The 'Sports Hernia': A Cause of Groin Pain

Athletes who participate in sports that require repetitive twisting and turning at speed, such as soccer or ice hockey, may be at risk of developing a 'sports hernia'—disruption of the inguinal canal without a clinically detectable hernia. Insidious onset of unilateral groin pain is the most common symptom. Concurrent pathologies, such as osteitis pubis and adductor tenoperiostitis, may complicate diagnosis. Plain radiographs and a bone scan can aid differential diagnosis, but herniography is not recommended. Surgery is the preferred treatment. Structured rehabilitation should enable athletes to return to sports activity 6 to 8 weeks after surgery.

Clinical Findings in Patients Who Have a 'Sports Hernia'

Pain Characteristics

Typically insidious onset Usually localized to the conjoined tendon and inguinal canal May radiate to the adductor region and testicles Aggravated by sudden movements May be exacerbated by coughing or sneezing Resistant to conservative treatment

Physical Exam Findings

Dilated superficial inguinal ring Local tenderness over the conjoined tendon and inguinal canal Tenderness exacerbated by resisted sit-up Signs may be similar to those of osteitis pubis and adductor tendonopathy

The pain is most often unilateral but may be felt bilaterally. It is common for athletes to describe symptoms, unresponsive to conservative treatment, that have been present for a number of months (9). The pain increases with sudden movements, acceleration, twisting and turning, cutting, and kicking, and it may be provoked by lesions, symphyseal instability (demonstrated by flamingo views), hip osteoarthritis, and bone tumors. A bone scan can be helpful in making a diagnosis of active osteitis pubis, tenoperiosteal lesions, and stress fractures.

Targeted Rehabilitation

Specific rehabilitation that avoids sudden, sharp movements should enable athletes to return to sports participation within 6 to 8 weeks of surgery. All aspects of pelvic flexibility, strength, and stability should be addressed throughout this period. Athletes should begin isometric abdominal and adductor exercises on the first day after surgery, increasing the number of sets and repetitions during the first week and then progressing to a concentric and eccentric strengthening program. They should begin walking during the first week after surgery and progress to jogging by day 10. Straight-line sprinting is encouraged from day 21, and the subsequent introduction of sport-specific exercises should enable a full return to sport after 6 to 8 weeks of rehabilitation. Overlapping conditions should also be addressed, and coexisting osteitis pubis or adductor tendonopathy may indicate a more gradual return to athletic activity

Prevention Tactics

Since preventing this condition is easier than treating it, prevention should be considered for those who are at risk, especially those whose sports involve repetitive twisting and turning movements at speed.

Particular attention should be paid to the strength and flexibility of the hip flexors, abductors, adductors, abdominals, and pelvic stabilizing muscles. Functional, controlled closed-chain strengthening and improvement of pelvis stability should also be emphasized. These exercises can be structured by your physiotherapist.