What is Athletic Pubalgia/Sports Hernia?

A sports hernia is also referred to as athletic pubalgia, sportsman's hernia, and Gilmore's groin; it involves some injury that is usually a tear in the muscles and tendons in your lower abdomen or groin. The injury can cause chronic pain in the affected person. People who experience nerve irritation from this type of injury may suffer more pain and sensitivity. The term "sports hernia" is a misnomer since this is not a hernia. More accurately, healthcare providers prefer the term "athletic pubalgia."

A sports hernia typically strikes someone playing a sport that involves intense spurts of direction-changing or severe twisting motion, but you do not have to be playing a sport to get one.

Where on the body are sports hernias found?

A sports hernia is a tear in soft tissue in your lower abdomen or groin area. The most commonly affected soft tissues are:

Your oblique muscles in your lower abdomen.
Your tendons attach your oblique muscles to your pubic bone, part of your pelvis.
Tendons connect the muscles in your thighs to the pubic bone, which is a component of the pelvis.

What makes a hernia different from a sports hernia?

Though the symptoms may be similar with a hernia and a sports hernia, the pain from a sports hernia is related to an injury to the soft tissues that might be like tearing the lower abdomen or groin. A muscle or tendon is usually torn. Pain from a hernia is caused by an actual tear in your abdominal muscle that allows your intestine or other soft tissue bulge through and protrude under the skin.

A sports hernia can cause injury to athletic pubalgia, but in many cases, the classic hernia itself is a different injury from the athletic pubalgia.

Which sports are prone to sports hernias?

Such sports that bring repetitive motions, including a jerky movement, especially twisting your pelvic area, can lead to a tear or damage of the soft tissue in your lower abdominal or groin (a sports hernia). The following sports are primarily known to cause sports hernias:

Ice hockey
Soccer
Football
Wrestling
Rugby
Skiing
Tennis
Hurdling

Who gets sports hernias?

Athletes in specific sports involving jerky, forceful movements, especially the twisting of the pelvic area, are at risk of getting sports hernia. Sports hernia is many times more common among males than females. Typically, an individual who develops a sports hernia is between the ages of 26 and 28. An older person and a child rarely suffer from sports hernias. You do not have to be an athlete to suffer a lower abdomen or groin injury, referred to as a sports hernia; however, it is much more common among athletes.

What are the signs of a sports hernia?

Physical therapy: Generally, it will be two weeks after the day of your injury when your treatment team will ask you to perform some physical therapy. These exercises will facilitate the strengthening and flexibility of your abdominal and inner thigh muscles.
Anti-inflammatories: Ibuprofen or naproxen, to name a few, is given to remove swelling and pain.
You have sudden and severe pain at the time of injury.
The pain is chronic and felt as dull or burning.
You have difficulty localizing pain to a particular area in the low abdomen or groin
Rads down into your scrotum and/or inner thigh
Frequency of strenuous exercise, particularly sprinting, twisting, kicking, or standing from a sitting position
Associated with a cough or sneeze in your groin.
You are forced to stop doing your sport, or you scale down the activity level to a marked extent due to pain.
The pain may relieve following rest but it recurs with sport-related activities.

What causes sports hernia (athletic pubalgia)?

This condition is also termed as athletic pubalgia, and it is described as weakening or tearing of the deep layers of the lower abdominal wall, or the tendons that connect the muscles to the pelvis. Amongst these are some of the contributions that might cause a sports hernia:

Forceful and repetitive hip movements include twisting, kicking, jumping, and cutting/slicing.
Aggressive and inappropriate abdominal and hip exercises
Abdominal muscle weakness and lack of appropriate conditioning.
Imbalance between the strength of your hip and abdominal muscles.

What is the diagnosis sports hernia (athletic pubalgia)?

In fact, sports hernias are notoriously hard to diagnose because there are so many conditions and injuries that could hurt you in the groin area-and they include things like hip-joint osteoarthrosis, rectal or testicular pain, or a fracture of the pelvis. Additionally, you may be feeling pain in your groin area from injuries that began somewhere else in your body, such as your leg; that is referred pain. It is caused by the many nerves in the groin that extend to other parts.

To diagnose sports hernia, your healthcare provider will thoroughly examine your symptoms and history and then perform a physical examination. They might also have you undergo some imaging tests to either confirm that you suffer from athletic pubalgia or simply exclude other possible injuries.

What is the test that helps diagnose a sports hernia?

A sports hernia may be diagnosed using history and physical examination. Your health care provider will first ask you about your symptoms and history to see if you might have a sports hernia. They will then give you a physical examination of your injury and pain. He or she may ask you to sit up and/or flex your abdomen against resistance. These exercises will ache if you have a sports hernia.

Because a sports hernia is a type of umbrella, it's likely that you'll have another lesion or several contributing lesions and this can cause the groin pain. Your healthcare provider may send you for imaging tests, which are:

MRI
X-ray.
Ultrasound
CT scan.
Bone scan.

These imaging tests will help your healthcare provider if you do indeed have a sports hernia (athletic pubalgia) or something else.

What is the treatment of sports hernia (athletic pubalgia)?

Generally, sports hernia treatment and rehabilitation aims to ease the pain, recover the range of motion, regain strength, regain the function, and return to sports and daily activities. The best treatment for a sports hernia depends on factors such as injury severity, age, health status, and desired activity level. Sports hernias are treated with either non-surgical or surgical treatment options. If you have a sports hernia, your health care provider will likely provide you with non-surgical treatment first to see if that addresses the issue of your sports hernia before turning to surgery.

Forms of nonsurgical treatment for sports hernias include:

Rest: Rest and ice will be sufficient within the first seven to ten days after the initial injury that caused the sports hernia.
Physical therapy: Generally, it will be two weeks after the day of your injury when your treatment team will ask you to perform some physical therapy. These exercises will facilitate the strengthening and flexibility of your abdominal and inner thigh muscles.
Anti-inflammatories: Ibuprofen or naproxen, to name a few, are given to remove swelling and pain.
Corticosteroids: Another name for steroids, corticosteroids are classes of anti-inflammatory drugs. If over-the-counter or prescription medications can't do the job, a doctor may prescribe cortisone injections.

You will, most likely, be in pain and under non-surgical treatment for two to six months, then you will need surgical treatment to correct your sports hernia. The kind of surgery depends on which muscles or tendons are involved and the extent of the damage. The most common general types of surgical treatments are:

Laparoscopic Surgical Procedure: Laparoscopic surgery involves the application of small incisions and a thin tool equipped with a very small camera at the end. A surgeon uses this camera tool to view what lies inside the body with a small incision. They will insert other tools into some small incisions to perform the surgery. Laparoscopic Surgery: Laparoscopic surgery is minimally invasive.
Open surgical procedure: In open surgery, the patient's skin and tissues are cut open so that the surgeon can view the area he or she is working on.
Surgical rehabilitation: After your surgery, your healthcare team will assemble a physical therapy and rehabilitation program designed specifically to help you regain your strength and endurance.

Do sports hernias heal on their own?

Normally, any treatment besides rest is needed for a sports hernia, which is unlikely to recover spontaneously. Physical therapy, anti-inflammatory drugs, and/or corticosteroids are commonly needed to treat a sports hernia. Sometimes, surgery is needed. A groin injury not a sports hernia, such as a minor muscle strain, might resolve independently.

What type of physical therapy should I be doing with a sports hernia?

Your physical therapist's main goal is to gradually strengthen and increase the flexibility of your abdominal muscles and hips without doing this in a way that seems to worsen the injury and pain. He or she will tailor your physical therapy as directly as possible to the sport or activity you were doing and the specific nature of the injury.

Some common types of physical therapy for a sports hernia include:

Core exercises.
Stretching.
Swimming.
Yoga
Stability of posture.
The use of medicine balls.
The use of resistance bands.

Is a sports hernia or athletic pubalgia preventable?

Sports hernias can be difficult to prevent because the stresses of some sports will naturally put a lot of stress and strain on the pelvis and hips. If your sport puts you at high risk for a core muscle or tendon injury, your healthcare team may wish to discuss a sports hernia prevention program with you. A core strengthening exercises program is one part of a sports hernia prevention program, which may also include:

Abdominal strengthening exercises.
Strengthening exercises for the hip
Flexibility exercises to lessen tension across the lower abdominal region where tears of the core muscles are most likely to occur

What is the recovery time for a sport hernia?

The treatment and rehabilitation of athletic pubalgia, or sports hernia, depend on the type and severity of injury. Generally, most patients who have a sports hernia and are treated with physical therapy can experience significant improvement within six to eight weeks of physical therapy.

About 90% of open and laparoscopic surgeries to correct sports hernias, also called athletic pubalgia, are successful. With rehabilitation and physical therapy after surgery, a sports hernia patient can often return to sports or other activities by six to 12 weeks.

Occasionally, the damaged tissue will again tear when you return to participating in sports. In such instances, you will likely need surgical repair again.

Living With

When to see a doctor?

See your healthcare provider immediately if you have symptoms of a sports hernia (also called athletic pubalgia). Sports hernias do not typically heal by themselves, so you probably require some kind of treatment.

Contact your care team if you are already getting treated for your sports hernia and experiencing new or worsening symptoms.