Sports Medicine

A Sports Hernia is probably the least understood of all the injuries that affect professional level and collegiate level Athletes. A Sports Hernia is a tear to the oblique muscles or an injury to the hip adductors. Unlike a traditional hernia, the Sports Hernia does not create a hole in the abdominal wall, and there is no associated bulge. A lack of a bulge confuses most physicians, and the Athlete does not get the appropriate treatment.  The Athlete if often told that he/she the diagnosis of a groin strain, and the Athlete is advised to rest and that the problem will go away. Unfortunately, the pain and weakness of a Sports Hernia will recur as soon as the Athlete returns to playing his/her sport. It is critical for the physician to understand the underlying issues surrounding Sports Hernias to avoid unnecessary delays in diagnosis and treatment. Assume that any Athlete who suffers chronic groin pain that is aggravated by sports and is relieved by rest has a Sports Hernia.

A Sports Hernia occurs when the muscles in the inguinal region or groin are injured or torn, resulting in weakness and pain. Look at the image below and visualize the anatomy in your mind. The Rectus abdominis muscle and the Oblique muscles attach to the superior aspect of the pubic bone. When the Rectus abdominis contracts, the pubic bone is pulled up. When the Oblique muscles contract, the pubic bone is pulled upward and to the side. The Adductor longus muscle attaches to the inferior aspect of the pubic bone just below the attachments of the Rectus abdominis and the Oblique muscles. When the Adductor longus contracts, the pubic bone is pulled down. When the abdominal muscles (Rectus abdominis and the oblique muscles) and Adductor longus muscles contract at the same time, there is a tug-of-war with the pubic bone in the middle. The adductor muscles are stronger than the abdominal muscles. The Adductor usually wins the tug of war and the Rectus abdominis and the oblique muscles to tear. Occasionally the Abdominal muscles win, and the adductor tendon will tear. And rarely the pelvic bone will be injured at the pubic symphysis resulting in osteitis pubis.

Sports Hernias can occur in all levels of Athletes from the weekend warrior to the professional Athlete. Sports that involve making extreme and repeated twisting-and-turning movements are most susceptible to the injury. 

Many doctors in the United States do not believe that a Sports Hernia is a real injury. Most insurance companies use that fact to deny payment for Sports Hernia surgery. Recently the English Hernia Society published a consensus statement based on the testimony of the experts stating that a Sports Hernia is a real injury. And that with appropriate treatment, the Athlete can return to his/her sport. 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.