Sports hernia: six questions to ask your doctor

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. And I went ahead and asked ChatGBT what are questions you should ask your doctor about a sports hernia.

As some of you listeners have been on this podcast before, you know that we see a lot of people with sports hernias or core injuries, groin pain, and so on. And so I thought I would see if we can clean up a little bit of Q&A here of what you would want to ask your doctor. And I'll answer it as the best as I can. By the way, just some housekeeping. If you guys don't have it already, there is an amazing sports hernia PDF book or an e-book that I wrote that outlines how we treat things. It even has videos in it from YouTube that are unlisted, so you won't see them anywhere on YouTube except for on that thing.

So please take advantage of it. It's completely free. There'll be a link in the description for the podcast. Now, the question first that Chad DBD comes up with is what are common causes and symptoms of a sports hernia. Now, I can tell you that textbook case, we call it, of a sports hernia is going to be the mechanics are lumbar extension and hip abduction. So basically, imagine kicking. So kicking couples with lumbar extension or anterior tilt, usually at the same time, and that would be the mechanics of it. Just like if you were to tear a bicep, the mechanics would be like pulling, like contracting the bicep really hard, like in a tire flip.

But I can tell you from working with a lot of people with sports hernias that most of them don't have those mechanics. I've heard many people have a core injury or athletic fibalgia or sports hernia. I'm going to use those interchangeably as we move forward in this podcast today. I've heard them have it with deadlifting. I've heard them have it with squatting. I've heard them say they woke up with it. I've heard people say that they are running and they've had it at various different distances. I've heard people say with hockey, baseball, soccer. I mean, it's really across the board, but I would say with a true mechanics of what we're talking about, it has to include lumbar extension and hip hyper or lumbar hyperextension and hip abduction, which is leg out to the side.

I'll talk a little bit more about how we use those mechanics in rehab or reverse engineer them, but I think it's, the mechanics still make a lot of sense when it comes to diagnosing it. And so symptoms of it is usually sensitivity in the lower abdominal area, which may or may not intersect to the pubic bone region. Sometimes it travels down to the adductor, the inner thigh muscles, and that's usually the extent of where it goes. It can, people, I have talked to people who've had it up into the rectus femoris, kind of the mid line of the abdominal area, and I've talked to a couple that have it more up into the flank region.

Oftentimes, they do have associated lower back pain, but not all the time, but they do oftentimes complain of having tight hip flexors or tight groin muscle, and then very minimally, but sometimes people have it down into the inner knee, and men sometimes have it with testicular tightness. I would say about 15% of men, I think according to research, I think it's pretty fair, do have pain with intercourse, and I'd say actually, it could be a little bit higher, especially if we understand the mechanics of how squeezing the knees together tends to bother them. I think it depends on the position that you're doing having intercourse in, so if it's more of a spread knee type of position, there would probably be more of a symptom with it.

I don't, these symptoms tend to masquerade around as other hip conditions, such as a hip impingement, labral tears, but there's slight differences between them, groin strains or adductor strains, or adductor tendinopathy, even inguinal hernias, are sometimes masquerading around as this, and we've seen plenty of people with that, but it's important to get physically examined to figure out what you have, because all of them seem very similar, and it's very easy to get confused if you mess with it on your own. Question number two is, how is poor ternia diagnosed? I think physical exam is most of the time good enough, and I think there's been a lot of literature to suggest that a physical exam is good enough, but if you need more information, you can get an MRI or musculoskeletal ultrasound, which can be very helpful.

X-rays won't show it, CT won't show it, but a physical exam, if you've looked over some of the other literature that I've gone over, there's two tests in particular that are very sensitive, and I think 75% or more of the people who have a sports ternia have problems with these things. One of them is like a resisted sit-up test, so it's you performing a sit-up plus the knee coming towards the chest. I have them kind of curl up into like a little cannonball when they're face up, and I just resist the knee or the thigh and the chest, and that will get them sometimes. Other position too is laying on their back with their feet flailed out, and I have them pushing to my hands, which is between their feet.

Almost imagine if you were kicking a soccer ball, you're kind of pushing it with the inner part of the foot, and that tends to match up with some of the symptoms that people have with at least soccer. So there are a lot of tests you can do, but there's also a lot of garbage ones as well. I would look at, if you're doing a thorough physical exam, you should look at the lumbar spine, you should look at pelvic position, you should look at core stability, you should look at leg training, past injuries to the knee or foot, past injuries to the back. These can all become players, and also we need to look at stiffnesses, if there's any stiffnesses in certain joints compared to their neighbors on the other side.

That will give a better insight of actually how to treat the person more effectively versus only managing symptoms. You all know that if you have a sport journey or some type of core injury, if you just don't do anything, most of the time it goes away. Trouble is it comes back. So when it comes back, we need to make sure we've identified risk factors or other things that are not painful, but also are a big part of the puzzle. Usually a hip is a big part of it as well. What are the treatment options available for a sport trinia? Well, I can tell you that a lot of people will believe that it's either rest or surgery or PRP or something like that.

I'm not saying these things don't work, they certainly do, but are they appropriate for you? Not everybody wants to spend $20,000 on a surgery, which I think is what I see referenced in most of the time the going rate. Not everybody wants to do PRP or can afford it. And rest is only available for some people who are on a time crunch. There is rehabilitation that you can do. There are manual treatments, like a soft tissue treatment that you can do, and it's all based upon how old your injury is or how recent it is. And if you've looked at some of the work of Stuart McGill, one of the low back experts and researchers, he had something called a virtual surgery.

And I completely agree with what he said with it. So we came up with the virtual sports hernia treatment. And it's available on YouTube for free. And I'll send you guys a link to it in the description for this podcast. But essentially, when people have a surgery performed, especially like say for a low back, all of a sudden life stops. They don't go to work. They're on disability sometimes. They're not allowed to sit for X amount of time. They're not allowed to flex their spine. They're not allowed to go to the gym and do weight training. They're not allowed to play their sport. So there's things that they'll do because they have the surgery that they normally would not be willing to do if they did rehab instead of surgery.

So what the thought is, is you do surgery instead of, or sorry, you do the rehab or all the things you need to do and all the activities that you change instead of the surgery and see if you fare as well as the surgery. Because I'm a fan of seeing if we can reduce triggers and improve the risk factors. And I would say that a lot of people that we manage here at Performance Place in telehealth or in person, we've done them both. And they tend to fare very well when you take those factors in context. Like you remove triggers and then you try to build up and reduce risk factors. But we tell them, I always tell people that at least with, if you're going to reduce an activity, like say like, hey, you can't do that anymore.

They won't listen to you. But if it's after say a quote unquote surgery, a virtual surgery, and you just end up saying like, look, you can't do this for two to three weeks, then we're going to start to integrate it back in again. I think people are more willing. I would feel the same way. If you told me I couldn't play baseball anymore, I would probably not want to go see you. And if you told me, hey, we're just going to take about two to three weeks off to let this injury mend itself and we're going to do all these exercises in the meantime. Hey, by the way, you can do this, this, and that. And kind of establishing what's safe and what's not.

Like those are big things. And that I think is the best recut treatment to do. There are manual therapies that help. I'm not going to lie. I've had a lot of people who we've done sessions with virtually who need manual care. And they either come in for manual care or we find a place locally to them to do manual care. Something like active release can be very helpful or something like Stecco work. 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. Now the recovery times, the question is what is the expected recovery timeline? I think it depends on the extent of the injury. Originally, I didn't mention this, but people with larger injuries, they'll feel a pop. They'll see a bruise happen. That means there's a larger soft tissue injury present than just a simple strain. So if you've been dealing with something that's more of a pop, yeah, the timeline's going to be a little bit longer. If it's something more of a strain and you've had it for a longer time versus this just started yesterday, that timeline is also different.

So what we typically say is if you have had a problem and you have pain right now doing something, usually you're about three weeks away from feeling a lot better. Now, that's not to say you're going to be perfect in three weeks. That's more to say that you're going to be in a much better state. So I think three weeks is a pretty fair timeline to feel a lot better. If you think it's a ridiculous timeline, just think about how people feel after a surgery. They wake up and after the initial shock and irritation of a couple days, of having surgery, they feel better. It does its job. Rehab and exercise and treatment are the same thing.

So if you do the right treatment, usually three weeks, the people feel a lot better. But beyond that, you may be wondering what's the real timeline to get back into sport. I would say if it's not a popping and a bruise type of scenario, it's going to be probably within that first month. If we pop in a bruise scenario or some type of bone or edema found on your MRI, then possibly it's going to be a little bit longer. I'm a big fan of having people do stuff as soon as they possibly can. So that's why I'm being a little bit vague with timeline. But if your sport is like you have to play soccer, you're probably just going to be going back in the field and doing ball work for a little bit of time.

You may be doing like more punch kicks versus like long draws, right? You may not be sprinting. You may be jogging. But ideally what we want is the person to be able to go back in some form because you'll gain a lot by getting back sooner. All the other muscles and tendons to your body will be more conditioned from when you actually do get to play. And so usually we try to get people within about six weeks to do some type of cardiovascular or physical activity, right? But that's not to say to be reckless with it either. A lot of people are very reckless with it, which is why we put them in a virtual surgery category.

But usually about three weeks to feel a lot better. Usually the expected time to stop having to come in for care or getting suggestions from somebody is about six months. So anywhere between three to six months is pretty fair, at least for managing expectations and giving you different things to do over time. The other question that is next, is there any risk or complications associated to treatment? I'm sure surgery has all the risks. We already know that. You guys can look them up. Just Google risk associated to any surgery and they're very much the same. I think the risk for rehabilitation is basically none.

There's not a lot at all. Now, if the person examining you does a bad job of identifying what's safe and what's not, what's not, you may have some flare-ups. But it doesn't mean you're typically disabled. It'll just hurt a little bit. Hurt is not the same thing as harming. But I think at least for rehabilitation, there's not a lot of side effects or negative side effects for manual therapy. Sometimes you bruise, it gets uncomfortable. That's pretty common. But I'd say there's not a ton of them. There is a risk of resting too long, though. Resting too long does carry a big risk of having deconditioning of the tendons and other muscles around the area.

And I think one of the biggest mistakes people make is they're inactive for too long. Beyond 10 days, I don't want to say 10 days, 10 days is kind of like the mark for like a non-bruising type injury. If it bruises, like, you know, creative, being creative about your rest for about three weeks or so, meaning rest the tissue, not the person. And beyond that, I think you're having a lot more fallout associated to excessive rest. Now, the last thing we're going to cover is what are preventative measures I can avoid for future injuries? I think this is a great question. I'll cover some basic things that I see.

Remember, everybody is different, but after you get the exam done, I feel like most people end up having a limitation of range of motion or function in one hip. Sometimes they have both, but normally one hip is stiff, especially with internal rotation and flexion, sometimes with extension. as compared to the other. We have on our YouTube some of the telehealth tests that we do, like scours, for deer, for bear. These are all tests that can identify generally lack of range of motion. They won't identify lack of function. Usually a squat assessment or a wide drill are great ways to assess function of the hip.

Also, dynamometer testing is a great way to identify if the hip is weak or the glute is weak, which is a risk factor, I think, associated to having a reoccurrence of the injury. Also, abdominal strength or intra-abdominal pressure are big factors. If you can't hold a good plank without feeling any pain for more than easily a minute, then I think that is a big risk factor. I think the standard is about 90 seconds to two minutes. I know it's a big spread, but I don't recall exactly. I know it's over a minute. I mean, that's going to be from the feet. But most people end up having compensation associated to their plank, meaning they can perform the plank and they can get away with it.

It doesn't hurt, but they'll feel other areas working like their low back or their hamstring. So, these ones are signs of poor core activation, but you can get away with cheating the test. Not like you're doing on purpose, but those are signs of it. And the last thing I usually see is that people's strength and conditioning is oftentimes very poor. And so, preventative measures for that is to make sure you have a good strength and conditioning program dialed in and you can work with the strength and conditioning coach to figure out what that looks like. But I think people abuse reps and sets. I think people abuse certain exercises for the wrong purpose.

For example, like a deadlift, you shouldn't be doing 50 of them or 100 of them in a day. Like, power cleans are supposed to be generally fast and kind of short in reps. Like, you shouldn't be doing 15 of those per set either. So, there's a lot of things that people tend to abuse like the general purpose of the exercise and that gets them into trouble with not just, I don't want to say back stuff, but they end up losing the value of the exercise. Sometimes they have back pain, sometimes they have overactive tissues such as hip flexors and certain glutes and so on like piriformis and then they end up having a problem with hip function which then leads to this problem in the first place.

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.