronic groin pain can also be indicative of this type of injury.
Most sports hernia injuries heal on their own with minimal and non-invasive treatment. Some non-surgical treatment options include physical therapy with muscle re-education, flexibility exercises, and hip and core strengthening.
Though many athletes want to ‘get back out there’ as soon as possible, proper healing of a sports hernia is a 4-6-week process of rest and rehabilitation. In less common cases, surgery with a general surgeon familiar with sports hernia surgery may be required to correct a sports hernia injury to release the tension in the inguinal canal or by reinforcing it with mesh or sutures. After surgery, recovery is closer to an 8-10 week process and includes rehabilitation through physical therapy – which aims to restore range of motion, flexibility strength, and dynamic movements for return to sport.
As with any sports injury, prevention is an important training factor. To help prevent a sports hernia injury, focus part of your training and exercise regimen on appropriate flexibility and strength training of the hip, groin, and abdominal muscles.