Sports Hernia Surgery, Treatment and Diagnosis

What is a Sports Hernia

A sports hernia is a painful condition of the groin predominantly arising with athletic activities. The term sports hernia is a misnomer as there is no true hernia. It is the result of repetitive athletic activity that leads to damage of the soft tissues and nerves in the groin. While more common in the professional athlete, I is common to also occur in the weekend recreational athlete.

History

The term “sports hernia” was first coined in the 1960’s describing Spanish soccer players who developed groin pain with no evidence for classic hernias (inguinal hernias). Gilmore described the underlying pathology of sports hernias which became known as Gilmore’s Groin. With a better understanding of this entity the diagnosis of sports hernias has become much more common.

Cause of Sports Hernia

Studies over the years have implicated the imbalance between the strong adductor muscles of the leg and the inherently weaker abdominal core muscles. These opposing muscle groups insert onto the pelvic frame close to one another. In the susceptible patient, the greater force from the leg can overpower the core muscles of the abdomen resulting in significant tissue damage and pain. In some cases the imbalance of forces can cause the two fused segments of the pubic bone to separate and cause tenderness in this area. This can be a clue to the diagnosis of a sports hernia and is referred to as “pubalgia”.

Diagnosis

The diagnosis of a sports hernia begins with a thorough history and physical exam. There are no specific blood tests or radiologic imaging studies that pinpoint this entity. MRI of the pelvis can be helpful but is not highly accurate. Thus, a sports hernia is essentially a diagnosis of exclusion, meaning that a number of other diagnostic possibilities must be ruled out before making the diagnosis. While it may be possible for a sports hernia to coexist with an inguinal hernia, it is very uncommon.

Some of the physical findings that can be associated with a sports hernia, include pain in the groin with sit ups, flexion and rotation of the hip and straight leg raising. While hip pathology can mimic the groin pain of a sports hernia, an MRI of the hip usually will identify any hip pathology. Most often this would involve such findings as a labral tear or stress fracture. However, some studies have found up to 60% of patients who have a sports hernia also have a labral tear of the hip.

Treatment

In most cases, conservative treatment of sports hernias with rest and physical therapy has a very low success rate. The surgical approach predominantly aims to strengthen the groin to counter the excessive forces generated by the strong adductors of the leg. This can be accomplished using the Shouldice technique to perform a repair and reinforcement of the damaged groin structures. While other surgical approaches have been proposed, they lack overall acceptance by the surgical community.

Typical recovery requires three to four weeks of rest followed by a period of progressive physical therapy to reach maximum athletic capacity. Following completion of the physical therapy program, most patients are able to return to full participation in athletic activities.

If you have symptoms suggestive of a sports hernia, contact the Hernia Center of Ohio for an expert consultation.

Contact 216-591-1422 to learn more about hernias or to request a free brochure.