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 the 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 when the muscles in the groin tear. This causes weakness and pain. Visualize the anatomy in your mind. The internal and external oblique muscles attach to the superior aspect of the pubic bone. When the oblique muscles contract, the pelvis is pulled upward and to the side. The adductor muscles attach to the inferior aspect of the pelvis just opposite the attachment of the oblique muscles. When the adductors contract, the pelvis is pulled down and the pelvis is tilted. When both oblique muscles and adductor muscles contract at the same time there is a tug-of-war with the pelvic bone in the middle. The adductor muscles are stronger than the oblique muscles and so the most common result is for the oblique muscles to tear. Occasionally the adductor tendon will be injured where it attaches to the bone. And occasionally the pelvic bone itself will be injured resulting in osteitis pubis.
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.
Many doctors in the United States do not believe that a sports hernia is a real diagnosis or a real injury. Most insurance companies consider the surgery experimental. Recently the English Hernia Society met and the experts concluded that a sports hernia is a real injury. It is a common injury among athletes and surgery is very effective. The British decided that “Inguinal Disruption” would be a better name for the injury. Please click here to read their consensus statement. Hopefully this strong statement by the British Hernia Society will lead to better understanding in the United States by physicians and insurance companies.