The Biggest Mistake People Make With Sports Hernias

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. The biggest mistake that I see people make with sporternias, athletic pubalgia, groin strains, or abdominal strains, and we would classify this as like an anterior chain injury.

That's all kind of one sling. And I'll go a little bit into detail about this today, but also not blow everything out of proportion because there are references that you can go more in detail with. We have a free book for a sports hernia that is on the link description for the video. It's intended to educate you more and also show you a lot of the methods that we use and have had success in helping people with it without having to send them out to surgery. So the biggest mistake that I see people make with these types of conditions is they load the affective tissue too early. So let me give you some examples of this.

And also, I'm not going to go too much into detail about what the difference of these conditions are. That's topics for other podcasts that I've gone more in detail with as well. But generally, just know that they're kind of like in the same category of an injury. The anterior sling is almost imagine like you were throwing a javelin or a baseball. It's the front of your body that is kind of in this bow position. So it's a sling of tissue that incorporates muscles and fascia and other things too that go from the shoulder all the way down the abdominal area to the groin, to the foot to transfer load to the object through propulsion to the floor or the ground.

So these injuries are really, really common. And the biggest mistake that I see people make with them is they load the affective tissue too early. So I'll give an example with a groin strain. Let's just say, and by the way, this all comes down to context and timelines and stuff like that, because this answer may be slightly skewed because of a different timeline or different type of case or a different severity of case. But let's give an example of a groin strain. And let's just say when you were doing your sport or activity, you felt a pop. The pop also followed almost immediately by the inability to walk or move the leg fully.

And you started to notice the next few days that you had bruising, you had swelling there into the upper thigh area. And this is more indicative of actually more of a actual tissue tear, whether it's to the tendon or the muscle or the fascia that's debatable. But either way, my opinion and the opinion of a lot of people I know is that if a bruise forms, then something has torn. There's actually bleeding involved. And so the bleeding involved insinuates that there's actually a disruption of the tissue there, meaning that there's actually been a substantial injury. It's not disabling, but it certainly needs a little bit of time to rest.

So in the beginning, the biggest mistake that people make is they think, you know what? That area feels really tight. I know it's a little bruised and I think I'm just going to start doing adductor exercises or they start stretching the adductor. Either way, stretching or a Copenhagen or adductor machines at the gym are all forms of putting load through that tissue. When I know that when I tore my hamstring and I did a podcast about it earlier this year, by the way, I know I haven't done an update, but I have fully recovered. I'm able to sprint again. And that was, I think it happened at least three to four months ago and I feel perfectly fine.

Although I know that there's risk factors I need to address. I also took a good three, four weeks off of actually loading that tissue because I couldn't deadlift, which is hamstring dominant. I could barely walk upstairs, which bending the knee puts load through that hamstring as well. I didn't stretch the hamstring. I didn't provoke it. And that's because the timeline to allow the tissue to get load through that tissue required a little bit of time to mend. It needed some time. What's wrong with giving it some time? So, but as I learned, people tend to do this very often. And it's not to say that it's like everybody's a dum-dum or anything.

Personally, I think that there's some human nature to, let's just say, if I was lost in the woods, I would probably try to find my way out, right? People try to do something. And I think the saying is with search and rescue, like you could try to, you'd go to the last spot the person was sighted, but also be under the assumption they probably made a decision to try to move around and go somewhere. Like they looked up and saw a cell tower and they decided to walk towards that, even though it may have gotten them into a worse situation. Most people left up to their own devices will try to do something.

And I think common sense, at least seems like getting the tissue to work or stretch or activate is the first go-to. Now, I'll tell you why it's a mistake. And I did mention that the tissue may not be ready for that type of load, which is scenario one. Scenario two may be that the tissue is more active already. It's already very willing to help, which is not really in a scenario where there's a tear of tissue, but it's an overactivity of tissue. So essentially, if you do more adductor work without getting other areas to cooperate and do their job, you're making it so that area may be more and more tight, which we know by, if you do some weight training, you know that the long-term effect is stiffness of that tissue.

Like if you had someone who's super, super flexible, if you do some strength training with them, they'll probably, their flexibility will reduce. And that's not a bad thing always. It's just an effect of that tissue being challenged over time. So this happens over a long time. And if you keep challenging that tissue and encouraging it to be more stiff, more overactive, more tonic, more willing to do the work, then you may be emphasizing or what I call endorsing a movement pattern, which is already corrupted. Okay. Now this isn't to say you can't do anything. For me, with my hamstring tear, the very next day, I needed to go to work and I did sissy squats with somebody.

I had to demonstrate it. And I realized, hey, I can do this. Actually, it didn't hurt at all. I'm going to do it. And I did it with 35 pounds. I did a bunch of reps. I did it with the person because they wanted me to do it with them. And I had no pain. Now we can say, well, that's stupid. Like you need to rest. Not really because I am actually still abiding by the principles of not loading the symptomatic or torn tissue. By the way, I did have a bruise because this is knee dominant. And I told a trainer friend of mine and he's like, that makes complete sense. It's knee dominant. It's quad dominant.

So you're challenging the quad. That's the biased tissue. Not to say the hamstrings aren't working. They are working, but they're not the ones that are doing most of the work. So I'm not disobeying these principles. And so with either scenario, it doesn't mean that you actually don't do anything, but it means that you may have to scale back quite a bit on certain types of activities and prioritize other ones in your training program. So in the book that I wrote, I discussed in the strength and conditioning category about how loading the sagittal plane, if you don't know what the sagittal plane is, just Google that, loading the sagittal plane is sometimes a problem because that is where the corrupted pattern is.

And so things like back squats and jumping and sprinting and things like that are kind of a little more of a sagittal plane movement because you're driving forward through the sagittal plane. And it doesn't mean we can't load the hip and the body in different planes. We can do the frontal plane, for example. The frontal plane is a very neglected one that can be used as a preventative type of training program as well. You can do it very early with many different types of conditions. You can do it pretty heavy with many different types of conditions even early. An example, although it's still in the sagittal plane, the sissy squats for my hamstring tear.

I could still do it very quickly. And this keeps the rest of the body online. It also breaks some of the movement pattern tendencies to dominate with the anterior chain, which is the one that's problematic in the first place. 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 do show videos of how I do this in that book. So please look at it if you're interested in it. Again, these are all starting points. I wish I could say that every single person had the exact same reason and risk factors associated to their problem with their groin or their abdominal area, but they don't. Everybody's a little bit different and we even cover in that book a screening process that we do to identify risk factors. Most people have some stuff in the hip, stickiness of the hip, past injury of the hip, limited range of the hip, limited function or strength of a hip, which is a risk factor.

A lot of other people have poor intra-abdominal pressure, but some don't. So if you want to spend your time wisely, you have to identify the risk factor, build that into your training program, and then try to address that risk factor regardless of pain levels or not. I know if I drive fast, it's a risk factor for wasting gas. It's going to probably result in wasting gas. If I break too hard, I can assume that that habit or that risk factor is going to land me with break jobs more often. Don't be surprised. So addressing those risk factors are a way to keep tabs on your injury, but also prevent reoccurrence.

Okay? I am never a fan of telling people that things will never happen again. They will. Sports injuries, abdominal strains tend to happen again, but ideally management over a long period of time ends in less occurrent flare-ups, keeping the person physically active sooner than later, and knowing when to shut things down in lieu of adding them back in later. So before I end up going, because I'm almost at work, let me give you more examples of the big mistakes that people make with the same loading the tissue too soon. So we know that sit-ups for most people, I think 75% of the people with sporternias don't tolerate sit-ups well, and that's because it's part of the anterior chain.

So the sit-ups, crunches, Russian twist, V-ups, all of these things are probably going to irritate the tissue. I'm not saying everybody can't do it, and you've probably seen a lot of our YouTube videos, by the way, check out our YouTube channel, we have tons of free resources there too, that we do show versions that we do, but remember, it comes down to context. Is it too soon to load the tissue? You can't avoid it forever, but you have to at some point. So those are all ones, the abdominal ones that tend to not work well. The isometric ones work better, like planks or side planks and things like that, mainly planks, buttress planks, ab wheel rollouts, those are all isometric versions.

They're not bad, but for a lot of people that I've worked with early on, those are ones that we really have to tinker with quite a bit. And we have to coach a different group of tissue to help out with making that become non-symptomatic as well. So in my opinion, most of the time, exercises that you use or stretches that you should not duplicate symptoms, they should not make things worse, you should not feel worse after it, you shouldn't feel worse during it. In a slight different subcategory, some people with tendinopathies, we may notice that for our first couple sets, but for people with strains and overactivity, we really shouldn't.

We're trying to encourage other motor patterns to work better. We're trying to make other tissues work better. In that case, the outcome is that the exercise doesn't really hurt, it can just be hard. Side planks are really nice to do a lot of times. Wall wedges are nice to do. These are all in the book. Ones that don't really work super well are flutter kicks or things where you're on your back or put in the category of your quote-unquote hip flexor strengthening ones. These ones tend to not work super well and groin stretches tend to not work super well unless done in a specific way. If these are things that you're doing, just know that they're not bad again, but you're choosing to do ones that are probably not the lowest hanging fruit and they can encourage other tissues to work harder or the cinnamon tissue to work harder and it may set you back a little bit.

I've known a lot of people who once we first reduce the amount of time or reps that they're doing with those, even if we don't take them away completely, they significantly get better just by not doing things that provoke it. Now, devil's advocate, people may say, well, you can't avoid doing that forever. I'm not saying that. I'm saying for now, let's reduce the amount that we're doing in lieu of putting things back in later and some exercises you may actually find aren't worth it. There's some exercises that carry more risk than reward for certain types of athletes. In that case, don't do it.

A good strength conditioning coach can come up with many different ways to challenge the tissue that you were interested in without creating pain or discomfort in the process. 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.

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