The sports hernia has been getting the buzz lately as many high-profile athletes have been diagnosed with it. But what is it?
A sports hernia is more accurately called athletic pubalgia. There is no real hernia but it is characterized by pain in the pubis seen in athletes. It is an increasingly common injury but the cause is not known. It may occur because of an imbalance of the strength of the muscles that attach to the pubis. In athletes involved in a rigorous workout happening all year round, it is possible that the lower extremity muscles may become preferentially strengthened compared to the abdomen, leading to an imbalance that can result in tearing of muscle fibers in the groin or abdomen.
The pain from a sports hernia typically begins slowly and increases gradually with continued activity. It is usually a one-sided groin or abdominal pain and is associated with sports that require frequent bending, twisting, and turning at speed. It can worsen with sudden twisting or turning.
The diagnosis is clinical, based on the findings mentioned above, but they can be seen with other conditions. X-rays and other imaging techniques are used to support the diagnosis.
Conservative treatment begins with rest, which ranges from a few weeks to a few months. Anti-inflammatory medication such as NSAIDs can help with pain relief at this time. In some cases, oral steroids may be prescribed. Physical therapy is recommended following the initial rest period, which is focused on strengthening the abdominal muscles as well as stretching the lower abdominal muscles and leg muscles. Other nonsurgical treatments include treatments include dry-needling, therapeutic massage, and ultrasound therapy. Steroid injections, nerve blocks administered to the ilioinguinal and iliohypogastric nerves, or platelet-rich plasma (PRP) injection are other such options and have varying success rates.
If rest and conservative treatment fail, surgery is the definitive treatment. There are various surgical approaches targeted at reinforcing the abdominal muscles, and restoring balance of muscles across the pelvis as needed. Surgery typically requires 6- to 8-week period of intensive physical rehabilitation to rebuild muscle strength and endurance after surgery. Some surgical approaches may involve the placement of a synthetic mesh in the groin area to help stabilize the injury. While up to 80% of these procedures are reported to be successful, with the athlete returning to sport, some treatment-resistant cases of sports hernia require multiple surgeries.
Sports hernia is a new name for a known condition of athletic pubalgia, and it can be quite disabling, making it impossible for the athlete to play the sport. It is also quite likely to be misdiagnosed, so getting the right diagnosis is critical, which can sometimes mean getting second/third consults. Once diagnosed, the athletes have to work closely with their physicians to find a way to manage their injury, ensuring a successful and timely return to the sport.