What Is a Sports Hernia?
A sports hernia is a painful condition of the groin predominantly arising with athletic activities. The term sports hernia is a misnomer as there is no true hernia. It is the result of repetitive athletic activity that leads to damage of the soft tissues and nerves in the groin. While more common in the professional athlete, it has been discovered to also occur in the weekend recreational athlete.
The term “sports hernia” was first coined in the 1960’s describing Spanish soccer players who developed groin pain with no evidence for classic hernias (inguinal hernias).Since then, Gilmore described the underlying pathology leading to the reference of sports hernias as Gilmore’s Groin. With a better understanding of this entity the diagnosis of sports hernias has become much more common.
Cause of Sports Hernia
Studies over the years have implicated the imbalance between the strong adductor muscles of the leg and the inherently weaker abdominal core muscles. These opposing muscle groups insert onto the pelvic frame close to one another. In the susceptible patient, the greater force from the leg can overpower the core muscles of the abdomen resulting in significant tissue damage and pain. In some cases the imbalance of forces can cause the two fused segments of the pubic bone to separate and cause tenderness in this area. This can be a clue to the diagnosis of a sports hernia and is referred to as “pubalgia”.
The diagnosis of a sports hernia begins with a thorough history and physical exam. There are no specific blood tests or radiologic imaging studies that pinpoint this entity. It is essentially a diagnosis of exclusion, meaning that a number of other diagnostic possibilities must be ruled out before accepting the presence of a sports hernia. While it may be possible for a sports hernia to coexist with an inguinal hernia, it is very uncommon.
Some of the physical findings that can be associated with a sports hernia, include pain in the groin with sit ups, flexion and rotation of the hip and straight leg raising. While hip pathology can mimic the groin pain of a sports hernia, an MRI of the hip usually will identify the pathology. Most often this would involve such findings as a labral tear or stress fracture. However some studies have found up to 60% of patients who have a sports hernia also have a labral tear of the hip.
In most cases, conservative treatment of sports hernias with rest and physical therapy has a low success rate. The surgical approach predominantly aims to strengthen the groin to counter the excessive forces generated by the strong adductors of the leg. This can be accomplished with either a tissue repair of the damaged groin structures or reinforcement with mesh materials. While other surgical approaches have been proposed, they lack overall acceptance by the surgical community.
Typical recovery requires three to four weeks of rest followed by a period of intense physical therapy to reach maximum athletic capacity. In most cases patients are able to return to full participation in athletic activities.
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