Sports Hernia Symptoms and Treatment

A sports hernia, medically known as athletic pubalgia, is a soft tissue injury resulting in the strain or tear of the muscles, tendons, or ligaments of the groin area in athletes. Sudden changes in direction, twisting, and other repetitive explosive movements during sports can lead to a sports hernia..

A sports hernia is not a true hernia in the sense that there is no protrusion or "outpouching" of soft tissue. Groin pain is a common symptom of a sports hernia, but it is important to rule out other possible causes of groin pain, such as muscle injury, cartilage damage, nerve problems, or urologic conditions.

What Causes Sports Hernias?

Overuse and repetitive explosive movements are the most common mechanism of injury regarding sports hernias. A muscular imbalance between the abdominal and thigh muscles, which both attach to the pubis, may make an athlete more prone to a sports hernia injury. The obliques and adductors are the most commonly strained muscles that cause athletic pubalgia.

While they happen in the same part of the body, sports hernias are not the same as inguinal hernias. 

The inguinal canal is the part of your lower abdomen just above your groin. If these muscles are weak or overused they are prone to tearing. If a hernia happens, tissue (like your intestines) bulges through an opening in the wall. 

While they both have "hernia" in the name, inguinal hernias and sports hernias are different injuries:

• Inguinal hernia: Abdominal tissue pushes through an opening in the lower abdominal wall causing a palpable, painful bulge.
  
• Sports hernia: Painful strain or tear of soft tissue in the lower abdominal region causing groin pain, but no bulge.

While a sports hernia is not an inguinal hernia, it can lead to one. Weak muscles in the lower abdomen can, over time, create the right conditions for an inguinal hernia to form. 

Symptoms of a Sports Hernia

You may feel severe pain at the moment that you get hurt, but sometimes, the pain from a sports hernia comes on gradually. You might have a hard time telling exactly where the pain is in your lower abdomen, but it’s often just on one side. 

Other symptoms of a sports hernia include:

• Pain in the groin
• Pain in the testicles
• Pain that gets worse with activity (e.g., running, bending, sitting up, sneezing, or coughing)
• Pain that gets better with rest
• A dull, burning sensation

How Sports Hernias Are Diagnosed

To diagnose a sports hernia, your provider will ask you about your symptoms, your activities, and your medical history. They will also do a physical examination and diagnostic tests.

One common imaging modality utilized to diagnose soft tissue injuries or tears, including hernias, is magnetic resonance imaging (MRI). Along with X-rays and dynamic ultrasound, MRIs can also be used to rule out other causes of groin pain.

There are other causes of groin pain in athletes, many of which are more common than a sports hernia. For example: 

• Adductor muscle strains
• Hip labral tears
• Osteitis pubis
• Stress fractures in the pelvis
  

How Sports Hernias Are Treated

Unlike a strain, a sports hernia will not get better on its own. Nonsurgical treatment is the preferred method of care for sports hernia injuries. Treatments will typically look like the following:

• Rest and ice for the first seven to 10 days after the injury
• Physical therapy (for four to six weeks) after two weeks to stabilize the pelvis, activate the core, and improve strength and mobility in the inner thigh and abdominal muscles.
• Anti-inflammatory medications such as Advil (ibuprofen) or Aleve (naproxen) may help reduce pain and swelling. 

If conservative treatments are unsuccessful or the athlete has pain after returning to their sport, surgical intervention may be necessary to address tears in the soft tissues.

Between 65% and 90% of athletes can return to play after surgery for a sports hernia. Rehabilitation from surgery for a sports hernia usually takes between six to twelve weeks.

A Can Sports Hernias Be Prevented?

You can’t always prevent a sports injury, including a hernia. There are, however, steps you can take to play your sport safely and reduce your chances of getting a hernia.

For example:

• Do exercises to keep your core muscles strong
• Do hip strengthening exercises
• Work on improving your flexibility 
• Make sure you’re using proper form when participating in your sport
• Always warm up before you start playing 
• Go slow and work your way up to more intense activity when you’re starting something new
• Maintain your overall health and wellness by eating a balanced diet, staying hydrated, managing your weight, and getting enough sleep

Summary

Core and pelvic stability are key to preventing muscular imbalances which could make an athlete more prone to a sports hernia type injury, which is a strain or tear of the muscles that attach to the pubis or groin area.

If you are experiencing groin pain due to a sports hernia, better known as athletic pubalgia, your healthcare provider will typically prescribe rest, ice, anti-inflammatory medication, and a course of physical therapy. If symptoms persist or a tear is identified via imaging, surgical intervention may be necessary.