The sports hernia has garnered significant attention in recent years. Many high-profile athletes have been diagnosed with a sports hernia, yet it was rarely heard of a decade ago.
A sports hernia is somewhat mislabelled — there is no real hernia (or bulge through muscle tissue). Some doctors prefer the term athletic pubalgia, which refers to pain in the pubis (front pelvic bone) caused by athletics. There is no single consensus among doctors as to what causes a sports hernia, though there is general agreement that sports hernias result from overuse.
A leading theory is an imbalance in the strength of the muscles that attach to the pubis. The groin muscles in the leg attach to the pubis at a location similar to where the abdominal muscles attach. With year-round conditioning, the lower extremity muscles may be preferentially strengthened compared to the abdomen, creating an imbalance. Given that forces across the pelvis are extremely high, this imbalance can result in tearing of muscle fibres in the groin and/or abdomen.
Symptoms and Diagnosis
The pain from a sports hernia usually begins slowly, is one-sided, and increases gradually with continued activity. Sports that require frequent bending, twisting, and turning at speed — such as hockey, soccer, rugby, football, and field hockey — are common triggers. Patients report pain in the lower abdomen and groin that is worsened with sudden twisting or turning; many describe a tearing sensation.
Diagnosing a sports hernia is challenging, as it can be difficult to distinguish from other causes of groin pain. X-rays and other imaging are generally used to assist with the diagnosis.
Treatment
Treatment generally begins with rest. Continued activity makes it difficult for a sports hernia to heal, which is why many in-season athletes carry the diagnosis for a prolonged period. The required rest can vary from a few weeks to a few months. Anti-inflammatory medication can also be helpful during this time.
Surgery is used if rest and conservative treatment fail. Several surgical approaches have been described, most relying on reinforcing the abdominal muscles — similar to conventional hernia repair. Restoring muscular balance across the pelvis by releasing some groin muscles from their pelvic attachment can also be helpful. Most reported procedures achieve at least 80% success in returning athletes to sport. The existence of several different procedures further demonstrates the lack of consensus, though most doctors agree surgery should be a last resort.
Dr. Gourineni's View
Dr. Prasad Gourineni believes that sports hernia / athletic pubalgia is secondary to hip impingement. Treatment of the hip impingement should be performed first, with hernia repair offered only for persistent pain after hip correction.