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The Invisible Hernia

Sports hernias mimic the symptoms of a traditional hernia, but without the visible bulge or pouch under the skin.

It is not uncommon for individuals with sports hernias to be diagnosed with a groin strain and be told to rest until the problem goes away. And it does for a while. But the pain associated with a true sports hernia will return with a vengeance once the ibuprofen wears off and activity resumes.

What is a Hernia?

hernia

A traditional hernia stems from a weakness or hole in the muscular wall that keeps abdominal organs in place. With these hernias, a visible bulge or pooch sticks out in the lower abdominal region and makes the diagnosis fairly straightforward. Most primary care physicians are able to diagnose and treat these hernias without surgery.

What is a Sports Hernia?

Sports hernias most often occur during activities that require sudden changes of direction or explosive twisting movements, such as in football, hockey, soccer and tennis. The outcome can be a tear in the muscles in the lower abdomen, especially where the tendons attach the oblique muscles to the pubic bone. The tendons that attach the thigh muscles to the pubic bone (adductors) are also often stretched or torn. This group of muscles are responsible for stabilizing the pelvis and moving the leg towards the midline of the body.

What are the Symptoms of a Sports Hernia?

With a sports hernia, groin pain becomes more pronounced when straining in the abdominal area, especially in explosive-type activities or twisting. Doing a sit-up or flexing the trunk against resistance will be painful.

Any athlete — or extremely active adult, even in workouts — whose chronic groin pain is aggravated by sports or aggressive workouts, but relieved by rest, should strongly be considered to have a sports hernia.

What is the Solution?

Some sports hernias can be treated with physical therapy or injections. However, with athletes or active adults, I recommend surgery.

The procedure repairs the torn tissue through a small open incision in the upper part of the groin. The acquired adductor contracture is released and the lower rectus muscle is reattached to the pelvis. This restores normal biomechanical movement to the pelvis. In essence, the procedure rebalances the disruption that has taken place in the pelvis to compensate for the loss of support from the injured area.

More than 90 percent of patients who go through non-surgical treatment and then surgery are able to return to sports activities. At our clinic, we’ve had football players’ return to the rigors of full play four to six weeks after surgery. Without treatment, this injury can result in chronic, disabling pain that prevents you from resuming sports activities.

By: Benton A. Emblom, MD

Andrews Sports Medicine and Orthopaedic Center

Image credit: USAG – Humphreys and Marc Levin

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