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Sports Hernia Treatment

Sports Hernia,  aka Sportsman’s Hernia, Athletic Pubalgia, Gilmore’s Groin

Is it easy to diagnose a sports hernia?

No, it is not.  Sports hernias are not as common as regular hernias.  Sports hernia is a tear within oblique muscles of the abdomen.  Because of specific feature of human anatomy in this area, there is usually no bulge traditionally associated with the hernia.  Unfortunately, it is not uncommon for a patient to see multiple specialists who dismiss their concerns, until they get to someone who actually understands injuries specifically associated with athletes.  The athletes usually report sharp pain in the groin area.  They are diagnosed with muscle strain and advised to rest and take non-steroid anti-inflammatory medications, such as Tylenol and Motrin.  Unfortunately, once the athletes resumes their activity and the effects of medications wears off, the pain usually returns.  Some doctors try steroid injections to decrease inflammation.  It may work for a short while but once the athlete returns to training, the pain slowly returns and sometimes with vengeance.

What kind of pain is associated with sports hernia?

Sports hernia pain is usually fairly severe and sharp at the time of injury in the groin area.  In time pain usually gets better but it can come back when you are able to resume your activities.  It usually gets worse with twisting motions.

Can sports hernia happen without specific trauma?

Yes it can.  In many patients sports hernia develops overtime.  Remember, the pain of sports hernia is not a primary problem.  The pain is alarm that tell you that something is wrong.

What is the most common sign of sports hernia?

One of the most common signs of sports hernia is recurrent or chronic groin pain worsening with exercise and relieved by rest and non-steroid anti-inflammatory medications.

Are only professional athletes susceptible to sports hernias?

No, anyone performing repeated twisted motions, including professional and amateur athletes, as well as people who perform similar movements at work can develop sports hernias.

Is sports hernia treatment covered by most insurance companies?

Good question.  The answer is, it depends...  In Europe, many surgeons believe in diagnosis of sports hernias.  In 2014 British Hernia Society published a position paper in British Journal of Sports Medicine about Sportsman Groin (that is how they call sports hernia in Britain).  They renamed it "inguinal disruption" and multidisciplinary panel confirmed its existence as real condition.  The link to the article is available here.  In United States many surgeons do not believe that sports hernia is real and many insurance companies refuse to cover this condition.  However, some insurance companies do cover the surgery.

So what actually happens with sports hernia injury?

If you look at the anatomy book, the central groin area has several strong muscles attaching next to each other in the groin area:  rectus abdominis, external and internal obliques, adductor longus, and others. Some of these muscles pull the pubic bone up, others up and out, up and in, or down and out. In essence, these muscles pull the pubic bone in opposing directions and as the result during vigorous activities one or several of these muscles can get torn.  That creates pain and depending on specific muscle torn, the pain can be somewhat different.  That is why sometimes we need to repair the actual muscle insertion in the process of sports hernia repair.

Can more than one muscle be affected in Sports Hernia?

Yes.  Occasionally it may also involve the bone itself.  In this case the condition is known as Osteitis Pubis.

What do the surgeon need to know to diagnose sports hernia?

Most common questions the surgeon would ask would be
                When did original pain occur?
                What you were doing at that time? 
                Did it happen at work?
                Did it happen after car accident?
                Where is the main pain point?
                What makes your pain worse?
                What makes your pain better?
                Does your pain radiate in the testicles or genital area?
                What treatments or surgeries have you had in the past for this condition?
                Have you had MRI?
                What medical problems did you have?
                Have you ever had any trauma in the groin area?
               

What clinical signs are associates with Sports Hernia Diagnosis?

Most common clinical signs of sports hernia are pain or tenderness at
                pubic tubercle, where tendons insert,
                deep inguinal ring,
                external inguinal ring with associated dilation of the ring compared to other side,
                adductor muscle insertion,
                groin radiating to testicle, genital area, perineum, inner thigh or to midline.

What sport activities are commonly associated with Sports Hernias?

Most common sports activities associated with sports hernias are tennis, soccer, football, rugby when there is excessive cutting, kicking, and sharp turning.

What tests can be used to diagnose sports hernias?

Several tests can be used, such as ultrasound, CT scan, MRI and others.  However, all of them have very significant false negative rate, meaning that they do not specifically diagnose the injured site.  Perhaps, osteitis pubis and adductor injuries may be the exceptions to the rule, though. 

What surgical options are available to repair Sports Hernias?

Just like regular hernia, sports hernia potentially can be treated with open, laparoscopic and robotic techniques.  Each one of them has its own advantages and disadvantages.  With laparoscopic technique, the only available repair technique is to place mesh the reinforce the posterior wall of the inguinal canal.  It is usually done under general anesthesia.  However, the muscle repair cannot be performed with this method as the muscles lie on the outer surface of the abdominal wall and not underneath.  Robotic (Da Vinci) method is also available.  It is very similar to the laparoscopic one with one exception that it allows repair of the posterior muscle only in addition to placement of mesh.  The most effective is direct repair.  It allows repair of all the muscles, release of the affected nerves as well as re-attachment of adductor muscle, if needed, all that the same time and through the same incision.  In many cases it does not require general anesthesia.  It can be dome under sedation with local.

How do you treat adductor muscle injury?

Adductor Longus muscle may get torn during athletic or work related activities.  Sometimes the actual tear may be visible on MRI scan but it commonly requires musculoskeletal specialist in Radiology to diagnose.  Even though some doctors try to treat it with steroid injections, the effectiveness if this treatment is not very high with visible tear on MRI.  The muscle can commonly be reinserted.  Also, muscle reinsertion in combination with stem cell injections also is very promising.

What other conditions can cause the pain in the groin?

Regular hernia, osteitis pubis, hip or pelvis fractures, stress fractures, muscle strains and tears and labral tears have to be ruled out.  Labral tear is injury associated with frequent flexion of the hip. Labrum is a piece of cartilage in the hip joint that allows "better seal" of the hip bone to the acetabulum.  Labral tears can create pain that is similar to sports hernias.  MRI can help with diagnosis.  Labral tears are usually treated with rest, physical therapy, anti-inflammatory medications, and occasionally surgery.

How soon after injury do I need to have surgery?

The first line of treatment is non-surgical.   We recommend at least 3 month period of physical therapy, anti-inflammatory medications, and rest before considering surgery.

How long is the surgery for sports hernia?

Depending on complexity techniques and exact structures requiring repair, the surgery may take from 1 to 3 hours.

How long is rehabilitation for sports hernia?

Rehabilitation process usually takes up to 6 or 12 weeks depending on complexity of surgery.

Can the tissues tear again after sports hernia repair?

Unfortunately, yes.  In those cases another repair or additional surgery may be needed in the future, for example, such as adductor tenotomy.

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Dr. Volshteyn is a board certified Plastic Surgeon, who is specialized in reconstructive and plastic surgery.

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