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Athletic Pubalgia (Sports Hernia) A sports hernia is a painful strain or tear of any soft tissue (muscle, tendon, ligament) in the lower abdomen or groin area. It is characterized by insidious onset, gradually worsening, unilateral groin pain that may radiate to the perineum and upper medial thigh.  It most often occurs during sports that require sudden changes of direction or intense twisting movements. The soft tissues most frequently affected by sports hernia are the oblique muscles in the lower abdomen. Especially vulnerable are the tendons that attach the oblique muscles to the pubic bone. In many cases of sports hernia, the tendons that attach the thigh muscles to the pubic bone (adductors) are also stretched or torn. Sports hernias often occur where the abdominals and adductors attach at the pubic bone.  A traditional hernia occurs in the inguinal canal. These are two different injuries. There may be pain with coughing, sneezing, turning over in bed at nighttime, sprinting, kicking, sidestepping, weight training and performing certain maneuvers specific to your athletic activity. A sports hernia can also be the result of severe trauma, such as an automobile accident or sports collision. It is most often seen in male athletes. Sports most commonly associated with a sports hernia are ice hockey, soccer, football, and sprinting.


Causes

Athletic Pubalgia may develop from overuse, increased shear forces across the hemipelvis, lumbopelvic and leg muscle strength, endurance, extensibility and coordination imbalances, loss of dynamic abdominal wall rotational stability, or congenital inguinal wall weakness. Restricted hip range of motion in addition to an imbalance in strength between the stronger leg muscles and weaker abdominal muscles increasing shear forces across the pubic symphysis and subsequent tearing of the transversalis fascia, conjoined tendon, inguinal canal, or overlying musculature. Furthermore, sports activities that involve planting the feet and twisting with maximum exertion can cause a tear in the soft tissue of the lower abdomen or groin.


Treatment

 
Traditional conservative treatment for athletic pubalgia includes 6-8 weeks of rest followed by an active programme designed to improve strength, endurance, coordination, and appropriate hip and abdominal muscle synergistic balance. Extensibility deficiencies and imbalances at the hip and abdominal muscles must also be addressed.
 
Surgical exploration and repair should be considered when rest and non-surgical treatment over a minimum of 6-8 weeks has failed. When surgery is selected either an open or a laparoscopic approach can provide good results. Surgical procedures reinforce the abdominal muscles or fascia near the inguinal ligament. A wide variety of techniques can be used to reinforce the existing tissue layers with or without mesh. During post-surgical rehabilitation early sharp or sudden movements after surgery are avoided and core and leg muscle inflexibility, weakness, and poor endurance/coordination are identified and corrected. Walking is encouraged early in the post-op period with progression to jogging or running by 3-4 weeks. Recovery after a laparoscopic repair generally takes 6=8 weeks before full return to competition is permitted.
 
 
References: Caudill et al., Br J sports Med, 2008;Active P.T. Solutions; AAOS.org; www.mendmeshop.com
ProSport Physical Therapy, 1000 N. Bristol St, Ste. #25, Newport Beach, CA (949) 250-1112
Article produced by: Adrienne Peterson, Student Physical Therapist