Sports Hernias: What Causes Them and How Are They Treated?

For athletes involved in high-intensity sports like football, rugby, and tennis, groin pain can be a frustrating issue that affects performance and training. One potential cause of this pain is a sports hernia, a condition that, despite its name, isn’t a traditional hernia. Sports hernias, also known as athletic pubalgia, involve the soft tissues in the lower abdomen or groin. They can cause chronic pain and discomfort, often making it difficult for athletes to return to their sport without treatment. In this article, we’ll explore what sports hernias are, their causes, symptoms, and the most effective treatment strategies.

What is a Sports Hernia?

A sports hernia occurs when the muscles or tendons in the lower abdomen or groin are damaged due to repetitive stress or sudden twisting movements. This injury is particularly common in sports that involve sharp, twisting motions, such as football, rugby, hockey, and tennis. Unlike a traditional hernia, where an organ or tissue pushes through a weak spot in the abdominal wall, a sports hernia doesn’t result in a visible bulge. Instead, it manifests as chronic pain in the groin area, which can worsen over time if left untreated.

Symptoms of a Sports Hernia:

Chronic Groin Pain: The most common symptom is a persistent pain in the groin, lower abdomen, or upper thigh, which may worsen with physical activity.
Pain During Twisting or Pivoting Movements: Athletes often experience sharp pain during sudden twisting, cutting, or kicking motions.
Tenderness in the Groin Area: The affected area may feel tender to the touch, and pain can radiate into the inner thigh or lower abdomen.
Pain with Coughing or Sneezing: Like traditional hernias, sports hernias can cause discomfort with activities that increase intra-abdominal pressure, such as coughing or sneezing.

While the pain from a sports hernia may improve with rest, it often returns once the athlete resumes their sport, making proper diagnosis and treatment essential.

Causes of Sports Hernias

Sports hernias are typically caused by repetitive stress on the muscles and tendons in the lower abdomen and groin. This stress can result from high-intensity activities that involve twisting, sudden direction changes, and explosive movements.

Common Causes Include:

Sudden Twisting or Pivoting: Sports like football, rugby, tennis, and ice hockey require frequent twisting and turning, which can strain the soft tissues in the groin area, leading to a sports hernia.
Explosive Movements: Sprinting, jumping, and kicking put significant pressure on the abdominal and groin muscles, increasing the risk of tearing or overstretching.
Weak Core Muscles: Athletes with weak core muscles are more prone to sports hernias, as their bodies may rely too heavily on the groin muscles for stability during dynamic movements.
Overuse Injuries: Repetitive strain from overtraining or insufficient rest between intense workouts can weaken the muscles and tendons in the lower abdomen and groin, increasing the likelihood of injury.

Treatment Strategies for Sports Hernias

Managing a sports hernia requires a combination of rest, rehabilitation, and sometimes surgery, depending on the severity of the injury. Early intervention is key to preventing chronic pain and ensuring a full recovery.

Non-Surgical Treatments:

Rest and Activity Modification: In the early stages of a sports hernia, rest is crucial. Reducing or eliminating activities that aggravate the injury, such as twisting or high-impact exercises, allows the soft tissues to heal. This may involve taking a break from sports for several weeks.
Physical Therapy: A tailored rehabilitation programme focusing on strengthening the core, hip, and pelvic muscles can help alleviate pain and prevent re-injury. Exercises targeting the abdominal muscles, hip flexors, and adductors are particularly effective in promoting stability in the groin area.
Anti-Inflammatory Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help reduce pain and inflammation, making it easier to participate in physical therapy.
Injections: In some cases, corticosteroid or platelet-rich plasma (PRP) injections may be recommended to reduce inflammation and promote healing in the damaged tissues.

When Surgery is Necessary

While many athletes recover from sports hernias with non-surgical treatment, some cases may require surgery. Surgery is often considered when conservative treatments fail to provide relief or if the athlete’s symptoms persist despite rest and rehabilitation.

Surgical Repair of the Hernia: In sports hernia surgery, the damaged tissues are repaired, and the weakened abdominal wall is reinforced. This procedure is typically performed using minimally invasive techniques, such as laparoscopy, which involves small incisions and the use of a camera to guide the surgery.
Recovery After Surgery: Recovery from sports hernia surgery typically involves a period of rest, followed by physical therapy to restore strength and mobility. Most athletes can return to their sport within 6-12 weeks, depending on the severity of the injury and the specific demands of their sport.

Rehabilitation for Sports Hernias

Rehabilitation is a critical component of recovering from a sports hernia, whether or not surgery is required. A physiotherapist will design a customised rehabilitation programme to target the muscles involved in stabilising the hip and pelvis.

Key Elements of Rehabilitation Include:

Core Strengthening: Building strength in the core muscles, particularly the lower abdomen and obliques, is essential for preventing re-injury. Exercises like planks, bridges, and leg raises are effective for strengthening the core.
Hip Mobility and Flexibility: Improving hip flexibility through stretching exercises can help reduce tension in the groin and prevent further injury. Hip flexor and adductor stretches are commonly included in rehabilitation programmes.
Progressive Return to Activity: Rehabilitation should involve a gradual return to sports, starting with low-impact exercises before progressing to more dynamic movements. Athletes will gradually reintroduce sport-specific activities, such as cutting, sprinting, and pivoting, as their strength and mobility improve.
Neuromuscular Training: Incorporating neuromuscular exercises, such as balance drills and agility training, can help improve coordination and reduce the risk of future injuries.

Treating and Preventing Sports Hernias

Sports hernias can be a frustrating injury for athletes, especially those in sports that involve frequent twisting or pivoting. However, with proper diagnosis, rest, rehabilitation, and in some cases surgery, most athletes can make a full recovery and return to their sport. Early intervention and a focus on core stability and strength are key to preventing future injuries. At MSK Doctors, we specialise in the diagnosis and treatment of sports hernias, offering personalised treatment plans to help athletes recover quickly and safely. If you’re experiencing chronic groin pain, contact us for expert advice and care.

FAQ Section:

What is the difference between a sports hernia and a traditional hernia? Unlike a traditional hernia, which involves a visible bulge where an organ pushes through the abdominal wall, a sports hernia affects the soft tissues in the groin and doesn’t cause a visible bulge. However, both can cause pain and may require medical treatment.
Can a sports hernia heal without surgery? Yes, many sports hernias can heal with rest, physical therapy, and other non-surgical treatments. However, if symptoms persist, surgery may be necessary to repair the damaged tissues.
How long does it take to recover from a sports hernia? Recovery time varies depending on the severity of the injury and whether surgery is required. Athletes who undergo non-surgical treatment may recover within a few weeks, while those who require surgery may need 6-12 weeks before returning to sports.
What exercises can help prevent a sports hernia? Core strengthening exercises, such as planks and leg raises, along with hip mobility stretches, can help prevent sports hernias by improving stability and reducing strain on the groin muscles.
Can you play through a sports hernia? Continuing to play through a sports hernia can worsen the injury and lead to chronic pain. It’s important to seek treatment early and rest until the injury heals.
Is surgery for a sports hernia successful? Surgery for sports hernias has a high success rate, particularly when followed by a comprehensive rehabilitation programme. Most athletes are able to return to their sport without recurring issues.