Sports Hernia: A Common Cause of Groin Pain

Thursday, May 26, 2005

If you’re an athlete or physically active person, you may have occasional aches and pains. When pain strikes in your lower abdomen or groin, your first thought may be that you’ve pulled a muscle. You try applying heat and ice, reduce your physical activity, and get as much rest as possible. But nothing seems to help.

Perhaps what you have isn’t a “pull” at all, but a tear. Certain professional athletes, as well as some active “weekend athletes,” are susceptible to a sports hernia, also known as athletic pubalgia. While most athletes think they’ve got a pulled groin muscle, they actually may have a tear in the area where the muscles meet the bones of the pelvis.

This type of injury is caused by repeated trauma to the groin area, resulting in muscle and tendons pulling away from the pubic bone. Sports hernias are common among athletes or anyone who participates in sports that involve repetitive twisting and turning while moving, such as soccer, ice hockey, rugby, field hockey, tennis, or track.

The injury isn’t limited to professional athletes, however. Anyone can develop a sports hernia, including people who do a lot of twisting and turning during a workout, or students who participate in high school or college sports. Females are just as susceptible as males.

Symptoms and Diagnosis

The major complaint of people with a sports hernia is groin pain, which usually occurs during exercise or other physical activity. The pain may be worse with sudden movements such as sprinting, kicking, side-stepping, sneezing, or coughing.

This is chronic condition that may be misdiagnosed during an initial visit to a primary care physician for groin pain. The physician may recommend rest and applying heat and ice, as well as anti-inflammatory drugs and physical therapy. If these don’t relieve symptoms, the physician probably will refer the person to a specialist for further evaluation.

The best way to identify athletic pubalgia is by taking a thorough history and performing a physical exam. An MRI scan can often identify a tear, and a bone scan may reveal inflammation of the pubic bone.

Treatment

Once athletic pubalgia is identified, the tear can be corrected surgically to reattach the muscles to the bone. A few years ago, the only way to repair the tear was to perform an open operation that involved a 5-inch incision in the abdomen and a recovery time of three months.

Today, the procedure can be performed using minimally invasive (laparoscopic) surgery. Laparoscopy uses three ¼-inch incisions to allow insertion of instruments used to visualize muscle damage and perform the repair. To reinforce the repair and make it stronger, a synthetic mesh-like material is used.

Compared to open surgery, laparoscopy results in a much shorter recovery time, less pain and need for pain medication, and minimal scarring. The shorter recovery time is a great help to athletes, who often can’t afford to take a lot of time off from their season.

With the minimally invasive procedure, patients are walking the day of the surgery, with no exercise during the first two weeks. During weeks two to four, they can resume aerobic activity such as biking or jogging. At four weeks, they can start lifting, sprinting, and resume playing their sport.

Open Surgery–Hospital stay–Same day
Pain during recovery—Moderate
Return to work time–4-6 weeks
Cosmetic results–5-inch scar

Laparoscopic Surgery–Hospital stay–Same day
Pain during recovery—Minimal
Return to work time–4-5 Days (full sports in 4 weeks)
Cosmetic results–Three ¼-inch scars


Dr. Richard Cattey is a general vascular and laparoscopic surgeon at Columbia St. Mary’s and a founding member of the Milwaukee Institute of Minimally Invasive Surgery. He is one of a small number of surgeons in the world who perform laparoscopic athletic pubalgia repair, and has helped college and professional athletes from across the U.S. and abroad. For more information, call 414-961-3254.
 

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