Sports Hernia or Athletic Pubalgia is also called as gilmores groin, sportsman’s hernia, slap shot gut and groin disruption.
Consultant surgeon Dr. Jerry Gilmore was the first person who described Sports Hernia or Athletic Pubalgia. According to him Sports Hernia or Athletic Pubalgia is caused due to the longstanding groin pain. In some cases Sports Hernia or Athletic Pubalgia is also known as the sportsman’s hernia, however, symptoms of such a hernia often result in misdiagnosis as there is no presence of actual hernia. Sports Hernia or Athletic Pubalgia is very common in sports in which large amounts of stress is often placed on the groin and pelvic region through kicking and twisting movements. Sports Hernia is more common in sports like tennis, hockey, football, distance running, rugby and soccer which involve repeated turning and twisting. Frequent participation in these sporting activities may overload the tendons and bones present in the pubic symphysis and may also result in injuring more than a single groin at a time such as adductor tendinopathy or osteitis pubis associated with Sports Hernia.
Sports Hernia or Athletic Pubalgia is a condition in which the junction of the leg and the torso gets injured. Aponeurosis is a region where the muscles of the abdomen such as transversus abdominus, internal obliques and external obliques join to develop the inguinal ligament. Many vessels and nerves pass through the archway of the muscle called external oblique muscle. In case of Sports Hernia or Athletic Pubalgia, the tearing of a groin muscle often results in wide opening of this archway. Later the tears in the obliques also force them to lift up and away from inguinal ligament due to which transversus abdominus muscle becomes unstable. Often ilioinguinal or genitofemoral nerve entrapment is also seen.
Sports Hernia or Athletic Pubalgia is a chronic condition which often results from overuse of groin area and repeated trauma. Inflexible, tight, damaged and weakened hip flexor muscles and inner thigh and groin muscles that stretch the lower abdominal muscles and bend pelvis forward often lead to the gradual development of Sports Hernia.
Repeated trauma and overuse of groin area associated with repeated turning and twisting movements are often responsible to promote force imbalances of pubic symphysis and pubic bones that pressurize the posterior wall of inguinal canal. This causes disruption of inguinal canal resulting in tearing and weakness of abdominal tissues and muscles which also pulls away tendons, ligaments and muscles from pubic bone.
Males are ten times more prone to Sports Hernia or Athletic Pubalgia when compared to females. However, females may also suffer with this disorder.
Causes and Risk Factors of Sports Hernia or Athletic Pubalgia
Sports Hernia or Athletic Pubalgia is caused by a muscular injury that affects the region where abdominal muscles join to form the inguinal ring. The groin area is at extreme risk of chronic overuse injury caused during sports activities specifically while playing hockey, soccer, football and rugby. Safety measures such as using protective sports gear, while playing sports and training helps in preventing such type of chronic injuries.
Apart from this age-related weaknesses resulting from degeneration in muscles and bones, obesity, defects in groin area from birth and previous surgery could also be responsible for Sports Hernia.
Signs and Symptoms of Sports Hernia or Athletic Pubalgia
- Exacerbation of pain in the groin while twisting, turning, running and sprinting.
- Stiffness and tenderness is also experienced by athlete after training. The person may have pain in the groin while turning or even with getting out of a car.
- Groin pain is experienced while sneezing and coughing.
Treatment for Sports Hernia or Athletic Pubalgia
The initial treatment for any kind of muscle injury often involves rest, ice, and compression.
Rest: Resting is obviously required to avoid any further damage or aggravate the condition. Resting period can be anywhere from weeks to months depending upon the severity.
Ice Therapy: Application of ice to the affected area for about 10 to 15 minutes every four hours all over the day also helps in reducing the swelling and pain caused by injury in Sports Hernia.
Compression: Compression shorts and warm pants also help in controlling the symptoms of athletes who still have time for surgical intervention. However, these may not reduce the symptoms of Sports Hernia, but help in preventing worsening of tear till the time of surgical intervention.
Medications Sports Hernia or Athletic Pubalgia: Anti-inflammatory medications like ibuprofen may also help in reducing the swelling and pain. However, anti-inflammatory medications are often considered to be a short-term treatment in Gilmores Groin as they do not treat the problem.
Physical Therapy for Sports Hernia or Athletic Pubalgia: Physical therapy is required for all the patients to speed up the healing process and restore normal functioning. Physical therapy routine often concentrates on strengthening the muscles of the pelvic area and specifically the core muscles, lower extremity muscles and tendons and stretching the lower abdominal muscles.
Surgery: Surgery is performed only when conservative treatments fail to work appropriately. Surgery is performed laparoscopically, which shortens the recovery period significantly.
Exercises for Sports Hernia or Athletic Pubalgia
Standing Groin Stretch for Sports Hernia or Athletic Pubalgia:
This exercise is performed with a wide posture and bending one knee in order to lean sidewards until a pain-free stretch is felt on the inner side of the straight leg. Hold the position for about 20 to 30 seconds. Repeat two to three times ensuring there is no exacerbation of symptoms. Performing this exercise helps in stretching the long adductor muscles.
Short Adductor Stretch for Sports Hernia or Athletic Pubalgia:
This exercise is performed by sitting straight on floor by keeping the soles joined together. Place the elbow on knees in order to apply pressure in the downwards direction until a mild to moderate pain-free stretch is felt on the inner groin. Hold the position for about 20 to 30 seconds. Repeat two to three times ensuring there is no exacerbation of symptoms.
Hip Flexor Stretch for Sports Hernia or Athletic Pubalgia:
This exercise is performed by placing one knee on floor with another leg foot front side. Now keep the back in a straight position and push the hips in a forward direction in order to stretch the front side of the hip. Hold the position for about 20 to 30 seconds. Repeat two to three times ensuring there is no exacerbation of symptoms.
Hamstring Stretch for Sports Hernia or Athletic Pubalgia:
This exercise is performed by sitting straight on the floor. Lean forwards from the hips in order to stretch the hamstrings present at the back of the thigh. Hold the position for about 20 to 30 seconds. Repeat two to three times ensuring there is no exacerbation of symptoms.
Gluteal Stretch for Sports Hernia or Athletic Pubalgia:
This exercise is performed by lying down in a straight position and bringing the knees up towards the chest. Pull the knee towards the head and across the body toward the opposite shoulder until a pain-free stretch is felt in the buttock. Hold the position for about 20 to 30 seconds and release. Repeat two to three times on both the sides ensuring there is no exacerbation of symptoms.
Tests to Diagnose Sports Hernia or Athletic Pubalgia
A complete history and thorough physical examination is necessary to diagnose Sports Hernia or Athletic Pubalgia.
Typical test involves inverting the scrotum and placing the examining little finger in each of the superficial inguinal rings. The ring is seen to be usually dilated on the affected side and also a cough impulse may be seen along with tenderness. Other diagnostic tests may include:
- CT scan.
Dynamic ultrasound is generally used to check for any inguinal wall abnormalities.