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ByTad Leusch MS ATC
Sports hernias are different from other hernias in that they are not easily identified by an exam or imaging technology. They may only show up as groin pain that occurs during physical activity and disappears during inactivity. A tear in the Transversus abdominis is responsible for this hernia.
A sports hernia typically begins with a slow onset of aching pain in the lower abdominal region. Symptoms may include: Pain in the lower abdomen Pain in the groin Pain in the testicle
Typically the symptoms are exacerbated with Running Cutting Bending forward
Sports hernias are found in many types of athletes most commonly Hockey players Football players Soccer players
There are no diagnostic tests that can be used to detect a sports hernia. The diagnosis is made by the patient's history and physical examination. Other tests may be performed to rule out other causes of groin pain.
Conservative Treatment Ice Rest Anti-inflammatory medications Physical Therapy
Surgery Involves a patch of mesh-like material, held in
place with surgical tacks. Rehabilitation from surgery for a sports hernia
usually takes about eight weeks.
Male 21 year old D1 College football player Position: Cornerback Demands of position: Linear running to
explosive change of direction movements, backpedaling and opening of hips to change direction
Symptoms began approximately 1 year prior to August 2008 surgery date
Reported to the athletic training room following practice
Stated he felt a pop in his right groin during practice
No bulge was noted No bruising was noted Strength was 4/5 ROM was equal compared bilaterally
Athlete was allowed to return to play and continue normal weight training schedule
During this time he was receiving treatment for his pain which included: Heat Modalities (estim and ultrasound) Stretching of the groin, hip flexor, abdominals, piriformis Soft tissue release techniques including:
Foam rolling of leg and pelvic girdle Softball rolling over involved side hip flexor and groin and well
as piriformis Strengthening exercises such as:
4 way hip movements(adduction, abduction, flexion and extension)
Seated internal and external hip rotation with theraband Ball squeezes with leg lifts Swiss ball core strengthening exercises
With conservative management, athlete was able to participate in all activities but felt limited due to pain
During the 4 week winter break period, athlete was instructed to go home and rest
If he felt his pain decrease, he was instructed to begin straight ahead jogging in order to maintain a level of fitness
When athlete return to campus, he stated that he was almost pain free
A slow return to play progression was initiated which included: Progression of linear running which went well Progression of explosive cutting drill during which
pain returned which halted progression Athlete was re-examined in March at which
time an MRI was obtained No hip pathology noted Received a cortical steroid injection at the
pubis symphysis which provide some relief
With the relief of pain following injection, running progression was initiated again
Athlete was able to achieve about 75-80 percent of speed before pain returned
Even with a significant amount of rest, anytime athlete would state his symptoms were decreasing and activity was ramped up, pain would return
This patterned continue on through the summer until athlete was unable to participate in any of the team workouts
After approximately 1 year of conservative treatment, athlete was not able to fully engage in all activities
Pain became localized in the right groin area Pain with squatting Pain in lower abdominal area with core
strengthening Pain with explosive change of direction
movements Athlete was re-examined by the team
physician and it was determined that he needed to be referred to Dr. Brad Pierce, a recognized surgeon that deals with sports hernias
Research in this area is sparse Protocol is very open Generally speaking return to full activity
is projected at 6 weeks Typically we have been able to progress
athletes back to full activity by 10-12 weeks
Straight line physical activity only for first 3 weeks
Start out with low impact exercises By week 3 athlete should be back to
jogging and running Re-introduction of sporting activities
between week 4 and 6 Continue core strengthening and
flexibility treatments
Athlete was seen approximately 3 days following surgery
Athlete was in noticeable pain upon entering the athletic training room
Walked with a slightly forward hunch due to pain
Initial treatment consisted of ice to control pain
After approximately 10 days following surgery, athlete was able to walk with normal gait and mild pain
Week 2 athlete was able to walk on treadmill for 10 minutes
Exercises consisted of: Isometric core strengthening Gentle abdominal stretching
Ice following rehabilitation session Week 3 Pace was increased on treadmill but still at a walking
pace Progression of core strengthening Body weight movement such as
Lunges Side lunges
At week 4 athlete began to notice an increase in pain Activity level was decreased until pain subsided:
approximately 2 weeks
After pain subsided, athlete resumed progression of exercises
Core strengthening and machine upper body exercises which did not create a valsalva maneuver
Body weight movements progressed into movements with weight Lunges Squats Side lunges
After approximately 4 weeks, athlete was able to transition to weight room activities
At week 8 athlete began running progression Week 8 linear progression
55 yard running (jogging to running) Cross Field’s Build ups
Week 9 Add in slow tempo change of direction Box drill 90 degree cutting drills X pattern drills
Week 10 Weeks 10 was a progression of tempo during
linear and change of direction exercises Begin to incorporate position specific drills
Week 11 Continue drills from week 10 Add reactionary change of direction
movements Week 12, athlete was given a recovery
week
At week 13, athlete was allowed to progress into football practice activities Individual drills for first 2 practices Individual drills and 7on7 Individual drills, 7on7, and 1on1 No limitations by the middle of the 16th week
Increase in pain during week 4 Demands of the sport Mentality of the athlete As a Sports Medicine Staff we try to
account for Amount of whole body de-conditioning an
athlete may have Make sure that the athlete can tolerate activity
level Make sure not to rush return which may lead to
other injuries