Definition
A Sportsman’s hernia is a condition characterised by chronic groin pain usually as a result of physical activity and can be regarded as a repetitive strain injury in the groin. There is no definable hernia identified with a rupture of muscles or tendons in the inguinal canal often attributed to the cause of the condition. Many professional footballers have had surgery for this condition.
Other common definitions include:
- Athletic pubalgia
- Incipient hernia
- Pubic inguinal pain syndrome
- Pubic Symphysitis
- Inguinal Disruption
Where is the pain felt?
The diagnosis is made clinically if at least three out the five signs below exist:
- Pin-point tenderness over the pubic bone
- Tender point over the deep inguinal ring (middle of the groin)
- Pain and/or dilatation of the external ring with no obvious hernia evident (pain near the top of the scrotum)
- Pain at the origin of the adductor longus tendon (deep in the groin area)
- Dull, diffuse pain in the groin, often radiating to the perineum and inner thigh or across the mid-line (pain along the middle across both pubic bones and the inner thigh with radiation to between the scrotum)
Who commonly presents with it?
Young athletes both elite and amateur commonly present with this type of groin pain described as a sportsman’s hernia. It is especially common among football, hockey, rugby, fast bowlers in cricket players and runners, with a twisting action causing particular strain and discomfort. Simple walking does not usually bring on the pain, but excessive straining or stretching does exacerbate the symptoms. Various scans have been used to try and diagnose this condition, magnetic (MR) scans are often performed to try and detect a possible hernia or muscle rupture but are generally used to exclude other injuries such as:
- Osteitis pubis
- Bone marrow oedema
- Adductor muscle tendinitis
- Pubic symphysitis
- Femoro-acetabular impingement (FAI) of the hip joint
How does it present?
Sportsman’s hernia present with persistent groin pain usually associated with physical activity makes, with rest relieving the pain. There is usually no hernia associated with this condition.
What can be done?
The chronic groin pain requires treatment by a multidisciplinary team.
You will undergo a Stress ultrasound of the groin, as well as a Magnetic resonance scan (MRI) of the groin.
Rest and physiotherapy are recommended initially for at least 6 weeks and sometimes continued for up to 6 months. Local anaesthetic and steroid injections can be offered as the first line treatment after conservative measures and prior to any surgery. Surgery if contemplated is usually necessary for severe on-going pain after all other treatments have failed.
Surgery
Surgery requires reinforcement of the inguinal canal using a mesh, which can be performed, by open or keyhole surgery. In some cases the main conjoint tendon to be released and reconstructed with tension-free mesh placement, to strengthen the repair. Other surgical techniques have also been advocated for sportsman’s hernia such as the minimal repair technique, which only uses a stitch to reinforce the inguinal canal. , Both the keyhole and minimal repair techniques have the advantage of a quicker recovery.
Surgery in all cases is combined with a careful follow up and physiotherapy program which you will be advised of.
How long will your recovery take?
Recovery does not take long, with most patients being discharged within 24 hours of surgery. Complete recovery is based on individual needs and fitness of the individual. Patients are encouraged to start mobilising immediately after surgery and refrain from lifting heavy objects for at least one month. A return to full sporting activities is expected within 2 to 3 months.
What are the main risks of surgery?
Your surgeon will advise on any specific complications and risks. For all types of surgery there is always a risk of wound infection, a 1-2% risk of recurrence of the hernia and a 2% risk of on going pain. For keyhole surgery there is always a very small risk of bowel and bladder injury.
For more information please click here for Professor Sheen's leading article on the Sportsmans groin.