Sports hernia treatments that work and ones that don't

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 is 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? Download our Sports Hernia Athletic Pupalgia Recovery Guide absolutely free. In just one hour, you'll have a complete recovery plan, helping you get back to your normal activities with less discomfort and more confidence, whether you're playing soccer, baseball, or sprinting in any sport. No more endless searching and piecing together conflicting information. This guide gives you the clear, structured steps that you'll need to dramatically improve your recovery.

And avoid setbacks. Download now and start your recovery today. Find the direct links in your podcast player. Now onto the show. We're going to be focusing for a spurt on sports hernias. We have a few episodes in the past. I think it's been about three or four weeks focused on different aspects of it. I have been seeing more people with this condition, lower abdominal pain, pubic bone pain, sometimes in the adductors, who really are not sure what to do anymore. As I covered one of the prior podcasts, we talked about the lack of information out there about this condition, how to manage it. Will you ever get better? Is there a way to get better without surgery?

And I think I've learned over the years that, yeah, you can get a lot better without surgery. And most people don't actually need it, although some people do. So I have mentioned in the past too, that there are also YouTube references that we have. We have a lot of videos on YouTube about sports hernias. We demonstrate some of the principles that I'll talk about today. And we also demonstrate like the mechanics of how things happen. Other considerations that you may want to have and be educated about if you're going to make some informed decisions about how to get rid of this. First off, just know that you will be okay. This almost always goes away with the right type of treatment or the right type of time.

I don't know too many people where this lasts super, super long, although there are cases that are a lot harder, unfortunately. I want to cover different types of treatment today. I will be completely transparent. I don't know everything about all of them, but I'll tell you, based upon the hundreds of people that I've seen with sports hernias, I think I've noticed some trends. And I'm not an expert in all these, and I don't condone all of them. Also, keeping in mind that the people who end up in our office, a performance place in California, we probably see people who have failed other care. Also, other offices have probably seen people who failed our care.

So, I'm just telling you what I've heard, and also realize that not everybody requires the same treatment. Not everybody responds to the same treatment, even with the same exact condition, because your body is uniquely different than everybody else's. There's always different variables. So, that's why customizing your care is going to be important. Customizing the things that you should be doing, your treatment is important. And honestly, I don't think AI is ever going to replace that. You know, there's an art form to this, and it really comes down to the skill of the provider. So, the things I'm going to be covering today is rest, soft tissue care, stretching, cupping, percussion guns, ice, heat, corrective exercises, regenerative injections, or like your stems, PRPs, PRLOs, anti-inflammatory injections, weight training, surgery, and change of activity.

I'm going to be tanging off in each one just a little bit, because I think there's some context that needs to be had in each one. Rest is probably the first thing that people use. Rest is not bad, but generally for acute conditions, meaning things that come up recently, the first time you've ever had it, is much different than I've had this thing for months, or I've had this thing years ago, and it just came back. I should note, too, that some of these treatments are going to work differently based upon acute or chronic nature. Acute, again, is recent onset, typically first time. There is something called an acute exacerbation, meaning I've had it a long time ago, but it just came back, so it's acute then.

And there's chronic, which is kind of like a lingering over six months type of scenario. Also, it's goal-based. Things that work for people with certain goals, like I want to be able to hike a mountain, or I want to be able to kick a soccer ball, is very different than I just want to be able to get on and off the ground. In a past podcast, I talked about being able to set your goals appropriately and focusing on long and short-term goals. A lot of people that I do talk to, they start with, well, what's your goal? And they say, well, I just want to be able to move without any pain. Okay, if you had a 15-year-old person body, and you had no pre-existing condition, you didn't know about this problem whatsoever, and you don't have a thought in your mind about, I'm too old for that, what would you do?

Well, I just want to be able to move without pain. That's, yes, that's a short-term goal. That is a very valid short-term goal. But as a lot of you probably figured out, if you just rest, you've reached your short-term goal. But as you've gone back to activity, if you have tried at all, it comes back a lot of times. And so what your physical activity, whether it be soccer or whether it be traveling with your husband or wife, and you're retired and you don't want to do, quote-unquote, physical activity or sports anymore, that's okay. Everything has their different goals that need to be met. Even traveling requires you to be able to sit for five hours at a time as you drive.

There's things you can build in your program to help out with that. You may be required to get a folding table out of the RV and help someone set it up. You may have to move a rock away so you can level your RV. Like these are all things that can be built into your program because if you don't encounter them again, then you're not going to, then it's just an unknown, okay? It's an unknown and you may have a flare-up when you encounter it again. So those considerations, acute, chronic, and also goal-based. So rest. Say we're first talking about systemic rest. Like that's your whole body resting.

Sure, you can get away with it for about five, seven days or so, usually in an acute scenario. Chronic people don't really respond super, super well to rest. You've probably seen in lots of forums and stuff where people say, well, I just rested and went away. Right, do they go back to activity though? Sometimes they do, sometimes they don't. If you go back to activity, rest sometimes works, sometimes it doesn't. Overall though, like I tend to think it's better to take the approach of a specific rest. Rest the specific structure. If, and we covered the structures in other podcasts and YouTube videos, but rest the specific structure.

And the way we could do that is you do everything that you possibly can that feels fine and good. And a lot of activities, movement can be medication, it can be helpful. And so do the things that feel normal and good. Those help you keep your attributes that are going to be helpful as you go back into soccer or hockey or baseball or traveling. So you're, you're using your pain system in your body to figure out what those are. If it hurts to do a sit-up, maybe not doing sit-ups or quote unquote resting your sit-ups for five to 10 to seven days or so is fine. But maybe not resting the whole body.

Usually the timeline for rest, at least in the cute scenario, is usually going to be about, you know, seven days or so. Let's just say if you had an actual tear. Because we covered in other podcasts that some people have, a lot of people have negative imaging. There is no tear. There is no fray. There's no mechanism for it. It just starts to hurt. Or the image is completely negative and everything looks fine. In that case, yeah, you probably can rest less if there's no evidence of any tearing. If there was evidence of tearing, let's just think of a worst-case scenario. You had a little bruise develop.

You had some frays that were shown in your MRI or ultrasound. And how long should you rest then? Well, 21 days is probably around the mark where if you look at the underlying tissue, like the histology, the cells, what they're doing. For about three weeks, they're forming a crossbridge. Prior to the three-week mark, they have a gelatinous material to them. It's kind of like the matrix that is forming the crossbridge. So the crossbridge at some point links the two torn ends. And that's the body's normal way of repairing. Like that's how the body operates. Some people put a bad spin on scar tissue.

This is what scar tissue does. It's there for a purpose. You're not going to want to remove it. And so by the point of three weeks, your body has a functioning segment again. It actually allows pull across one section of the muscle to transfer to the other safely. So in that amount of time, the worst-case scenario for most people is you have a little tear. Three weeks later, it should be able to transfer load. And that's when you can start doing activity again. That's usually when pain dissipates as well. And then you can have more structured rehabilitation or reintegration of activity into your program.

Soft tissue care. Now, soft tissue care, this can be done by chiropractor, physical therapist, massage therapist. I've heard of even things like Rolfine and so on. There's various different types of soft tissue care. Let me start with that. I don't know all of them. And historically, I've seen people come in who have tried various things, generalized tissue work like self-massage. People tend to, honestly, they just try to focus on the area that hurts, which can be helpful for a little bit of time. But sometimes they actually notice it actually feels worse after. I know I've met a lot of people who have had the injury say happen today.

And then, you know, through the course of the night, they end up rubbing the area pretty aggressively. And they, you know, they get a tool and they beat on it a little bit. And the next day, they have a bruise. Personally, I don't think massaging it early is a good idea. Because how do we know the bruise didn't come from your massaging or from the actual tissue tear? Like, how do we know the quality and the severity of the injury? We don't. And in that case, you may have to go more for an image if you're considering that. But not everybody needs an image. But it's really nice to know, like, the clean aspect of the injury.

Like, is there actually a bruise that forms on its own? Because in that case, there's probably been some tissue disruption or some frame. So I wouldn't really do it too early. Plus, if we consider, was there a tear at all? Are you going to massage and rub the jelly material that's forming there? Are you going to rub and massage the actual, like, void in the muscle? Like, there's nothing to really rub it at, right? Like, you're supposed to allow the tissue to heal itself. And then you can put some forces into it, which help need the scar or whatever you might say. I think there's two types of tissue work I've found has worked historically well.

That's not to say other types won't work. But these are ones that I've found that work well. Accure-release technique. And you can go online and look for an accure-release provider. Typically, it works well, but it really comes down to the skill of the provider as well. Typically, as we kind of know about sports hernias, is there typically other factors associated to the problem, like a lack of hip internal rotation, weakness of the adductor, possibly trigger points or fixations of the soft tissue or the fascia around the area that's not specifically at the location of your problem. So a skilled active release provider will find the area of not only of concern that you have, but also other areas around it that aren't moving super well.

Back in the day, active release used to promote the idea of scar tissue removal. I think they've gone away from that recently, and it's more based upon either slide of adjacent tissues, meaning one tissue next to another. Are they separating and then sliding? Because ideally, you want to be able to move like it's greased up. And if it's not, then you put some force into it, try to separate the tissues. Fascial manipulation is another one. They call it FM. That one is a little bit more based upon fascial tracts. Some people listening to this podcast may have heard of things like fascial trains.

There's a book by Thomas Myers that's been popularized over the years. And fascia has been a conversation of interest for a lot of people with different types of injuries. And so this, with the sports hernia, like there's a fascial connection between the lower abdominal muscles through the pubic bone and through the adductors. So there's a consideration there. And there's a possibility that parts of the fascia, even in the area that you don't feel pain, may have some stickiness to it. The theory in this is that there's multiple layers of fascia. Fascia is kind of like you have a, like a chicken breast and you see like a slime on it.

That's fascia. So it's transparent stuff, but also thickens. It thickens into like covering certain sections of muscles, tendons, organs, even everything's enveloped in fascia, even nerves are. So if there's a nerve-based aspect to this problem, sometimes there's a fascial aspect too. It's a, it's a, it's a thing that helps the body move its structures freely amongst each other. But also it does have some spatial awareness to it as well. So that's a whole different consideration. Either way, there's multiple layers of fascia and there's a superficial and the deep layer. And they say that there's a layer of hyaluronic acid, which is, think of it like a, like a tar type of material or jelly.

And it's just too firm or dense in an area. Mechanical heat will heat that up and dissipate it so the tissues can move freely amongst each other. And this takes knowing where to rub, but also how long to rub. And this is based upon the person's knowledge of the fascial tracts. So fascial manipulation is something I think is helpful. Active release technique, again, is helpful. But if you find a skilled massage therapist or someone who knows how to do tissue work, you may find a gem there too. I found a lot of people with groin or lower abdominal strains where I've tried some of these other treatments with them.

And they just don't respond as quick as I want them to. I remember this one girl, she had, she had lower abdominal and groin pain that she wasn't able to run for, gosh, it was like six months plus, you know. And so I did some of the corrective exercises with her. I did a little bit of cupping. I did a little bit of adjusting to joint manipulation. And she responded, she did okay, but she still wasn't able to run completely. And we did tissue work, we did active release on her that next time and it was lights out from there. Things got a lot better. She's running close to 60 miles right now in a week and doing perfectly fine.

So usually there is a, there's a treatment that needs to be done as an entry point. Like it's, it's what unlocks the potential to do other things. From that point on, we took her into doing pogo hops, single leg strength exercises, which all helped out with her running because running is really just bouncing side to side from a single leg stance aspect. So there are other things that we did with her, but active release was the thing that really broke the mold in that scenario. Stretching, I think can be helpful, but I, I don't know how many comments I've had this on YouTube where they, they say, well, like, well, look with a, with an X, Y, and Z condition, let's just say a hip flexor strain, why are you stretching it?

You know, you shouldn't be stretching it. And I think the answer is, is it always depends. Now, if I had a hip flexor strain, yeah, maybe I don't want to be stretching it, but is it okay to stretch the hip capsule below it? So it depends what you're stretching. In one of the recent videos on YouTube, I did one on piriformis syndrome. We were talking about how you can stretch the joint. You can stretch the soft tissues or you can stretch the skin above it or the fascia. And so stretching all three may have some benefit, but then maybe stretching one of them won't feel really good or it's not appropriate at that time.

So if there, it was a cross bridge that needed to be formed and you had that bruise that formed and there was evidence of a, of a recent tear, yeah, maybe don't do things that stretch your abdominal muscles or your adductors. That makes sense, right? But it doesn't mean you can't stretch things around it, which again, variables that contribute to the problem are a lack of hip internal rotation and flexion. We know that. Why not stretch the hip joint? Is there ways to do that without involving the adductor? Yes, there is. There's a lot of them. We showed a lot on YouTube and there's like, it's essentially just localizing the stretch to a certain area.

You can also stretch the spine and that could be the lumbar spine or the thoracic spine. Both of them may hold some merit. Ideally, localizing the stretch into a certain area that is actually deficient in range is ideal. So a stretch generalized gets everything. But if you really had a deficiency of range in L5S1, which is not allowing the abs to work well or allowing the glute to work well, which makes the hip have a deficiency of range, perhaps we stretch that one segment. Or if the mid-back is stiff, leading to poor intra-abdominal pressure, which we covered in another podcast, then maybe we stretch the mid-back or a certain section of it, a certain two segments.

You can also stretch the abs at some point. I don't know too many people who have ever, I don't know anybody who's ever torn their muscle with a generalized stretch. It may hurt, okay? It's okay to have some pain after. And that doesn't mean you tore anything. But there needs to be force or a mechanism, enough load to tear a muscle. Okay, you can't tear your shoulder, sorry, you can't tear your lat by stretching your lat. You can't tear your glute by stretching your glute. You can't tear your hamstrings by stretching your hamstrings. Now, if you did splits from a chair like Van Damme, you know, or two Ottomans, yeah, that's probably enough load.

That's your body weight. That's a lot. That's a lot more. And the leverage, the pure leverage on the way Van Damme does it, yeah, you could tear it, you know, but generalized, like, just kind of going through easy stretching, even to the point where you feel a little bit of stiffness develop, there's not enough load associated to it. So I wouldn't worry too much about that. The same thing with the adductors, too. Early on, though, there's not a real big need to go through painful stretching, okay? I recently did another podcast where we're talking about should you go through painful stretching or not.

No, most people do not need to go through painful stretching to feel better. They just need to go through stretching, which decreases stiffness in the area of interest. 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. Next, let's get on the cupping here. Cupping, I think, actually really works for people with sporternias. There's a lot of evidence to show that some of the superficial neurological structures underneath the skin layer are involved, like nervy pain. People really respond to things like skin rolling the area. Again, we have YouTube videos on that. Cupping is the same thing. Cupping is really just a way to lift the skin and traction it. It's a form of neuromobilization. Now, I don't care about the bruising part.

Bruising is, in my opinion, just, it's just harder to get more cupping in the next day because you can't go through the bruise. Now, acupuncturists or other people who use cupping, they may actually want the bruise. I'm not sure why. I don't have any input on that. But in my opinion, it's just mainly the traction in the skin which helps these people. It's not an end-all, be-all, but it certainly does help out most people with pain management. Percussion guns. I've met a lot of people where the percussion guns do actually help, especially if they have a lot of sensitivity of the skin and the tissue around it.

I've met a lot of people who can't tolerate the pressure of even their pants or clothes on the area. They have to wear loose-fitting clothes around the area where they have the injury. And just the overall tension and sensitivity of the area is not helpful. Percussion guns can help. Cupping can help that. Even, like, some forms of even generalized soft tissue work can help in that area, too. Ideally, you can get rid of a lot of the sensitivity with simple things like this while that allows you to get to the root cause and get a little deeper. Like, imagine it. Like, it's going to be hard to get someone to allow somebody to do hard soft tissue work in an area that you may need it on the side of the hip, let's just say, that you can barely tolerate the pressure of your own pants on it.

So, desensitizing the area can be really helpful to get to other entry points that you may actually need. The next thing is ice and heat. I'm going to include this, but I don't think there's a lot of value to it. A lot of people do use it. I had a guy just yesterday I talked to where he said, dude, heat really helps me. And I said, okay, use it. And he said, what about ice? I said, does that help you? He said, no, don't use it. You know, I personally, I think the position that people lay in to put the ice or heat on is the more valuable part. I've met a lot of people who sit and they have their symptoms while sitting and they lay with a heat or ice pack on their back while they're sitting in a chair or a lazy boy.

And they say, well, it doesn't feel good. In contrast, we just, I just asked them to use the heat or ice while laying in a face down position. And all of a sudden it helps them. Personally, I think it's the position. Now, there is science to show that ice and heat can help out with pain. Okay. It's, it's, that's not going to really be refutable or at least nothing I've seen at this point in time. All it does is it, the, the sensation of heat or ice or temperature gets the brain quicker via the same pathway as pain, as pain does. So pain is generally a lower pathway. It's as low, it's a lower freeway to get there.

And so the sensory that you get from heat or ice actually beats it there to the same part of the brain, which interprets pain. So it actually just overrides it. But when the sensory goes away, pain just comes back. And that's not something that can be, that's something that still can be useful. You know, it's, it's always nice to get a relief from it, you know. And I know a lot of people who feel just like mentally tortured, like it's preoccupying their mind, the pain is. And so there's nothing wrong with taking a break. Obviously with heat or ice, there's a time thing with it. You can't go super long or else you'll create like an ice burn or a heat burn.

So make sure you use them appropriately. Corrective exercises. I do think there is a big value in this. I've met a lot of people where essentially we use the methodology where movement is medicine. And we get them moving. We give them specific things to do based upon the exam that we've, that we've done. There are certain things we won't give them to do. A lot of people with this type of condition don't fare well with Copenhagen, like a side plank with the knee or the adductor, or they don't fare well with sit-ups. I'm not going to program those things in their program. But it doesn't mean we can't do other things to stimulate the ab wall to work in unison.

And it doesn't mean that we can't challenge the adductor either because we do know from a past podcast that adductor weakness is part of it. So we've got to challenge it at some point. But it doesn't do any favors to just work through pain to try to get these things. And it'll probably just make you feel worse. So corrective exercises, if you find ones on YouTube or Instagram or the internet, I'm not saying these things are wrong, but they're also not customized to you either. And everything comes down to context. So generalized exercise programs or corrective exercise programs can help. Typically, they come in the form of like 10 to 15 different exercises.

I don't know about you guys. I won't do that many. If I was in intense pain, sure, I would be a lot more motivated. But if it was something that just bothered me on a Sunday after I play and I feel it the next day and it starts to dissipate over the week, I'm probably not going to spend every day doing 15 exercises. It's too much time. Now, if you narrow that down into actually other exercises that I only spend maybe five minutes on per day or every other day and I still had the same benefit, would I do that? Yeah, I'd probably be more willing. If you're a father or a mother and you have kids, like you know that you're not going to spend all this time and you get preoccupied.

So for mothers and fathers, what we usually ask is, can we get five minutes of your time every day? And can you do these exercises? And that's it. You know, go for a walk, take your kids for a walk and just do something else that feels good. So there's things, there's attributes or principles, I think, that work very well in corrective exercises for people with sports hernias. For some cases of, say, like, discogenic pain, disc herniations, disc protrusions, some people fare very well to what we call bracing and creating stiffness. Bracing is one form of stabilization of the core. And bracing actually comes with a side effect of compression.

All right? There's nothing wrong with compression as long as compression is helpful. The way you're going to know if compression is helpful is if bracing, you feel better and or if you feel worse. As a common theme, I've seen that people who have been around the block a little bit with this injury tend to brace because they think it's appropriate. But to get them to stop bracing is really hard. It takes some coaching. So this is why intra-abdominal pressure or diaphragmatic breathing can be helpful. It changes the strategy for stabilization in the core, which helps to mend and decrease the amount of insult to the area of your current injury.

While bracing may have been helpful for your old injury, whatever that may have been, it's probably no longer useful at this point in time. Diaphragmatic breathing actually is more of a decompressive aspect for spinal stability or core stability. It all has its time and place, as I typically explain it to people, is there's different forms of armor. Essentially, your bracing or your breathing or your pressure or none at all really comes down to how much armor do you need for the activity at hand. Some people have no idea how to form different types of armor. Now, the concept of armor, when I explain it to people, I usually talk about like the old medieval times.

Medieval times, like if you're currently in a fight, you would probably wear some type of armor. Now, if I'm eating dinner, I just have my, I think they're called gambits. Gambits is like, it's like a softer material that goes underneath your armor. That's going to be the analogy of just breathing, relaxing, chill, you know, being able to breathe, not in a hyperventilating way, being able to lower your breath or breathe into the abdominal area. That's layer one, the gambit. Layer two is going to be chainmail. Chainmail is more reserved for like, like they'll stop things like probably, you know, daggers and knives, but they're not going to stop like, I forget what it's called when you, jousting.

Is it jousting when you have the, ride the horse and you, so that one, it's not going to stop that, right? But it's perfectly fine for the other thing and holding your pressure, creating intra-abdominal pressure, regardless of respiration cycle is chainmail. Next thing is hard armor. Hard armor is required for jousting or things like that. And hard armor carries a cost. It's heavy. You can't move as much. It's bracing. That's what bracing is. And bracing is used for like when you're picking up a house, when you're deadlifting heavy. But you need to learn how to layer your armor. Most people only use bracing as a means to stabilize, which carries the compressive aspect, which does create this type of scenario to happen.

Generally, as a theme, when we try to rehab someone out of a sports training, we try to make sure that they do have control over all parts of their armor. Because we do know in the mechanism, part of it is, comes down to poor intra-abdominal pressure. And through some of the ultrasound studies, they found that there's latency of the transverse abdominus, so the deep core. They've also found that the transverse abdominus muscle is also smaller in size on most individuals too, which that attaches to the internal oblique via the conjoined tendon, which is kind of where the injury happens. And so it's poor pressure management.

We also know too, if we're going to improve someone's internal hip rotation, we have to get better core support. So this is an important part. So regardless is if you find soft tissue or stretching or rest helps you, the part of the key to making sure that it doesn't come back is going to be some form of coaching of corrective exercise with typically some armor building. Okay, so I think corrective exercises for most people is really not a negotiable part. Like it's, I'd say for people that I've worked with the sports trainees, I would say it's at least 95% of people require some form of coaching of this.

Whether they have surgery or not, this is something which was absent typically if I were to reverse engineer the actual injury itself. So if you guys are looking for something like that, we do offer that performance based virtual or in person as well. Now we're going to get on to things that I don't know much about, but I'm going to give you as much information as I know. Regenerative injections. So regenerative injections, I would consider it a building injection. A lot of people have probably heard of things like stem cell, PRP, or maybe even prolotherapy. These are things that allow the body to rebuild.

I don't know if there's any evidence to support it. I really don't. I know in some scenarios, PRP and prolotherapy are supported or stem cell is supported as well. When other ones, they're not. It's really up to you to do your due diligence. But I can tell you if it were me and there was actually something that was not really attached there super well anymore, or like the tendon was still attached, but there was lots of fibers of the muscle detached from the tendon, I would consider that maybe if I could rebuild that area, I may invest some money to do so. It wouldn't be my first step. I would see if other cheaper things would probably work first.

And I would probably see if intra-abdominal pressure works first. I, for the cost benefit of each, for a good program of how to actually do your exercises, it can run you between, you know, $1,000 to $2,000, sometimes even less. For regenerative injections, like, it's steep. It's quite steeper. I think each injection, if I recall, for PRP or stem is going to run you around, you know, like around $2,000, $5,000. And it's usually a series of injections, I think. Prellotherapy is cheaper, but this is something I would probably more consider if there was a confirmed large tear of part of the tissue, whether it be the adductor or part of the abdominal wall.

And that's going to be up to your doctor at that point to see if you're a candidate for that at all. But I think regenerative therapies need to be understood as different than anti-inflammatory injections, which I'll cover next. So anti-inflammatory injections are for the opposite means. They're really not intended to build up anything. They're intended to cool down something. For some people who have more of a neurological aspect to their problem, like meaning that the nerves underneath the skin, ilio-inguinal ligament, or sorry, ilio-inguinal nerve, ilio-inguinal, sorry, ilio-hypogastric, or genital femoral nerves, they may find that something like an anti-inflammatory injection may actually calm their pain quite a bit.

I apologize. I've been talking for, I think, 45 minutes here, I feel like. There's a lot of information to go through. I'll do my best to slow it down. But for those of you who are struggling to find any relief whatsoever, something like this may be more of benefit. I would suggest if it were being done to me, I would want to make sure that the injection is hitting the location of interest, which means that they'll probably have to ultrasound guide it. I know quite a few sonographers who work for places that ultrasound guide injections to make sure they hit the right areas. Because I think it'd be really frustrating if you got some injections done and nothing changed.

How do you know you hit the right area? I mean, those nerves aren't very big. Some people even have a referral into some of these areas from the facet joints in the back. It'd be nice to know that you're hitting the areas versus blindly going in. So I think, I don't know if it's currently the standard of practice, but I think it should be. I think if we're going to inject into an area, at least for your knowing that you hit the right area, and you can kind of put this idea to rest that it works or it doesn't, or even confirm the structure which is creating your pain in the first place, it'd be nice to know that the medication bathed the correct area, and actually it had the result that you're looking for.

If it didn't, then maybe we're looking at other conditions, labral tears, hip impingement, hip arthritis, joint infections. So there's other things that aren't being injected that still could create pain into that area as well. So I'm not against anti-inflammatory injections, but this certainly wouldn't be my first step. There's a lot of other things I've seen people benefit from that are less invasive, less costly, and I think a better long-term approach. I'm not saying everybody that does injections is, you know, this way, but a lot of people end up, they're very motivated by their pain. If they're motivated enough, they'll do the injections or they'll do anything that you ask them to do.

You know, so you have a captive audience, which can be good and bad. Ideally, you know, you guide them to the right thing and you find the easiest, lowest risk, best long-term benefit thing first. But if you can't, injections can certainly be the way to decrease pain and give the person some sanity. It's hard sometimes when you do the injections with people that, because if they feel better, oftentimes they won't do the other things that I mentioned before. They won't strengthen the adductor. They won't work on intra-abdominal pressure, which eccentric loads the pelvic floor, which eccentrically loads the transverse abdominus, which helps out with pressure management over time.

They won't work on improving internal hip rotation because their pain is gone. And the general public tends to understand that pain is the enemy. We can change that scenario or change the narrative. Pain is actually there to help you recover. You know, it's not convenient, but also it's very motivating. Pain is a good measurement tool to figure out if the treatment planning that you're doing is appropriate or not. And if it's not, then it's going to remain, you know, for the most part. So I would just be cautious on it for any of the things that reduce pain quickly, if via the means of medicine or rest, because they really don't.

These things are what we call passive therapies. They're things that you don't really have to do. They're things that people do to you, and they don't change the mechanics of how your body got that way in the first place if it wasn't trauma related. Obviously, time and place for regenerative, anti-inflammatories. I don't want to seem like I'm downing them, but I just want to caution you guys that there are a lot of benefits from doing active care or manual therapies prior to doing these things. And you may be surprised how well they work. Okay. Weight training is next. These I'm going to go for this is just two basic things with this.

There's what we call general physical preparedness, is if you're not physically able and you're deconditioned and you're just not very active overall, weight training can actually improve a lot of your problems. Obviously, you don't pick exercises which make the area irritated, but we've seen time and time again, you know, people with knee pain, they lose weight. They feel better. People with back pain, they feel better too. People who do 10,000 steps in a day report half as much pain, musculoskeletal pain, as those who don't walk 10,000 steps. Zone two cardio is also very helpful. I know it's not weight training, but it can help.

And maybe not to the point where you do it where you're in pain, but, you know, you cluster it up a little bit. There's also people who are generally physically active, have less onset of osteoarthritis or development over the years too. So there's a lot of benefits to it. I'm not just saying it'll be like this most specific treatment for this, but certainly to, if you are generally physically not prepared, I would consider having someone coach you through things, easy exercises you can do on a daily basis, just kind of getting a head start on things. Some of you actually may feel better from this and it may not take more than 30 minutes of your time.

An hour would probably be a lot to ask of people in the beginning. I prefer to, for that people work in bite-sized chunks. If you have not weight trained or done any physical activity for a long time, asking you to dedicate five hours a week is a lot. I would suggest 30 minutes, two days a week, build that up to 30 minutes, three days a week. Start with walking, you know, start with walking outside for about an hour and then start getting into a little bit of weight training. There's a lot of evidence to show that weight training and general physical activity can help, not only with musculoskeletal problems, but over the long term.

And this is what we talked about earlier about goal setting is if your goal is to be able to go on a road trip and travel with your husband or wife, and this is something that's stopping you. Something also that will stop you is diabetes or heart disease or knee pain. So ideally, you start to condition your whole body as a whole. And if you can get away with working around your current injury while doing this, you're actually ahead of the game. Surgery is the next thing. This disclaimer again, I'm not a surgeon, and you have to talk to your surgeon about expected timelines and so on. I know there are not a lot of places to do surgery on a sports hernia.

There are a few places that are more well known for it. I've heard of people traveling between different states to get this type of care. Some of the evidence that I saw, at least over the last couple of years, we were doing a research update in the office to talk about the recent things that have come up, what's the success rate of certain types of treatments or lack thereof and so on. And a common theme came up over the surgery topic, and it was mainly revolving around, do you repair the sport training itself only, or do you actually address the hip too? And so it seemed like the success rate of adding a hip surgery in addition to abdominal repairs actually was like the ticket.

I want to say, if I recall the numbers, it was something like only doing the abdominal wall was like 30% success rate or something like that. Doing the hip as well, I think it jumped to like 70 or 80. It was higher. And they're basing this based upon, again, the mechanics. Do you have the means to take workload away from the area to get it to stop re-aggravating? Hip internal rotation or function is a big part. I'm not telling you you guys need to do two surgeries necessarily, but if you had hip arthritis, release your hip arthritis on one side, there was a lack of range of motion. And because of that, then doing something to the hip may be useful.

Now, if you have just a lack of hip internal rotation, you're 15 years old, and there's no evidence of osteoarthritis, no labral tears, there's just something like hip impingement. This is a rehab case. The hip is a rehab case. So, whether the abdominal area is or not, there's ways to improve your hip internal rotation function overall without surgery, okay? So, just take that as intended. The surgeries are needed for some people, usually with some type of tissue deformity. You'll usually have a bruise associated to it as well. And when it first came on, I met a guy who had a tear of his adductor.

There was a big bruise and swelling and blackness of the skin associated to it days after. That's usually the scenario where I would see that there's going to be some type of tissue deformity or possibly something like resolving an internal blockage of the hip maybe in order. A labral tear, like a large labral tear, which is limiting range of motion. By the way, labral tears don't always hurt. They just limit range. And it's usually going to be like a stiff block. Osteoarthritis, also a stiff block. It's not like it gums around and there's range of motion that you can get and then it goes away the next day.

It's usually just not there. And so those are things that maybe something like a debridement or even a hip replacement may be in call for. And that would take workload away. And a lot of people, for as much as like, you know, like people poo-poo on things like surgeries is like, oh, I don't want to have surgery done. There's a time and place, man. Like there's, I've met multiple people who have put off things like a hip replacement. And you can see like by their movement, like at first exam, you can see like something's going on in there. Even with that image, you can tell. And then if they got that hip range motion back, what quality of life would they have after?

Like probably really good because right now they're not very happy and they can't do anything, you know. So there may be a time and place where something like if you assess your quality of life now and you've tried a lot of things and it's not improving, something like a surgery may be helpful and it may be exactly what you need. The last thing we're going to cover is a change of activity. I like to let people know if they're willing to hear it, that there are some of their old habits. Okay. We don't get overweight on accident. We don't develop these injuries on accident either. These are a sum of our old habits or a sum of our old habits plus the movement deficiencies that we have.

So if you're doing an activity that you know contributes to this, it may be a time to change the volume of it. I'm not saying that don't ever play soccer again, but perhaps playing soccer once a week is not working. Perhaps you actually play a little more, okay, because I know I'm sore as heck the next day for two days after playing sport on Sunday to the intensity that I want. I remember playing baseball in high school five days a week, perfectly fine. I felt fine and I don't want to talk that up too active, just age, but when I started adding baseball a second day of the week, actually I felt a lot better overall.

My hips stopped hurting, my hamstrings stopped hurting. I overall felt better, okay. So doing more sometimes, but also sometimes doing less. If you're doing, if you're playing soccer five days a week, you know, and to a really good intensity and you're 60 years old, perhaps there's a time and place to set realistic expectations and just scale back a little bit and see if that helps you too. I'm not, I would never tell anyone they're too old to do something, but I think there, we all do know that there are effects associated to aging. Usually in my opinion, it's recovery. It doesn't mean you can't sprint.

It doesn't mean you can't do headers. It doesn't mean you can't kick. But your recovery is different. And I think that mainly revolves around hormones. There's a reason why people feel better when they have testosterone added to their system. There's a reason why people have, there's so much money dumped into like hormonal therapy for longevity and like how people feel aging. I don't know if I'll ever do it, you know, but I do see a lot of people who say, man, I feel like Superman now that I got testosterone and they balance my hormones. I don't know the long-term effects of that, but I do know that people may have to adjust their activities based upon realistic expectations for age and recovery time.

Okay, so these are the things I think are the most relevant treatments out there. I didn't cover acupuncture, but I did cover cupping. I don't know much about kneeling, so I didn't cover it. I know I didn't mention physical therapy or chiropractic, but it doesn't mean they can't do recommendations for rest and soft tissue and stretching and cupping and corrective exercise. These are all things that can be done. I mentioned joint mobilization, which can be done self or assisted. So I like to think that I even know actually a physician's assistant who actually they do active release. I knew a medical doctor who does active release.

There's things within each person's scope of practice that can actually, it's really dependent upon their skill set. Like they don't, their degree coming out of school does not mean as much as like the things that they've specialized with over time. So if you find someone specializing in these things, don't worry about their degree quite as much. Even personal trainers, like I mentioned, the weight training part, general physical preparedness, that's something they can do. They can suggest stretching and they can suggest even corrective exercises. So there's a lot of things that people with different degrees can do.

It really comes down to skill set. So find someone that you feel comfortable with. Ask them the critical questions like, what is the timeline for recovery for me and my condition? Have you seen other people with this condition before? And if you were me, what would you do? I think that one's a really valuable question at the end because I can't tell you how many times people have asked that to their doctors and the doctor gives them a different recommendation than what they give the person. I don't want to say just doctors, chiropractors, physical therapists, trainers, everybody, right? Everybody should be treating you as they would treat their self or a family member.

So ask them what they would do if they were in your situation. I think that'll really get down on the brass tacks of what is going to be helpful. 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.