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Understanding Sports Hernias
A sports hernia is probably the least understood of the injuries that involve professional level and collegiate level athletes. It is not something that is taught as part of the stanard general surgical or orthopedic training programs. Thus it is a problem that is often not diagnosed.
Jerry Gilmore FRCS is one of the first surgeons to identify the problem and treat it appropriately [Gilmore1991]. Some general surgeons even do not believe that this is a true pathology and criticize surgeons that perform surgery for the problem. It is not uncommon for one of my patients to have seen four or five other consultants prior to seeing me. The athlete is often given the diagnosis of a groin strain and is told to rest and that the problem will go away. This represents a misunderstanding of the underlying problems and results in chronic pain and delay in diagnosis and treatment.
How Do Sports Hernias Occur?
Sports hernias occur most commonly in athletes that use the adductor muscles of the thigh. This especially includes hockey, football and soccer players.
The injury is a result of a mis-match in the strength of the adduction muscles of the thigh and the oblique muscles of the abdomen. The adductor muscles of the thigh insert along the inferior rami of the pubis. The abductor muscles adduct, flex, medially rotates the femur. The oblique muscles of the abdomen insert along the inguinal ligament and the conjoined tendon of the pubis. These muscles tense the abdominal wall and act to flex the trunk had to rotate the trunk. The oblique muscles pull on the pelvis from above and the adductor muscles pull on the pelvis from below [Gray1973]. The adductor muscles are much stronger than the oblique muscles and when both muscle groups are contracting simultaneously the oblique muscles lose and tear [Swan2007]. Thus the underlying anatomic injury in patients with a sports hernia is a tear of the external oblique muscle and the floor of the inguinal canal.
In the image above (left), one can see the adductor muscles attach to the inferior aspect of the pubic ramus. On the image above (right), one can see the oblique muscles coming down and attaching to the superior aspect of the pubic ramus.
Any athlete who presents with chronic groin pain that is aggravated by sports and is relieved by rest should be strongly considered to have a sports hernia. Imaging tests are not very helpful. The diagnosis is confirmed if the external inguinal ring is enlarged, and there is weakness of the floor. Surgical reconstruction of of the inguinal floor is very effective.
Learn more about Dr. Brown's approach to the treatment of sports hernias or contact Dr. Brown for additional information.
Dr. William H. Brown, III
Sports Hernia Specialist
Dr. Brown has been performing sports hernia surgeries and providing specialized rehabilitation programs since 1999.
His clients include the San Jose Sharks (hockey) and the San Jose Earthquakes (soccer) teams.
556 Mowry Ave,
Suite 100
Fremont, CA 94536
Phone: (510) 793 2404
Fax: (510) 793 1320
Email: