A sports hernia, medically known as Athletic Pubalgia, is a soft tissue injury of the lower abdomen and groin area. This condition is a common cause of chronic groin pain in athletes who participate in sports requiring repetitive, forceful twisting and turning movements, such as hockey, soccer, and football. Despite its misleading name, a sports hernia is not a typical abdominal hernia where an organ protrudes through a visible bulge. Instead, it involves a strain or tear in the muscles, tendons, or ligaments that attach to the pubic bone, particularly the tendons of the oblique muscles or the adductor muscles of the thigh. Healing this injury requires a structured and progressive approach, moving through conservative or surgical treatment pathways to a full return to physical activity.
Understanding the Injury and Diagnosis
Athletic Pubalgia presents as chronic, deep pain located in the groin or lower abdominal area. This discomfort is typically exacerbated by movements that involve straining the core, such as sprinting, kicking, twisting, or performing a sit-up. The pain often radiates downward, sometimes extending to the inner thigh or testicles. Because symptoms can mimic those of a simple groin strain or hip issue, diagnosis requires a careful process of elimination.
The diagnostic process begins with a thorough physical examination to rule out a traditional hernia, which involves feeling the area for a bulge. Specific actions, like a resisted sit-up or forceful coughing, are used to reproduce the pain and identify the tissues involved. Imaging, notably Magnetic Resonance Imaging (MRI), is utilized to confirm the diagnosis by visualizing tears in the soft tissues, such as the abdominal wall or adductor tendons. Ultrasound and CT scans may also be used to exclude other potential causes of groin pain.
Non-Surgical Treatment Pathways
The initial approach to healing a sports hernia is non-surgical, focusing on conservative management, which is successful for many patients. This pathway begins with a period of rest, requiring the athlete to avoid strenuous activities for four to six weeks. During the acute phase, applying ice and taking non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen helps manage pain and reduce inflammation.
Physical therapy (PT) is the core component of non-surgical treatment, usually beginning after the initial acute pain subsides. The primary goals of PT are to restore flexibility, correct muscular imbalances, and strengthen the core and hip musculature. The rehabilitation program emphasizes strengthening the lower abdominal muscles and the adductor muscles of the inner thigh to improve pelvic stability. A structured PT program lasting six to eight weeks can often resolve symptoms.
For pain unresponsive to initial rest and physical therapy, a physician may recommend a corticosteroid injection. These injections deliver anti-inflammatory medication directly to the injury site, such as the pubic symphysis or the origin of the adductor tendon. The injection can provide substantial pain relief, creating a therapeutic window that allows the athlete to participate more fully in their physical therapy program.
Surgical Repair Options
When conservative treatments fail to provide lasting relief after six to eight weeks, surgery becomes the recommended course of action. The goal of surgery is to repair the damaged soft tissues and reinforce the weakened posterior wall of the inguinal canal. There are two main surgical techniques: the open approach and the laparoscopic approach.
The open repair involves a single incision for direct access to the damaged tissue. During this procedure, the torn tendons and muscles are sutured, and a synthetic mesh may be used to reinforce the abdominal wall. The laparoscopic repair is a minimally invasive option that uses several small incisions, through which a camera and specialized instruments are inserted. Both techniques aim to stabilize the pubic bone region.
In cases where significant inner thigh pain persists, a secondary procedure called an adductor tenotomy may be performed. This involves surgically cutting the tendon that attaches the inner thigh muscles to the pubic bone, allowing the tendon to heal at a greater length. This lengthening procedure releases tension in the adductor complex. A surgeon may also address nerve irritation by performing a neurectomy, or nerve cutting, to alleviate chronic pain caused by an entrapped inguinal nerve.
Rehabilitation and Return to Sport
Rehabilitation is a necessary phase of healing, regardless of whether the initial treatment was non-surgical or surgical. The process is structured and progressive, designed to guide the athlete back to pre-injury performance levels. Following surgical repair, the initial phase focuses on immediate post-operative care, including gentle mobilization like walking and managing pain, usually lasting for the first two weeks.
The subsequent phases involve a gradual increase in activity, beginning with light core activation and gentle stretching to restore range of motion. As healing progresses, the focus shifts to more dynamic exercises, incorporating stability training and strengthening of the gluteal and hip rotator muscles. Athletes then move into sport-specific movements, which include cardiovascular conditioning, plyometrics, and resisted strengthening.
The timeline for a full return to sport is variable but typically ranges from six to twelve weeks after surgery, with non-surgical recovery often taking a similar duration. The physical therapist plays a role in setting these timelines, using functional milestones rather than fixed dates. Full-intensity competition is only permitted after the athlete can perform all sport-specific drills, such as sprinting and cutting, without any pain or compensation.