Sports Hernia: Systematic Review – provided by ResearchReviewService.comI would like to thank Dr. Andreo Spina for posting this article about sports hernias and Dr. Thistle from RRS for his ongoing work in the research department.
The incidence of groin pain among professional athletes overall is estimated to be 0.5-6.2%. Due to the nature of their sports, soccer and hockey players injure this area at a higher rate. To illustrate, injury data from the National Hockey League indicates that 13-20 groin injuries occur each year per 100 players(1) – this represents a significant problem. At any given time, most NHL fans could name 2-3 top players that are out of action because of a “groin injury”.
Injuries to this area can be anatomically complex, and difficult to diagnose and treat. They can also be chronically disabling for the athlete, and pose a significant threat to lucrative sporting careers.
The term “sports hernia” has recently been popularized in the media, despite the poorly defined nature of this injury. The anatomical culprits and general terminology used to define this injury varies widely. Some experts believe this is the most common cause of groin pain in athletes, while others consider it very rare.
This review paper attempted to clarify this oft-confusing injury by summarizing the existing literature on the pathogenesis, differential diagnosis,conservative treatment, and post-surgical rehabilitation of sports hernias.
Pertinent Clinical Details
The actual definition of a sports hernia remains controversial. Many sources define it as a bulge or incipient posterior inguinal wall hernia that leads to lower abdominal or groin pain and loss of inguinal canal integrity, without the presence of a true hernia. Additional descriptions have included abnormalities of the rectus abdominus (RA), partial avulsion of the internal oblique (IO) muscle from the pubic tubercle, tearing within the IO itself, and abnormality of the external oblique (EO) muscle and aponeurosis. All of these problems could weaken the inguinal wall or ring. The authors of this review suggest that the most succinct definition may be: “…the phenomena of chronic activity-related groin pain that is unresponsive to conservative therapy and significantly improves after surgical repair.” [pg. 954]
In general, the etiology of chronic groin pain normally falls into one of 4 categories:
Before arriving at a diagnosis of sports hernia, the prudent clinician must investigate thoroughly for the following conditions:
The following elements are reported to be consistently found in patients with “sports hernias”:
Although the success rate of conservative treatment for sports hernias is considered to be low, manual therapists in all disciplines can play an important role in the identification, treatment, rehabilitation, and prevention of this injury. Specific methods of treating this injury using manual methods have not been sufficiently studied to make concrete recommendations. There are however, some practical principles that can be applied to this patient population:
Week 2: active hip exercises, stationary cycling and basic TrA core stability
Week 3: flexibility work, resistance band/tubing hip exercises, active core work, jogging and swimming
Week 4: forward running, progressive resistance core work, light upper body exercise
Week 5: sprinting, multi-directional running, ball skills, kicking, continue core progression, gradual return to sport
Week 6: unrestricted exercise and return to sport
Off-Season Training Implications