A sports hernia, also known as athletic pubalgia, is a soft tissue injury that occurs in the groin area. The term refers to a strain or tears in any soft tissue, such as muscles, tendons, or ligaments, in the groin region. It occurs most often in sports that require sudden changes of direction or twisting movements.
Sports can be tough on the body, and injuries are not uncommon, particularly when intense activity may overload the muscles and joints. Injuries to the groin, including sports hernias, are more likely to occur in competitive sports that require repetitive fast twisting and turning movements, such as soccer and hockey.
In this article, we discuss sports hernias in more detail, including where they occur and their causes, symptoms, diagnosis, treatment, and prevention.
Sports hernia definition
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A sports hernia is a soft tissue injury in the lower abdomen, pelvis, or groin. Many people may refer to it using various other terms, including athletic pubalgia, sportsman’s groin, sportsman’s hernia, Gilmore’s groin, and incipient hernia. Although many of the names of this injury refer to it as a hernia, it is actually a different injury.
A sports hernia presents with similar symptoms and occurs in the same area as an inguinal hernia, but it is different. An inguinal hernia occurs when tissue, such as the intestines, protrudes through a weak spot in the inguinal canal. A sports hernia is an injury to the soft tissue in the abdominal and groin area.
Additionally, an inguinal hernia presents with a bulge in the groin, whereas there is no evident bulge, or true hernia, with sports hernias, which can make diagnosis difficult.
However, although a sports hernia is not a complete herniation, it may lead to a traditional hernia.
Where it occurs
A sports hernia occurs in the pelvic area, lower abdomen, or groin. It most typically affects the soft tissues that attach either the oblique or thigh muscles to the pubic bone. If there is a strain on these tissues from intense contractions or sudden twists when a person is playing sports, this force can result in damage to these tissues, which may lead to a sports hernia.
Causes
Typically, a sports hernia is the result of physical activity involving sudden twists and turns that may cause a tear in the soft tissue of the lower abdomen or groin. For example, they are more common in vigorous sports, such as ice hockey, soccer, wrestling, and football.
Sports hernias usually affect younger males who actively participate in sport, which experts believe is because they have a narrower pelvis than females. Sports hernias also occur in females, but less commonly, and they are relatively rare in children and older adults. Although these injuries are more prevalent among those who actively engage in sport, those who do not do so can still sustain a sports hernia.
Symptoms
A sports hernia usually causes pain during exercise that subsides with rest. If it results from an acute injury, some people may feel sudden, severe pain during the initial tear. The area may then be tender to the touch. Without treatment, the injury may result in disabling pain that can prevent people from resuming sporting activities.
A sports hernia does not cause a visible bulge in the groin area. However, it is possible for a sports hernia to develop into an inguinal one.
Diagnosis
A doctor will typically begin the diagnosis by asking the person about their symptoms and how the suspected injury occurred. They will also perform a physical exam, during which they may palpate the groin area to check for any tenderness and ask the person to perform certain movements to see whether they cause any pain.
A doctor will likely order imaging tests to confirm a diagnosis of a sports hernia and differentiate it from other possible conditions. Imaging tests may include:
- X-rays
- MRI scans
- CT scans
- bone scans
Treatments
A painful sports hernia can limit a person’s ability to function and continue sports activities. Prompt treatment ensures that they can get back to their regular routine and reduces their risk of recurrent hernias or further complications, such as developing an inguinal hernia.
Treatment options may include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs): These can help reduce swelling and pain associated with a sports hernia.
- Rest: Taking time off from regular physical activity can help with the healing process. This rest period should last at least a week. Applying ice can help with pain and swelling.
- Cortisone injection: If pain persists and does not improve with rest, a doctor may suggest this treatment option.
- Physical therapy: Strength training and flexibility exercises strengthen weakened muscles and can help prevent another sports hernia.
Doctors will usually recommend a combination of these therapies. Most people can expect to return to their normal physical activity levels within 4–6 weeks. However, some people who do not see improvement with these treatments may benefit from surgery to repair torn tissues. It can take up to 3 months to recover from surgery for a sports hernia.
Rehabilitation
A doctor will work with a person to develop a rehabilitation program following surgery or extended time off exercise. A rehabilitation program for those healing from a sports hernia typically involves relieving pain, improving strength, restoring range of motion, and getting sufficient rest. At a later stage, a person can start to work on regaining cardiovascular fitness.
According to a 2019 study, strength exercises may play a role in how fast a person returns to regular sports activities. The findings showed that balance and core-strengthening exercises helped athletes return to full activity levels faster than a nonspecific rehabilitation plan. However, the study included only a small number of participants.
Some of the exercises that the study participants performed throughout the 8-week study included:
- Bridge: This movement involves lying on the floor with the feet hip-width apart and the hands on the floor. A person then slowly moves into a bridge position by lifting their pelvis, keeping the knees from shifting inward or outward. They can aim to hold the pose for several seconds and do 5 sets of 10 repetitions (reps).
- Static adduction: For this exercise, a person puts a soccer ball or a ball of similar size between their feet while lying on the ground. They then press their legs inward against the ball and hold for 30 seconds, repeating the movement 10 times.
- Hip rotations: A person lifts their leg in a standing position and rotates their hip in a circular motion. They perform the rotation in both clockwise and counterclockwise directions, doing 20 reps on each leg.
- Bird dog: A person gets down on all fours and performs alternating opposite leg and arm extensions, doing 2 sets of 15 reps.
- Lunges: People can perform either forward or backward lunges, alternating sides. They can aim for 2 sets of 15 forward lunges and 15 backward lunges.
- Balance exercise: The yoga pose called Tree Pose is a good balance exercise and easy to do almost anywhere. A person stands on one leg with the hands together in front of the heart and holds the single-leg position for at least 30 seconds. As leg strength and balance improve, a person may be able to hold the pose for longer.
People should avoid any exercises that make their pain worse.
Prevention
It is not always possible to avoid acute injuries. However, people can reduce their likelihood of developing a sports hernia by:
- performing core stability exercises regularly
- improving pelvic stability with hip- and glute-strengthening exercises
- improving flexibility
Sports hernias do not only affect athletes. People who are starting a sport or exercise routine should be mindful of the importance of not doing too much too soon. Warming up before engaging in physical activity is also essential.
Summary
A sports hernia, which also goes by many other names, is an injury that occurs in the soft tissue of the lower abdomen or groin area. The term is a misnomer, as a sports hernia is not a type of hernia but an injury following strain or overexertion that causes weakness in this area.
People who play sports involving a lot of running and sudden twisting, such as football or hockey, are more likely to develop this injury. A sports hernia is often painful and requires rest and treatment to heal. In some people, a sports hernia can become a chronic issue that requires surgery. Performing core strengthening exercises may help reduce the chance of sports hernias occurring.
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