Our Sports Hernia specialists consider a number of factors, including age, symptoms, type(s) of tears, desired level of physical activity and more, to help diagnose a sports hernia and determine which procedure or treatment option is best for you moving forward.
The term “sports hernia” is used to describe a condition characterized by groin pain, often in an athlete, in which there is no demonstrable hernia. The term is a misnomer because there is typically no identifiable true hernia or defect in the groin or abdominal wall by examination. Sports hernia is, therefore, a clinical diagnosis.
A variety of other terms have been used interchangeably to describe this condition including “sportsman’s hernia,” “hockey groin” and “athletic pubalgia.” Throughout the past decade, this condition has become more commonly described as several well-known professional athletes have undergone surgical treatment of this condition.
Sports hernias result from chronic, repetitive trauma or stress to the musculotendinous portions of the groin. They typically develop in an insidious fashion without sudden or dramatic pain. Symptoms typically come from overuse of the lower abdominal musculature and the muscles of the upper thigh.
Sports hernias are more common in men than in women, and are more common with sports such as hockey, soccer, rugby, and football, in which the athlete bends or leans forward. However, virtually all sports can produce sports hernia because leaning or bending forward into the typical “athletic stance” is a common pose in any athletic endeavor.
Additionally, high speed twisting, turning and torquing the groin likely contribute to the development of the condition. This condition has also been identified in patients with hip or leg injuries.
Frequently, the symptoms can be reproduced by simple maneuvers such as performing sit-ups or crunches. Further examination is performed with the patient in a supine position with their knees bent and heels together (so-called frog position). If the patient has pain or discomfort with forced adduction against the examiner’s resistance, this is suggestive of a sports hernia.
Additional tests include putting the athlete into positions of stress from their particular sport and applying resistance to see if this reproduces symptoms. An example would be to have a soccer player assume the position of kicking across their body and resist the internal rotation and adduction of the lower leg.
Diagnostic tests, such as MRI or ultrasound, are usually ordered when there is concern for concomitant injuries, such as tears to the adductor longus or rectus abdominus. These tests may also be useful when there is pain in the pubic bone which may indicate a resulting condition known as osteitis pubis.
The initial treatment includes rest, icing, and NSAID’s (such as ibuprofen). Surgical exploration and repair is the most common treatment for sports hernia, although few randomized trials have been performed to confirm the effectiveness of this approach.
In one such randomized trial of 60 patients, including many high level athletes, with chronic groin pain diagnosed as sports hernia (minimum three months of symptoms), 27 of the 30 patients treated with laparoscopic surgery and mesh placement returned to full sport activity within three months of the procedure, compared to 8 of 30 managed with physical therapy and other nonsurgical interventions.
At one-year follow up, 29 of 30 surgical patients had returned to full activity, while seven of the patients treated conservatively during the study period subsequently opted for surgery and also returned to full sport activity; the remainder of the nonsurgical patients continued to experience disabling symptoms. Observational studies suggest that long-term improvement is seen in up to 90% of surgically treated patients, although relapses can occur in a small number. The large majority of athletes return to play and performance is not impaired by surgical repair.
Complications from sports hernia repair appear to be uncommon. In an observational study of 5460 procedures, hematomas developed in 0.3 percent of patients, superficial surgical site infections occurred in 0.4 percent, and 0.3 percent of patients developed dysesthesias of the ilioinguinal, genitofemoral, and anterior or lateral femoral cutaneous nerves. Dysesthesias resolved in half of affected patients within 12 months.
Have additional questions about sports hernia treatments, causes, symptoms or recovery timelines? In search of a top sports hernia doctor? We are here for you.
