Understanding the Often Misunderstood and Misdiagnosed Sports Hernia
A sports hernia is probably the least understood of all the injuries that involve professional level and collegiate level athletes. A sports hernia is a tear to the oblique abdominal muscles. Unlike a traditional hernia, the sports hernia does not create a hole in abdominal wall. As a result, there is no visible bulge under the skin. This means making a definitive sports hernia diagnosis is difficult.
It is not uncommon for one of Dr. Brown’s patients to have seen four or five other consultants prior to seeing him. The athlete is often given the diagnosis of a groin strain and is told to rest and that the problem will go away. And it does for a while, but the pain associated with a true sports hernia will return with a vengeance once the ibuprofen wears off and activity resumes.
Failing to understand the underlying issues surrounding sports hernias results in chronic pain for the athlete and an unnecessary delay in diagnosis and treatment. Any athlete who suffers chronic groin pain that is aggravated by sports and is relieved by rest should be strongly considered to have a sports hernia.
How Do Sports Hernias Occur?
A sports hernia occurs with the weakening of the muscles or tendons in a thin region of the abdominal wall. Once overexerted, a muscle tear occurs inside the groin. The overexertion occurs because of a losing battle with the adductor muscles of the thigh. The oblique muscles attach at the pubis in the groin. When contracting, they pull up on the pubis as the trunk flexes and rotates. Adductor muscles also attach at the pubis. The muscles pull on the pelvis from below as they work to move the femur medially toward the body. When both oblique muscles and adductor muscles contract at the same time, a tug-of-war of the pelvis ensues. Because athletes tend to focus on strengthening the lower body more so than the trunk, the adductor muscles are typically stronger. As a result the weaker oblique muscles tear, resulting in a sports hernia.
In the image above (left), notice how the adductor muscles attach to the inferior aspect of the pubic ramus. On the image above (right), you can see how the oblique muscles come down and attach to the superior aspect of the pubic ramus.
Sports hernias occur most commonly among professional athletes, specifically football, hockey, soccer and tennis players. However, weekend warriors and athletes making extreme and repeated twisting-and-turning movements are also susceptible to a sports hernia.