Feature Story
The Hockey Doc on groin strains and sports
hernias
Question: I have had a nagging groin strain over the
last 6 weeks of the season. What can I do to try to rehabilitate this to get
ready for next year?
Answer: What you are
describing is a common history for someone who may have a “sports hernia.” Most
true adductor strains, commonly called groin strains, resolve within a couple
of weeks of injury. True adductor strains most commonly occur at the junction
between the muscle and the tendon and resolve with rest, icing, stretching, and
hip adductor exercises.
Almost by definition, groin strains which
linger more then a few weeks are commonly sports hernias. While sports hernias
have probably been around for a long time, it is only more recently that we
have begun to recognize them.
Sports hernias are not like inguinal
hernias, where some of the intestines may slip into the inguinal ring, but
rather injuries to the small and thin abdominal wall muscles which attach
around the inguinal ring. Because they have only become recognized in the
sports community in over the last 5-10 years, it is not uncommon for an athlete
to see several physicians before their true pathology is identified.
The most common complaint of athletes
with sports hernias is that they cannot transition for on-ice activities and
have difficulty twisting or turning on the affected side. On exam, almost
everyone will have pain to palpation of the inguinal ring region, but they also
have pain with performing an abdominal crunch or with performing a resisted one
legged straight leg raise. In fact, it is felt that the most common physical
exam finding in patients with a sports hernia is that they have difficulty
performing abdominal crunches without pain.
Unfortunately, since sports hernias
involve a tear of the abdominal wall muscles, the only effective treatment is
either to stop participating in those activities which cause the irritation or
to look at surgery. Surgery is almost always performed by a general surgeon who
specializes in this area.
The surgery involves reattaching the
abdominal muscles and placing in a mesh to reinforce the muscles to minimize
the chance of tearing again. Depending upon the surgeon, their experience, and
their protocol, most athletes can return to on-ice activities within 2-4 weeks
after sports hernia surgery.
When one does have lingering groin pain,
it is important to see a physician to make sure that the proper diagnosis is
obtained. There can be many different causes of groin pain in athletes to
include stress fractures, infections, cancer, nerve entrapments, and other
causes. Therefore, any lingering “groin strains” should be carefully evaluated.
In summary, “sports hernias” are not true
hernias but are actually abdominal muscle wall tears. When one has a groin
strain which lingers, a careful evaluation should be performed to determine the
cause and proper treatment for it.
Dr. Rob LaPrade,
MD, PhD, is the team physician for the