I am proud to announce that a review article on Sports Hernias was published in in the Journal of Bone and Joint Surgery.
I helped write and edit the article with Dr. Justin Hopkins and Dr Cassandra Lee at Department of Orthopaedic Surgery, University of California Davis. Dr. Hopkins and Dr. Lee are very knowledgeable and experienced surgeons and it was a pleasure to work with them. I hope that you enjoy the article and if there are questions, please to not hesitate to contact me.
Don’t Let Insurance (or Lack Thereof) Keep You From Sports Hernia Surgery
You’ve been through the doctor appointments, the specialist visits and the consultations. Now, sports hernia repair surgery might be in your future. Even with recovery as your top priority, it’s hard to ignore the calculator in the back of your mind adding up the costs. Unexpected medical bills can throw even the most careful budgeter off track. It’s important to understand how insurance can affect the costs of sports hernia repair. Different plans and costs can be confusing, but Dr. William Brown’s team has years of experience working with patients to find the best financial options, whether you have health insurance or self-pay.
Most insurance plans have a deductible. This means that you’ll pay your deductible amount before insurance covers any costs. If your deductible is $2000, then you’re responsible for the first $2000 of your medical expenses.…
Dr. Brown’s Approach to a Sports Hernia Diagnosis
Now that you have a patient in the office, what do you do? Be sure to allot sufficient time with the patient, get a good history, and carefully examine the athlete. Often, you will determine the diagnosis without the need for MRI or ultrasound. The correct diagnosis leads to appropriate treatment.
From the patient’s history determine the site of the pain and work from there.
- For the athlete who complains of pain near the symphysis pubis (in the middle of the pubic hair above the base of the penis); osteitis pubis is the most likely etiology. This patient is often a distance runner. Many patients report that rolling over in bed is painful. With rest the pain improves. The pain is usually insidious in onset. On physical examination there is usually pain with direct pressure over the symphysis pubis and the edges…
Many athletes with sports hernias often report a component of their pain involves the testicle. The pain is usually characterized by an ache and swelling of the testicle after aggressive physical activity or sex. Pain usually gets better with rest. Shorts that provide scrotal support and ice bags are also often helpful. Many athletes have seen a urologist, who report that the genital examination is normal. Ultrasound of the scrotum and testicle is normal.
In my experience, many of these athletes have scarring between the posterior aspect of the spermatic cord and the pubic tubercle. This can be easily identified on physical examination by gentle traction on the testicle, and noticing that the spermatic cord no longer slides over the pubic tubercle. In these athletes, it is important at the time of surgery to examine the spermatic cord at the pubic tubercle. …
Many athletes with a sports hernia present with significant pain at the medial attachment of the inguinal ligament. The inguinal ligament attaches to the anterior superior iliac spine and then travels down to attach to the pubic bone at the pubic tubercle. Most of the abdominal wall musculature attaches to the inguinal ligament, thus inguinal ligament is subject to many of the same stresses that can cause injury to the oblique muscles and to the adductor tendons.
When examining a patient with a sports hernia it is very important to include careful evaluation of the medial attachment of the inguinal ligament. I check for pain with palpation and for thickening of the ligament. The diagnosis can be confirmed by infiltrating the medial attachment of the inguinal ligament with local anesthetic. If the athlete improves, that confirms the diagnosis.
The injury can also be seen on an…
Six-Week Rehabilitation Program for a Remarkable Sports Hernia Surgery Recovery (Part 2)
In our last post, we covered your rehabilitation program for weeks one through three. Today, we conclude this article with weeks four through six.
Week 4: Mix in functional rehabilitation activities
- Do mobility work, both active and passive
- Do stability work
- Add hydrotherapy
- Do cardiovascular exercises
- Swimming is okay
- Cycling is okay
- Initiate a running program, progressing from aerobic to anaerobic over the next 3 weeks
- Do submaximal to maximal isometric hip work (isokinetics if available) using bias towards presurgical isokinetic test results as guide
- Begin active concentric work once 25% or lower deficit between limbs
- Additional functional rehabilitation activities can include those unique or complementary to your sport. Again, if you’re unsure, check with your doctor or therapist.
Week 5: Re‐educate your muscles
- Return to active assisted work to re‐educate concentric/eccentric functional pattern
- Progress your…