Core muscle surgery treats chronic groin and abdominal pain, commonly known as a “sports hernia.” The medical term for this injury is athletic pubalgia, which reflects the complex nature of the ailment affecting the soft tissues of the lower abdominal wall and groin. The surgery’s primary goal is to repair tears or weaknesses in the muscles and tendons attached to the pubic bone, providing stability to the pelvic region and alleviating persistent pain. Surgery is typically considered when conservative treatments, such as physical therapy and rest, have failed to resolve symptoms after several weeks.
What Core Muscle Surgery Addresses
Core muscle surgery directly addresses athletic pubalgia, a condition involving injury to the musculature surrounding the pubic bone and pelvis. The term “sports hernia” is misleading because the injury is not a true hernia, which involves an organ protruding through a defect, but rather a soft tissue strain or tear. The pain originates from a mechanical imbalance and injury to the deep layers of the abdominal wall and the tendons that insert into the pelvis.
The pathology frequently includes tears or weakening of the transversalis fascia (a deep layer of the abdominal wall) and the oblique muscles where they attach to the pubic bone. This instability is often compounded by issues with the adductor tendons, the muscles on the inner thigh that also connect to the pubic bone. Repetitive, high-force movements common in sports like hockey, soccer, and football create a shearing stress that pulls these structures apart.
Patients typically experience chronic pain localized to the lower abdomen and groin, which can sometimes radiate down into the inner thigh or scrotum. This discomfort is exacerbated by activities that involve twisting, sprinting, or sudden changes in direction. Unlike a traditional inguinal hernia, a visible bulge is usually absent, though the pain can be sharp and worsen with actions that increase intra-abdominal pressure, such as coughing or sneezing.
The Surgical Procedure
The objective of core muscle surgery is to reinforce the damaged soft tissues to re-establish the structural integrity of the lower abdominal wall and pelvis. Surgeons typically choose between two main approaches: open repair or minimally invasive (laparoscopic) repair, with the choice depending on the extent of the injury and the surgeon’s expertise.
Open Repair
The open approach involves a single incision, generally in the groin area, which provides the surgeon with direct visibility and access to the damaged anatomy. This method allows for a tension-free repair, often using sutures to reinforce the posterior wall of the inguinal canal and reattach torn muscle fibers to the pubic bone.
Laparoscopic Repair
The minimally invasive technique uses several small incisions through which a camera and specialized instruments are inserted to perform the repair. This laparoscopic approach allows the surgeon to work from the back of the abdominal wall, often placing a synthetic mesh to reinforce the weakened area, similar to a traditional hernia repair. The mesh strengthens the deep layer of the abdominal wall to prevent further tearing and stabilize the area. Both open and laparoscopic repairs focus on stabilizing the pubic joint by broadening or tightening the attachments of the muscles and tendons.
Beyond the abdominal wall repair, the procedure may also address concurrent issues, particularly those involving the inner thigh muscles. If significant adductor tendon pathology exists, a simultaneous adductor tenotomy may be performed. This involves surgically cutting or lengthening the adductor longus tendon near its attachment to the pubic bone to release tension, which helps to alleviate persistent inner thigh pain. Furthermore, in cases where nerve compression is a source of chronic pain, the surgeon may perform a neurectomy, involving cutting a small, problematic nerve, such as the ilioinguinal nerve, to relieve the patient’s symptoms.
Recovery and Rehabilitation
Recovery from core muscle surgery begins immediately after the operation, focusing on managing pain and encouraging early, controlled movement. Patients are typically encouraged to walk within a day of the procedure, which helps to promote circulation and prevent deep vein thrombosis. Initial post-operative expectations include soreness and limited mobility, which are managed with pain medication and ice.
The rehabilitation process is structured and progresses through several phases to ensure complete healing and a safe return to activity.
Phase One: Immediate Post-Operative
Phase one, in the immediate post-operative week, focuses on gentle range-of-motion exercises for the hip and pelvis, along with light walking. The patient is instructed to avoid activities that significantly increase intra-abdominal pressure, such as heavy lifting or strenuous coughing.
Phase Two: Restoring Strength
As healing progresses, typically around two to three weeks post-surgery, the patient transitions to phase two, which introduces more intensive physical therapy. This phase focuses on restoring normal muscle length and beginning light core stabilization and strengthening exercises. The exercises progress from basic gluteal and quad sets to more functional movements like squats and step-ups, gradually increasing the load on the repaired tissues.
Return to Sport
For athletes, the recovery timeline is more aggressive and culminates in a final phase of sport-specific training. While non-athletes may return to normal daily activities within a few weeks, athletes often require a structured return-to-play protocol that can span anywhere from six to twelve weeks. This final phase incorporates advanced strengthening, eccentric exercises, and drills that simulate the twisting, cutting, and explosive movements required in their sport, ensuring the repaired soft tissues can withstand high-level strain before the athlete is medically cleared.