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Core Knowledge

Injury/Pain

Sports Hernia 101

Overview

Sports hernia is a broad term describing pain in the lower abdominal or upper groin region. Which is kind of like saying low back pain—it gives you no real information, but just tells you where the pain is located. Blame the nature of this injury for its vague definition.

"It doesn’t even always involve an actual hernia, but can be a variety of things," explains Sue Falsone, director of performance physical therapy at Athletes’ Performance. "Some clinicians describe it as a tearing of the posterior abdominal wall. Groin musculature and the pelvic floor can also be involved."

Dave Cruz

A sports hernia is an overuse injury that results in a torn, strained or weakened wall of the lower abdomen. In an inguinal hernia—one of the most common types of hernias—part of the intestine pushes through the abdominal wall. A sports hernia may be more painful than an inguinal hernia, but the hernia does not protrude through the wall.

A diagnosis is difficult because symptoms are similar to that of a groin pull, strained abdominal muscle, or other lower trunk injuries. Diagnosis may be a matter of ruling out other causes of pain.

“Initial examinations and imaging are not specific enough to provide information about sports hernias because of complex anatomy and biomechanical considerations that accompany this injury,” says John H Wilckens, MD, of Johns Hopkins Medical Center.

“Surgery is the only sure method to confirm a diagnosis," says Wilckens. "Other tests, however, can be performed to determine if other conditions exist. Diagnostic tools include imaging, training history, observation of specific movements, checking for muscle tears, strains, stress fractures, bursitis, and pain levels.”

How Sports Hernias Happen

There are only theories about how a sports hernia can occur, but the most popular is overuse of the thigh and lower abdominal muscles, which results in a weakness or tear of the back muscle wall of the groin. The injury is triggered by quick movements, twisting, turning, sprinting, bending forward, kicking, and performing sit-ups. In fact, pain that occurs while performing sit-ups may be an indicator that a sports hernia is present.

Sports Hernias by the Numbers

3
Number of months that may be needed to evaluate the effectiveness of conservative (non-surgical) treatment for a sports hernia before open or laparoscopic surgery is recommended

5
Percentage of athletes who report groin pain%

40-85
Percentage of chronic groin pain in athletes that may be caused by a sports hernia

80-96%
Success rate of successful surgical procedures for sports hernias

Who’s At Risk for Sports Hernias

Because of the nature of their sports, hockey, soccer and tennis players are at highest risk, followed by skiers, runners and hurdlers. Men are more likely to get sports hernias than women, but they can happen to anyone.

Symptoms

  • Pain in the groin, lower abdomen, or testicles (in males)
  • Pain that usually affects just one side of the groin area
  • Severe pain when accelerating, twisting, turning, lifting, coughing, or sneezing
  • Groin or lower abdomen pain that persists for weeks or months
  • Gradual onset of symptoms in runners

Initial Treatment

  • Rest. Avoid or limit the activities that cause the pain. Trying to play through the pain could make the condition worse.
  • Apply ice packs for 15-20 minutes, 3-4 times a day.
  • Aspirin, ibuprofen, and naproxen may relieve pain and reduce inflammation.
  • See a doctor if an injury causes groin pain or if pain in the groin has developed without any apparent cause.

If these measures are not effective, surgery is the only alternative for a permanent solution, but even surgery does not guarantee that a sports hernia will not develop again.

Comeback Strategy

Return to training should always be a gradual process. Perform all of the movements required in your sport (without pain) before returning to a full training and competition schedule. If laparoscopy surgery is performed, recovery takes 2-6 weeks. With open surgery, 2-6 months may be needed. Your recovery should be guided by the absence of symptoms, not a specific length of time on the calendar.

Prehab

Incorporate these exercises into your comeback routine:

  1. Kegel Exercises — Tighten the pelvic floor muscles for 10 seconds and release. Repeat 10 times.
  2. Pillar Bridge - Front Kneeling
  3. Pillar Bridge - Lateral

Strive for Muscle Balance

“Whether someone is trying to avoid an operation or rehabilitate after surgery, muscle balance is the key to recovery," says Falsone. "Ensuring proper pelvic position, hip and back range of motion, as well as muscle length and strength throughout the trunk, hips, and pelvis, is a must. 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.”

How to Avoid This Injury

Never increase training intensity, duration, and frequency by more than 10 percent a week.

Movement Prep

Incorporate these dynamic exercises into your warm-up routine.

  1. Hand Walks
  2. Glute Bridge - Single Leg
  3. Inverted Hamstring

Jim Brown, Ph.D. has written 14 books on health, medicine, and sports. His articles have appeared in the Washington Post, New York Post, Sports Illustrated for Women and Better Homes & Gardens. He also writes for the Duke School of Medicine, UCLA School of Medicine, Cleveland Clinic and Steadman-Hawkins Research Foundation.


Tags: Upper Body, Soreness, Injury, Prehab, Rehabilitation, Abs, Pain, Injury Prevention

References

  1. Sue Falsone PT, MS, SCS, ATC, CSCS, 
director of performance physical therapy at Athletes’ Performance
  2. Journal of the American Academy of Orthopaedic Surgeons
  3. ACC.com
  4. University of Michigan Health System

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