Most hernia surgeons refer to a sports hernia as inguinal pubalgia or athletic pubalgia, as it is not technically a hernia. A hernia occurs when abdominal contents protrude through a defect in the abdominal wall, but a sports hernia does not involve any contents leaving the abdominal cavity. The consensus of most hernia surgeons is that a sports hernia is a musculoskeletal injury that occurs as a result of a sport. Most patients with “sports hernia” present with groin or lower abdominal pain that is made worse with exercise. Patients often feel discomfort at night, do not notice a bulge in the groin, and do not have an inguinal hernia on physical examination.
Current treatment recommendation for sports hernia is aggressive physical therapy to treat the injury and correct any core muscle imbalance that caused the injury. If physical therapy is unsuccessful after 6 months, then surgery is occasionally recommended, though no single approach as been shown to be better than any other approach. We often work with our sports medicine colleagues to make the decision to proceed with surgery, as the injury we are treating is orthopedic in nature.
In our experience, correcting the imbalance in the musculoskeletal system is required for someone to have a long term recovery from a sports hernia. Surgery may offer a quick fix to the pain, but does not address the long term core muscle imbalance. For this reason, we feel that physical therapy is the best way to heal from this musculoskeletal injury. When a professional athletes or high level collegiate athletes have failed all conservative treatments and their therapists and trainers feel that surgery is the only option left for them, we sometimes perform surgery together with a sports medicine orthopedic expert. With aggressive post-op physical therapy and training, these athletes can get back to their pre-injury state.
If you have a suspected sports hernia, one resource is Andrew Millett of Move Strong Physical Therapy in Hudson, MA. He is an expert in what he does and has worked with many of our patients to avoid surgery.