Sports hernias are injuries that occur in the pelvic region. The term sports hernia is somewhat misleading, as sports hernias are not technically hernias. The technical name for a sports hernia is athletic pubalgia.
Unlike a regular hernia, which occurs when an internal organ protrudes through the muscle tissue that contains it, sports hernias happen when the muscles or tendons attached to the pelvis are strained or torn. Although entirely different, the pain from a sports hernia is similar to that of a regular hernia.
As the name suggests, sports hernias are a result of overexertion during physical activity. Sports hernias commonly occur during vigorous sports that require twisting the upper body while keeping the feet planted, such as gymnastics, hockey, and tennis. Sports hernias are most common in athletes but can occur outside of physical activity.
Common causes of sports hernias include:
- Repetitive explosive motions. Athletes who play football, soccer, rugby, and hockey are at risk for sports hernias.
- Explosive twisting motions
- Activities that involve vigorous running and jumping, such as sprinting or hurdles
- Playing a high-level or professional sport. High-level athletes are at increased risk of sports hernias as their training is more rigorous and more frequent.
- Weak core muscles. Athletes who have core muscles weaker than their thigh muscles are believed to be at risk for sports hernias.
In some cases, sports hernias have no apparent cause and develop slowly over time. Sports hernias that develop gradually may be related to an underlying issue such as pelvic floor disorders.
People with pelvic floor disorders have pelvic muscles that are either too tight or too weak. Symptoms of a pelvic floor disorder include chronic groin pain, incontinence, constipation, and nocturia. Pelvic floor physiotherapy can help alleviate symptoms of a tight or weakened pelvic floor.
Symptoms of sports hernias can include any of the following:
- Sudden and severe groin pain directly following the injury
- Groin pain that subsides while resting but returns during activity
- Groin pain on one side of the pelvis rather than both sides
- Pain during twisting motions
- Pain during actions that may cause the abdominal muscles to seize, such as sit-ups or coughing
- Bruising, swelling, and tenderness in the pelvic region and lower abdomen
- Chronic pain that limits the ability to play sports
One or all of the above symptoms may be present after a sports hernia injury. Athletes can experience very few symptoms but still have a sports hernia that requires treatment.
A sports hernia’s symptoms are similar to those of many other groin injuries, so diagnosis can be tricky.
If you believe you have a sports hernia, consult a physiotherapist. A registered physiotherapist can conduct a series of tests to check for weakness and hip flexion resistance in the area. In most cases, there is a clear link between groin pain and an injury that occurred during physical activity. However, your physiotherapist may refer you to a doctor for diagnostic imaging.
If the cause of the groin pain is unclear, a doctor may order an X-ray, ultrasound, CT scan, or MRI to help determine whether a sports hernia is likely. MRIs are particularly effective at identifying muscle, tendon, and soft tissue tearing.
Depending on the severity of the injury, sports hernias can be treated with surgery or physiotherapy and rest.
Non-surgical Sports Hernia Treatment
If your symptoms are mild to moderate, your physical therapist or doctor will likely recommend resting and avoiding physical activity until the injury has healed. Anti-inflammatory therapies such as medications and icing the area can help ease pain from a minor sports hernia.
Your physiotherapist will likely prescribe a set of stretches and exercises to help you increase strength and flexibility in the pelvic muscles. Exercises might include lunges, hip extensions, and sitting groin stretches.
Surgical Sports Hernia Treatment
If rest and physiotherapy do not improve your symptoms or muscle tearing is severe, you may require surgery. Sports hernia surgeries can be performed with a single long incision or as an endoscopic procedure.
During an endoscopy, the surgeon makes several small incisions and then inserts an endoscope camera inside. The surgeon will then repair torn tendons using sutures, glue, synthetic mesh, or other techniques.
Risks and Complications
Naturally, athletes are at increased risk for sports hernias. Rugby, basketball, hockey, football, and tennis players are all at risk. Wrestlers, gymnasts, and runners are also at risk.
Men are at higher risk for sports hernias. The condition is considered rare among female athletes.
Complications from sports hernias are rare. However, sports hernias can lead to chronic pain if left untreated.