Sports Hernia: A Misleading Name for a Pelvis Strain

You're listening to the Restoring Human Movement podcast. Thanks for joining the movement, movement. I'm Sebastian Gonzales, show curator and head clinician at Performance Play Sports Care in Southern California. This show's for active people, those who refuse to let pain and injury get in the way of their life and how they want to live it. Trails and trips, fields and courts, whatever moves you. Each episode features rotating host, expert guest, and real clinical conversations that help you move better and trust your body again. Here we go. Struggling with a sports hernia and looking for the right recovery plan?

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We have had many other podcasts on sports hernias. Recently, there were sports hernia treatments that don't work. Sports hernia classifying the extent of muscular injuries correctly. There's also understanding for sports hernias for normal people, how to recover from sports hernias without surgery, step by step. So we've covered various different topics in this forefront today. I decided to actually go through and listen to some of the other more popular podcasts. I don't want to say more popular than ours, but popular podcasts on sports hernias just to see what other information was out there for you guys.

And I actually liked what I found. I'd love to say that there's a reason for misinformation out on the internet about sports hernias, but actually I think there are some fairly good resources. One of them was a podcast by Choose PT. It was called Treatment of Core Muscle Injuries. Don't call it a sports hernia, which I completely agree with. So I'd encourage you guys to listen to that show. The show consisted of, there's a few points that I'll cover on it and I'll give you guys at the end some information of what I think maybe we can add to the scenario or common mistakes that people make and various different talking points.

But I think this podcast by Stefania Bell and William Myers, MD, I think was fantastic. There was a few points here that I remember that I had listened to or read a few articles where they were talking about why this thing is called a sports hernia in the first place. And it was, it's a very misleading term. I don't know how many people who have come to our facility who have talked about a hernia. They're talking about abdominal contents being outside of the body. They're talking about ultrasounds. They're talking about inguinal hernias and so on. They're talking about all the hernia things. The problem was, according to this podcast, was that nobody really knew what to call it or what it was.

But because general practitioners or PCPs had an idea that the most common thing in the area was a hernia, they would suspect that it was a hernia that they couldn't see. Hence, sports hernia because it's popular in sports. And then the name kind of stuck. Dr. Myers talks about in this podcast about the problem with specialized doctors or specialists. And however, this is kind of in the middle with things. Doctors, as we know, specialize in various different regions of the body. They specialize in different organ systems or bodily systems, just as physical therapists may specialize in geriatric populations or sport injuries.

Chiropractors may focus on different parts of the body. And populations, people have these different specialties. When it comes to something like a core muscle injury, again, we're talking sports hernia, lower abdominal strain, adductor, groin pain, that has no positive findings of a hernia, then we have to consider what else could it be too. Because it doesn't always have to be a muscular injury. It doesn't have to be a hernia. And this is why people end up going through different specialists. Some people go through the, they go to the urologist. Some people to females will go into a gynecologist.

Really, I think the main ones who should be the specialists involved in it should be the orthopedic surgeons because they would have the best specialization in musculoskeletal injuries and so on. According to, and I was not aware of this, according to the podcast that I just referenced, they said that it's hard for orthopedics to get into that pelvis area because of the organs and vessels involved. I can't, I can't vouch for that. It would make sense. But in my experience, what a lot of people get diagnosed with from their orthopedics is going to be a labral tear, a small labral tear, a large labral tear.

They'll have different presentations too. Hip FAI or hip impingement. I've met dancers who have been told they have hip dysplasia. And I'll comment on these in a few moments too. I've heard of adductor tendinopathy. So these are the other things they'll get diagnosed with. But the misleading thing with the sports hernia is that when you call it a sports hernia, when our medical industry calls it a sports hernia, the patient hears hernia. And they get misled about what it is. And I agree with the podcast. I don't think we should be using this term anymore. I know I've done various podcasts and YouTube videos on it.

By the way, if you haven't seen our YouTube channel about the topic, I think it's a wealth of information. The sad reality is there's a lot of conditions out there that I don't think they should be named at all. A lot of them I think are very disabling via their name. I think someone could have chose wiser. But there's also ones like this. It has no relationship to hernia whatsoever. Other things that I think are a little bit misleading is disdegeneration or joint degeneration, degenerative joint disease. It sounds like you're just going to be withered away, right? I don't know how many people I've met who have been told they have that and they say, well, I guess that's all I got.

I just got to wait and let it catch me. No, there's a lot of ways to manage it. And you don't have to be physically disabled just because of findings of degeneration in a joint. Now, I think that the way these things should be managed personally is I think that the rehab specialist or the musculoskeletal specialist should probably be at the forefront of this. I'm not saying orthopedics shouldn't be part of it. I do think they should because there's going to be some people with actually tears involved. But I think the physical therapists, I think the sports chiropractors, the people who have spent more graduate time in musculoskeletal injuries should be spending more time.

Granted, everybody has a specialist or they have a specialty. Some chiropractors only adjust certain areas of the body. They adjust the joints. Some physical therapists only do feet, right? So there's variance to this. But overall, like the graduate level education involves a lot of musculoskeletal health. And I think they should be able to, if they're doing a good job, they should be able to rule in and out if this is a musculoskeletal injury in the first place. So then they should be referring to the gynecologist or the urologist or the orthopedics or other organ specialists and so on or system specialists.

So I don't think we should be using this word anymore. The sad reality is it's this condition overall does stump a lot of medical professionals of various specialties. But I tend to think of this as, in the podcast, they said they call it a core dysfunction, core muscle injury. It's part of the title. I think the sports chiropractors is a terrible term. I think it creates a lot of confusion. I don't think we should call it a core dysfunction, really. I think we should call it a biomechanical pelvis strain, possibly. Don't hold me to that. I'm sure I'll try to improve it over time. But I think we need some type of diagnosis which describes potentially what is leading to the condition.

Because I think the hard thing for people to grasp on is that there's no imaging finding most of the time. There's no tear, right? In one of the prior podcasts that I covered, I talked about different levels of strains and how past a certain level of strain there is a muscular tear finding or there is more of an imaging finding on ultrasound and MRI. But prior to that, which is where most people lie, there is no positive imaging finding. So in that scenario, can we really call it a tear? I guess we can call it an injury, but you know, an injury to a lot of people I've talked to insinuates trauma.

There's not trauma in most of these. It's just something happened or they woke up with it. Okay. Biomechanical loading, I think, is a big part of this. And in the other podcast, they talked about how the core is more than just the muscles of the core. I think we should call this maybe a pelvis strain, mainly because it's in the area of the pelvis. It is part of the core too. And the core is all the way from the torso, front and back, inside to side, and so on, all the way to the ball socket joints and everything crosses the torso. So that's going to include the lat. It's going to include things that attach to the pelvis, such as the adductor, hamstrings, quads, and it includes almost everything.

So I don't even want to call it a core muscle injury because I think that at some point, once the public realizes what the core entails, that will be misleading as well because there could be other things involved. There's a reason why people have more of an adductor presentation of this problem up at the pubic symphysis where the pubic bone is. There's a reason why some of them feel more in the lower abdominal area. There's a reason why some of them feel more low back pain or stiffness. Some of them have been diagnosed with osteitis pubis. Sure, we can call this athletic pubalgia, but athletic pubalgia insinuates only a certain region.

So there could be other regions as well. So I think we should be even more vague with it because really biomechanical loading problems are vague in regards to where they present and I'll describe that in a second. Now for a quick pause before we keep going. Hey everybody, it's Sebastian. If what we've been describing in the show so far sounds very familiar and you've been dealing with some ache, pain, or stiffness that keeps coming back no matter what you do and no matter what you try, we're offering a free discovery call today where we brainstorm with you what has been working for you, what hasn't been working, and we also try to unravel what is a critical part of the puzzle that you've actually been missing that's keeping you from full recovery and getting back to full activity.

The link's in the description. It only takes a few minutes to fill out the form. Okay, back to the show. So I think we should move towards the idea of I'm okay with the idea of core muscle injury. I don't think we should call it a sports hernia. Athletic pebal just sounds a little scary to me. I think biomechanical pelvis strain seems a little bit easier because it's biomechanical most of the time. It's in the pelvis region and it's a strain meaning it's sub-tear level because if it was a tear I think we should just call it a tear of what the muscle's torn. So if you have a tear of the conjoined tendon of the internal oblique and the transverse abdominus just call it that.

Don't call it a sports injury. Don't call it a pelvis strain. If it's an adductor tear like a complete rupture off of the bone then just call it that. Don't call it any of the other things I mentioned. I think we should start calling it really what it is. So here's why I think we should call it a biomechanical pelvis strain. And I've described this to many of my clients before because everybody has variants of this. And the sad reality is I think a lot of people think that there's only one way to solve this problem and there's not. It's solely it's unique based upon the person's individual problems and restrictions.

It's based upon their movement habits or what their ingrained patterns are. So there's a lot involved. And so I describe most diagnosis really as the area of least resistance. And for a good analogy I hope this is a good analogy I'm sure I'll improve it over time is that essentially load your body manages load. Okay if I were to jump off of a short wall and I have two legs and I land on two legs where does the load go? Probably to your legs. Right? It goes through the entire system but it does dominantly go to the legs because the knees bend the hips bend and so on. And so the more load that goes to your legs the more it protects like your spine.

Now let's just say if you jump off of it and you land on your butt where does the load go? It goes up your spine. Right? Now that we remove a leg because you have an ankle turn and you don't want to strain that ankle anymore where does the load go? Well it goes to the other leg. Probably in part of the spine too in the remainder of the body. Now if you land on your hands and we keep playing this game right? Now the water or a river running through is the load. How high the wall is is how big the river or how fast the water is running. All right? The more load that you can manage the better you'll fare and that's what we call resiliency.

All right? But at the same time if you just have a flood you better expect to have some damage and that would be recklessness of too much too soon. You're really not scaling up your programming or your activity and just being being crazy with it. Okay? Now in a scenario where people have physical limitations like I just mentioned you know you have one leg you have an ankle turn or whatever it may be in that scenario where you jump off jump off the wall. Physical limitations most of the time with these people with the sports hernia or whatever you want to call it problem is going to be a loss of hip internal rotation which does not have to hurt by the way.

They have stiffness sometimes in the spine. I've met some people with L5-S1 stiffness from an old disc injury. I've met other people with their thoracic spine is stiff and it doesn't tend to move very well. It's stuck in flexion or around a lot of times and that limits how much extension it can do. It limits how much rotation it can do which also limits how much the shoulder can function which then limits the lat. The lat's part of the core and so on so there's a physical limitation that sometimes happens. Sometimes people have a loss of strength or there's an adductor weakness or an old injury.

Some people are hypervigilant about movements they just don't feel comfortable using their body and so they move stiffly even though there's really not stiffness around. So all these are physical limitations I guess some would be psychological limitations but they're limitations and so the limitation is a dam. A dam can only hold so much water before it starts to go somewhere. So in this scenario our diagnosis is where the water leaks around or through the dam. Let's just say the water decides because say we got a really good dam it's like the Hoover Dam and you put too much water behind it and it starts to go over the top.

Let's call that an adductor strain. So your physical limitations and load presented itself as an adductor strain because it found the area of least resistance in the dam which is over the top. Now let's say that there's an embankment that actually is not big enough and it starts to seep that way and that's the area of least resistance and the water goes around the dam. That may be a tear of the conjoined tendon of the transverse dominus and internal bleak. Say the water goes through the dam because there's a whole and there's a deficiency in the dam itself that may present as osteitis pubis or knee pain or upper glute pain or low back pain discogenic symptoms sciatica so on.

These are the variants people have and I've noticed that when people start to improve or they change what they're doing somehow they may actually change the structure of their dam. They actually get better hip movement because they spent time doing that but also can it move around the dam another way and so this I think this presents the scenario where people feel better but then they feel it in a different area which is really confusing to them and I know that some people there's a guy actually I was meeting with recently that he had lower abdominal pain and a little bit in the adductor and some of the SI joint area and so the lower abdominal strain completely gone.

By the way a lot of these people have testicular findings when they're men just in case I didn't mention that earlier but so lower abdominal part went away then he started to feel the adductor more and then the adductor went away and he started to feel the SI joint and the SI joint got better and all of them got better but then he started to feel like his upper glute medius was achy and then he started to feel the other side right so it just keeps moving around a little bit and there is a way out of it but it's I think if we just look at the problem as a quote unquote strain or just a problem with a specific tissue I think we're missing a big part of this and this is why your rehab specialist and actually someone who's able to walk you through the steps and confirm that you're doing the right things and so you don't worry too much but also know what to avoid if you need to why this is all important okay a lot of people cannot manage these on their own because they've been through enough people that are that don't know what to tell them what to give them what to give what to diagnose it as where they start to become a little bit more hyper vigilant about it but they they're more invested in that injury I know that I had a friend recently that their kid had a problem they had a fracture and so kid got out of the cast and you know he didn't even know about it care about it he feels good you know that's the perfect scenario when you have like a younger kid who has an injury they don't think twice like you know when he's 20 years old he's gonna think you know I had this cast on one time I don't remember what it was for but I guess it's okay I don't remember what arm it was you know and so adults maybe it's because of all the information available online or how many people they can talk to about it but there's other variables associated to it because they start to learn more and start to believe what things are and what things they shouldn't do and what things to stay away from and what things are gonna help them and when those things fail they get frustrated so the more I guess I don't want to say the more intelligent the person but the the more they learn it's not always the better they fare and that's why having somebody to guide them through and tell them what to do and help them interpret things is going to be important so just to recap on a few things here in this podcast is that number one it's probably gonna be called a sports tournament for a long time but I do think it's inaccurate I think we should name it something different I think you guys should listen to the podcast by with Stefana Bell and William Myers MD treatment of the core muscle treatment of core muscle injuries don't call a sports hernia I think it was really insightful and I think it's a good starting point to learn a little bit more about what's going on and also here's some really good stories that you know people get better people get better all the time from this if they do the right thing so it's more common than you think and actually too based upon the athletic pubology we see it in non-athletic populations as well so that's why I think we should call it a biomechanical pelvis strain but we'll see if that ever catches on so if anything in today's episode resonated with you visit the link in your podcast player there you'll find any free resource that we mentioned in the show any guest links and a link for a free discovery call with us we're licensed to work with our outdoor active people via telehealth across many states in the U.S.

at this point in fact we cover almost half of the population in the U.S. and we add more states every year thanks for listening subscribe to the show and we'll see you in the next one