Have you ever been playing a sport and felt like you “pulled your groin”? There’s a good chance you may have done more than just pull a muscle, you could have potentially torn a muscle causing a herniation. A hernia is a soft tissue injury that occurs in the groin/lower abdominal area, usually caused by a weakness in the muscle or fascia. When this weakness is combined with hard exertion or a strong contraction (think of a fast twisting motion, or a quick change in direction), a tear in the muscle may occur.
An inguinal hernia is the most common type, with over 96% of all hernias being of this nature. You will normally see a bulge in the groin area and it may or not be painful. The bulge is typically caused by a protrusion of the small intestine or lining of the abdominal cavity through the lower abdominal muscles. This occurs due to a tear in the outermost abdominal muscles. Males are more susceptible to an inguinal hernia due to the fact that the testes descend through this region, thus causing weakness if the area does not “close” properly after birth. Women have a series of ligaments in the inguinal canal to help hold the uterus in place, effectively strengthening this area. Generally speaking, inguinal hernias are not overly dangerous and can be managed with some lifestyle changes. Surgical intervention is the only option to truly fix this condition, but often times, people manage their pain and symptoms proficiently enough to avoid surgery. That said, if the area becomes increasingly painful or the bulge worsens, you should speak with your physician immediately, as an occlusion of an underlying structure may be occurring, which could become a medical emergency.
Sports hernias, on the other hand, still aren’t fully understood by many and often go undiagnosed. A sports hernia typically occurs with repeated, high intensity, twisting motions like those seen frequently in hockey, soccer, and tennis. Sports hernias do not involve a complete tear in the abdominal wall, thus there won’t be any visible bulges to help diagnose the hernia. They are normally painful during physical activity, especially as intensity increases. Most people do fine as long as their intensity stays at 75-80% of their max, but as they increase their intensity, pain worsens. The area become less painful when at rest and within a few days will usually be pain free. It’s this reason that it is often mistaken for a “groin strain”. It is not uncommon to be seen by a doctor several times before you are diagnosed with a “sports hernia”.
Initial treatment for a sports hernia is typically rest. After about 2 weeks, or when the patient is pain-free, it is common to begin physical therapy to strengthen the abdominal muscle focusing on the “core” muscles. For most recreational athletes this will work to prevent re-occurrence. If surgery is necessary for a sports hernia, the surgeon can either do an open or endoscopic surgery. An open surgery is exactly as it sounds, with the surgeon making a long incision and opening up the patient to repair the damage. An endoscopic surgery will consist of a very small incision so the surgeon can insert a small camera and repair the damage leaving a much smaller scar. In both surgeries, a mesh screen is placed over the weakened area and sutured in to place. After surgery, more than 90% of athletes are able to return to play with no complications within a few weeks (approx. 3-6 weeks).
In cases where there is still pain after a surgery, another procedure may be tried. This surgery is called an adductor tenotomy, in which an incision is made through the tendon that attaches the adductors to the pubis. Often times this will help release pain for the athlete and help increase their range of motion.
Below are some resources that may benefit you if you are currently experiencing pain in your abdominal wall. Most importantly, this article is intended to be used for education, not diagnosing a medical condition. Please see your healthcare provider for any pain that does not resolve on its own in a relatively short time period.