Sports Hernias: What Are They?

Despite its name, a sports hernia is actually not a hernia at all. The definition of a hernia pertains to the protrusion of an internal organ through the structures that contain it. True hernias are often found in regions where the organ isn’t contained by bone and where weakened or torn musculature exists. True hernias can be felt, or palpated, and this protrusion is visible to the naked eye.

So, Then, What Is a Sports Hernia?

In a sports hernia, there is no protrusion of internal organ, meaning it cannot be felt or seen. Instead it is caused by tears in tendons or muscles that attach to the pelvis and/or the femur. By definition, the term “sports hernia” is considered a misnomer. A more appropriate name for this condition is “athletic pubalgia,” so we’ll use that term here.

How Does It Occur?

There are many ways you can sustain athletic pubalgia, but most come down to overuse of smaller muscles or using muscles for a job they aren’t meant for. For example, the most commonly injured muscle is the external oblique, and it is often disrupted where the muscle attaches to the aponeurosis, which is a layer of flat, broad tendons that attach the muscle to the bones – in this case, the external oblique to the pelvis. Aponeuroses are found all over the body but are most common in the abdomen.

Who Gets Athletic Pubalgia?

Although athletic pubalgia can occur in any one, it is most commonly seen in athletes due to the repetitive nature of their movements. It is especially common in sports that consist of repetitive twisting (like in soccer), suddenly changing directions (football), pushing off (hockey), and prolonged turning (track). It rarely occurs suddenly, but likely has been building for a period of time. Similarly, the pain seems to creep in until it reaches the point where it prevents someone from doing normal activities.

Do I Have Athletic Pubalgia?

If you suspect that you may be experiencing athletic pubalgia, schedule an appointment with your doctor and, if you have direct access, schedule an appointment with a physical therapist. It can be difficult to diagnose and may require surgery to do so, but a quick checklist that you and your physical therapist can use may help to rule in or rule out the condition. The criteria for athletic pubalgia include:

  • Deep groin and/or abdominal pain
  • Pain that goes away with rest
  • Increase in pain when the area is touched or pushed
  • Increase in pain when pulling the leg into resistance, sudden change in direction, twisting, kicking, accelerating, or decelerating
  • Increase in pain when performing sit-ups, especially slowly
  • Pain that is on one side of the pelvis
  • Increase in pain with coughing or sneezing
  • Increase in pain when sitting for too long

*If you have any of these symptoms, it is important to contact your doctor for an evaluation.

How Is It Diagnosed?

Athletic pubalgia is difficult to properly diagnosis and, therefore, treat effectively. It can be truly diagnosed only through a minimally invasive surgery. The surgeon investigates the problem area with a camera (endoscope), and if they find it is a muscular and/or tendinous tear that is causing the discomfort, they will often perform laparoscopic surgery using the same small incision(s) to reattach the structures or repair and reinforce them with mesh lining.

Do I Need Surgery?

First, it’s worth mentioning that not all cases of athletic pubalgia need to be treated with surgery. Oftentimes, it is possible to manage this injury with conservative treatment. However, it should be noted that conservative treatment usually requires a slow recovery and leaves a higher chance for reinjury compared to surgery.

Prior to the investigative surgery, a person often goes through a trial of conservative care. Conservative care can include imaging, resting, icing, anti-inflammatory medications or injections, and physical therapy. In physical therapy, the main objective is to rule in or rule out other diagnoses through testing, assessing a patient’s signs and symptoms, controlling pain, and addressing deficits found at the patient’s initial evaluation.

Takeaway Points.

Sports hernias are not true hernias by definition and for accuracy should be referred to as athletic pubalgia. Oftentimes, athletic pubalgia is treated conservatively and is suspected when other diagnoses and treatments have been excluded. The purpose of imaging and visiting your physical therapist prior to surgery is to rule out other, more common injuries. If conservative care doesn’t seem to be effective, it is best to discuss concerns with your physical therapist and schedule an appointment with a surgeon. From here they can best confirm the presence or absence of athletic pubalgia through a minimally invasive procedure, but you can decide if surgery is right for you.

Physical therapy is very beneficial for identifying and addressing muscle imbalances and movement patterns, which can very likely lead to the soft tissue injury. Your physical therapist should tailor your treatment so you smoothly transition back into your recreational activities, sports, and/or job without pain.

Further Reading:

  1. A. F. Kachingwe and S. Grech. “Proposed Algorithm for the Management of Athletes with Athletic Pubalgia (Sports Hernia): A Case Series.” Journal of Orthopaedic & Sports Physical Therapy 38, no. 12 (2008): 768–781.
  2. C. A. Unverzaqt, T. Schuemann, and J. Mathisen. “Differential Diagnosis of a Sports Hernia in a High School Athlete.” Journal of Orthopaedic & Sports Physical Therapy 38, no. 2 (2008): 63–70.
  3. C. M. Larson. “Sports Hernia/Athletic Pubalgia: Evaluation and Management.” Sports Health 6, no. 2 (2014): 139–144.