Thigh and Abdominal Overuse Can Cause Sports Hernia
Repetitive twisting and turning by hockey, soccer, and tennis players, as well as by those who ski, run, or hurdle, may cause a sports hernia, according to a recent study in the Journal of the American Academy of Orthopaedic Surgeons. The exact incidence of sports hernias is unknown, but previous studies have indicated that 40 to 85 percent of chronic groin pain may be due to the condition.
Researchers from Johns Hopkins Bayview Medical Center in Baltimore reviewed diagnoses and treatments for sports hernias, which are often initially dismissed by athletes who think they may just have chronic pain. According to the study's co-author, John H. Wilckens, MD, sports hernias can occur after overuse of the thigh and lower-abdominal muscles, resulting in a weakness or tear of the posterior muscle wall of the groin.
"Initial examination or imaging are not specific enough to provide information about sports hernias because of complex anatomy and biomechanical considerations that accompany this injury," said Wilckens.
He added that surgical exploration is the only sure method to confirm diagnosis. Other tests, however, can be performed to eliminate other diagnoses and determine if other orthopaedic conditions exist. Diagnosis tools include imaging, training history, observation of specific movements, checking for muscle tears, strains, stress fractures, bursitis and pain levels. Sports hernia pain is created by quick movements, twisting, turning, running and bending forward, kicking, sprinting and sit-ups.
Non-surgical treatments of sports hernias include rest, ice packs, physical therapy, anti-inflammatory medications and cortisone injections. Returning to training should always be a gradual process.
Co-author of the study, Adam L. Farber, MD, an orthopaedic resident at the Johns Hopkins Center, noted that if non-operative approaches do not work within three months, laparoscopic or open surgery is recommended.
"After laparoscopy, athletes can return to sport within two to six weeks, while open surgery requires one to six months of recovery," he said. Farber added that with both conventional and laparoscopic techniques, success rates are typically 80 to 97 percent.
"Due to the potential underlying pelvic imbalance that can occur from sports, treatment of a contracted or overdeveloped adductor muscle should not be neglected," said Farber. "This can sometimes be corrected before surgery. If not, some clinicians recommend that the muscle be cut to allow it to lengthen and stretch in conjunction with the sports hernia repair."
Sue Falsone, director of performance physical therapy at Athletes' Performance, added, "Whether someone is trying to avoid an operation or rehabilitate after surgery, muscle balance is the key to recovery. Ensuring proper pelvic position, hip and back range of motion, as well as muscle length and strength throughout the trunk, hips, and pelvis, are musts. Progressive tissue loading in order to build tissue tolerance to activity is key. Doing too much too soon can overload tissue and exacerbate the problem.