A friend of mine came to see me recently complaining of an odd ache he'd noted in his lower abs and groin. He couldn't blame it on crunches at the gym, nor a cow kicking him in the belly again (he's a farmer). But he does spend a fair amount of his time on the football pitch and was now noticing that every training session and match was bringing the pain on - sometimes agonisingly so.
Author
- Dan Baumgardt
Senior Lecturer, School of Physiology, Pharmacology and Neuroscience, University of Bristol
The diagnosis? A sports hernia. This condition also goes by many other names, including athletic pubalgia and Gilmore's groin - after the late British surgeon Jerry Gilmore who was the first to coin it. It's actually a fairly recently described condition, dating back to only the 1980s.
The main symptom of a sports hernia is pain in the pubic and groin regions, brought on through athletic activity. The condition is actually more common that you think, especially so in footballers. Around 70% of all sports hernias appear to be related to the sport. It's also estimated that groin pain accounts for around 5-18% of athletic injuries .
A sport's hernia is not your typical hernia. In fact, it's not really a hernia at all.
A true hernia is defined as when a section of tissue or organ passes into a space where it shouldn't be. Many will be aware of those hernias which involve a section of bowel passing through the abdominal wall - such as an inguinal hernia .
There are other types of hernias as well. For instance, your stomach can pop through a gap in the diaphragm and into the chest (called a hiatus hernia ). More seriously, even the brain can herniate - out of one of the holes in the skull.
But a sports hernia is different, in that it actually arises from overuse of the abdominal muscles .
The abdominals include the long, straight and central " rectus abdominis " muscles - which allow you to perform a sit-up or crunch. Three layers of muscle also lie on either side of the abdominals. These are the obliques, which have important roles in twisting and turning our bodies. The muscles are also mixed with layers of tendon and connective tissue which not only attach them together, but also to the bones and ligaments of the pelvis.
Sports hernias are typically caused by moves which involve a lot of twisting and turning - and especially those occurring at speed. Hip movements can also put strain on where the ab muscles attach at the groin region. These actions appear to cause shearing and tears in the tissue, leading to pain. It's felt in the groin or lower abs, usually on one side. In men, who are particularly at risk, pain may also be felt in the genitalia.
Some sports rely upon these sorts of moves and actions during play. Think about dribbling in football and hockey, or pinning and throwing opponents in wrestling or martial arts. Slalom skiing is another prime example - travelling at speed and rapidly changing direction. Tackling and scrum action in rugby or American football, and explosive block starts and hurdling in track athletes might also be to blame.
The condition appears much more common in males, who are up to nine times more likely to develop it. This is perhaps because of the anatomy of their lower abs, which is different to females. The testes - which initially develop inside the abdomen - descend to the scrotum during the foetal period. But to do this, they actually have to pass through the layers of the abdominal wall which makes the structure weaker and potentially more prone to damage.
While sports hernias are vastly more common in athletes because of the regular repetitive strain they put their bodies under, it's still technically possible for non-athletes to get it.
If you work in a job where there's regular heavy lifting, pivoting as you do so - on a building site for instance - it may be possible to sustain the same injury. Or, doing too many advanced core exercises at the gym before you're sufficiently strong enough might also make you more prone. Dead lifts and core exercises that use a medicine ball (such as Russian twists ) are some culprits.
Managing a sports hernia
If you do develop a sports hernia, it appears that improving core strength may help you recover. Patients diagnosed with a sports hernia typically undergo a training programme to strengthen and stabilise their core muscles. In athletes who already have a strong core, it may also be worthwhile training muscles that strengthen the pelvis alongside a gradual return to sport. Physiotherapy, massage and acupuncture may also help.
Some cases might also require surgery to reinforce the groin structure, and relieve any tension on the tissues.
There's evidence to suggest that sports hernias are both under-reported and under-diagnosed . This may be because they get confused with other types of injuries - such as an inguinal hernia , which is also related to the groin, more commonly found in males and associated with abdominal wall strain and damage.
The key difference is that a real inguinal hernia causes a swelling in the groin region or scrotum, whereas sports hernias do not. Inguinal hernias can also cause complications if the bowel gets twisted and obstructed, which can have potentially severe consequences.
So, if you're someone who participates in these twisting, turning types of sports and notice any of the symptoms of a sports hernia, it's best to stop instead of pushing yourself through the pain. You should also speak to a doctor in case there are signs of a true hernia, which often requires further surgical treatment.
Dan Baumgardt does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
