12 Truths About Sports Hernias Your Doctor didn’t Tell You

1. Occurs in sports with cutting, pivoting, kicking and sharp turns

These types of motions are commonly found in soccer, hockey, tennis, football, and field hockey.

2. Sports hernias have a slow onset

A slow onset means it is not traumatic.

No body has to hit you.

You don’t have to fall.

You don’t have to hear a pop.

It occurs slowly meaning it is very preventable.

3. Pain is one sided (unilateral) around the groin/ pubic bone

The pubic bone is the bone at the very bottom section of the abdominal area.

Many muscles of the pelvis and abdominal area attach here.

Pain is usually only on the one side so if you have pain on both sides you could have another injury type.

4. Pain can radiate to the upper thigh

“Referred pain” happens with many different types of conditions.

Even injury to an organ like the heart can create radiation of pain.

Sports hernias refer to the front of the thigh and into the quad muscles.

5. The pain is “Hard to pin point”

Not being able to find the source of pain is extremely common and a very characteristic symptom of a sports hernia.

If you can not locate the apex of the injury yourself you should investigate the possibility of a sports hernia.

6. Pain or tightness can be felt in the scrotum

Obviously, this is just for the guys.

I have heard athletes say it feels “tight” or “numb” even into the ball sack.

Don’t ignore this one.

7. Other AKAs for a Sports hernia are:
  1. Sportsman’s Hernia
  2. Athletic Pubalgia
  3. Gilmore’s Groin
8. Top 4 diagnosis it can be confused with are:
  • Adductor Longus dysfunction
  • Osteitis pubis
  • Hip Joint Pathology
  • Hernia
9. Dynamic Musculoskeletal Ultrasound (MSUS) can confirm the diagnosis

An ultrasound is one of the best ways to know exactly the injury you are dealing with.

I know this images doesn’t look like much but it assists us in recommending the right treatment plan for you.

Here is an example:

Ultrasound Sports Hernia

Ultrasound of Sports Hernia

10. Rehab can be slow, frustrating and even unsuccessful

Bummer huh.

That’s the nature of the beast. Rehab can be very slow but the great news is if you rehab and it is a fast recovery you probably had something else.

You could have had hip impingement or hip flexor tendonitis.

Even more of a reason to confirm your diagnosis.

11. Rehab can include:
  • 6-8 weeks rest
  • ice/heat
  • sports massage
  • electrical stimulation
  • progressive hip strengthening
  • hip stretching exercises
  • correction of movement patterns
  • incorporation of sports motions starting slow to quick
  • gradual return to play
12. Surgery is suggested if rehab is unsuccessful.

The great news is surgery can be extremely successful but I would caution to not jump in too fast.

A successful sports hernia surgery would be an unsuccessful surgery on a hip labrum or other conditions that could also be causing your pain.

Read the rest of the article to find out how we can confirm a sports hernia…

What can I do to get better?

I created an 8 week video rehab course I give to patients after their exam. This is a framework I use with my patients who have a sports hernia, and with the right form and education, can help with your injury.

What is a Sports Hernia?

Sports Hernia Infographic

The term “sports hernia” is becoming mainstream with more professional athletes being diagnosed.

The following are just to name a few:

  • Torii Hunter
  • Tom Brady
  • Ryan Getzlaf
  • Julio Jones
  • Jeremy Shockey

If you follow any of these professional athletes, they all seem to have the same thing in common:

Lingering groin pain.

If you play fantasy sports, this is a major headache since it seems so minor, but it can land a player on Injury Reserve on a moments notice. In real life, it is a very frustrating condition to say the least. It is hard to pin point, goes away with rest and comes back after activity, but is hardly painful enough to make you want to stop. It lingers and is always on your mind.

Here’s a quick link jump to the sports hernia rehab section of the article for those of you who just want rehab concepts.

And if you’re looking for my step-by-step sports hernia rehab video course here it is.

One the best definitions of Sport hernias is the following by Harmon:

“The phenomena of chronic activity–related groin pain that it is unresponsive to conservative therapy and significantly improves with surgical repair. 4”

This is truly how sports hernias behave in a clinical setting. It is not uncommon for a sports hernia to be unrecognized for months and even years.

Unlike your typical sports injury, most sports medicine offices have only seen a handful of cases. It’s just not on most doctors’ radar.

The purpose of this article is not only to bring awareness about sports hernias, but also to educate.

Will you find quick fixes in this article for sports hernia rehab?

Nope. There is no quick fix for this condition, and if someone is trying to sell you one, they are blowing smoke up your you-know-what.

Sports Hernia

Is there a way to decrease the pain related to sports hernias?

Yes. Proper rehab and avoidance of activity for a certain period of time will assist greatly, but this will not always stop it from coming back.

Pain is the first thing to go and last thing to come.

Do not be fooled when you become pain-free by resting it. Pain is only one measure of improvement in your rehab.

Strength, change of direction, balance and power (just to name a few) are important, since you obviously desire to play your sport again. If you wanted to be a couch potato, you would be feeling better in no time. Watching Sports Center doesn’t require any movement.

Why is this article so long?

There is a lot of information on sports hernias available to you on the web. However, much of the information is spread out all over the internet and hard for athletes to digest due to complicated terminology.

This article lays out the foundational terminology you will need to understand what options you have with your injury. We will go over anatomy, biomechanics, rehab, surgery, and even the fun facts.

The information I am using is from the last ten years of medical research, up until 2016. We will be making updates overtime when something new is found as well.

So link to this page and share with friends. This is the best source for information on sports hernias you will find.

Common Names (or Aliases?) for Sports Hernias

  • Sportsman’s Hernia
  • Athletic Pubalgia
  • Gilmore’s Groin

How Do You Know If You Have A Sports Hernia?

  • Typical athlete characteristics:
  • Male, age mid-20s
  • Common sports: soccer, hockey, tennis, football, field hockey
  • Motions involved: cutting, pivoting, kicking and sharp turns
  • Gradual onset

Anatomy of a Sports Hernia

Bones of the Groin Region

  • Ilium
  • Ischium
  • Pubis
  • Sacrum
  • Coccyx
  • Femur

Joints of the Groin

  • Public Symphysis
  • Femoroacetabular Joint
  • Sacroiliac Joint

Cartilage of the Groin Region

  • Public Symphysis
  • Acetabular Labrum
  • Hip Articular Cartilage
  • Sacroiliac Joint Articular Cartilage
  • Triradiate Cartilage Complex

Ligaments of the Groin Region

  • Inguinal Ligament

Muscles of the Groin Region

  • Adductor Longus
  • Transversalis Fascia
  • Rectus Abdominis
  • Internal Oblique
  • External Oblique
  • Iliopsoas
  • Rectus Femoris
  • Pectineus
  • Adductor Brevis
  • Adductor Magnus
  • Gracilis
  • Tenor Fasciae Latae
  • Piriformis
  • Gluteus Medius
  • Gluteus Maximus
  • Biceps Femoris
  • Semitendinosus
  • Semimembranosus
Bones Sports Hernia
Cartilage pelvis
Muscles groin

How a Sports Hernia Develops

Chronic groin pain typically happens over time, which is why with sports hernias, we do not hear many stories of feeling a “pop” or a specific moment of injury.

It is thought to be the result of “overuse” mechanics stemming from a combination of poor strength and endurance, lack of dynamic control, movement pattern abnormalities and discoordination of motion in the groin area.

There is a lot going on in the groin area.

There are lot of muscles, tendons and fascia pulling in different directions. These contracting structures need to coordinate together for any athletic motion. This is also known as the injury prevention model.

Over 100 research articles on sports hernias point to the “overuse” model as being a probable cause of the injury 13, which also means it is preventable.

We believe it is a secondary level injury.

Repeated shear force coming from the hip adductor pulling against a weakened groin region (internal oblique and transversalis fascia) lead to a sports hernia.

“So you’re saying strengthen the abdominal muscles?

Not exactly. Think of the area as a “complex.” Everything works together. This includes the hip.

Hip range of motion has been found to be associated with chronic groin pain and injury to above named abdominal structures. 4,14,15

“So we need to stretch the hip?”

Maybe, but more so, just remember that your sports hernia was not an accident. It was not bad luck, because it is a preventable injury.

We can test hip range of motion and strength.

We can test abdominal strength and endurance.

We can look at how well or poorly you move. How well you squat, lunge, and change directions on the field.

Sports hernias, like most “overuse” sports injuries, are in theory preventable if we correct your “problem areas” before the injury begins.

Entheseopathies (inflammation of the tendinous attachment to the bone) can also be found in many groin pain patients. This means this is not a “new” condition. It happens over a period of time and taking preventative steps should not be neglected.

Sports Hernia Symptoms

  • Unilateral groin pain that can radiate to the area between the genitals and anus or the upper inner thigh
  • Pain radiating to the scrotum and testicles

What Else can Cause Groin Pain besides a Sports Hernia?

Want to know if you have a sports hernia for sure?

It’s tougher than you would think.

As of 2016, when this article was written, we still don’t know exactly how to test for a sports hernia with an orthopedic test. Orthopedic tests can be as simple as a muscle test or moving a joint in a doctor’s office.

Testing for sports hernias can require more than one test to diagnose, and often times, require an image to be taken. The area of injury is so dense with structures which could be the pain generator, it is hard to isolate each via orthopedic or muscle testing.

For groin pain we have to consider these top five diagnoses:

Adductor Longus dysfunction

Osteitis pubis

Sports Hernia (aka sportman’s hernia)

Hip Joint Pathology

Hernia

Repeated shear force coming from the hip adductor pulling against a weakened groin region (internal oblique and transversalis fascia) lead to a sports hernia.

“So you’re saying strengthen the abdominal muscles?

Not exactly. Think of the area as a “complex.” Everything works together. This includes the hip.

Hip range of motion has been found to be associated with chronic groin pain and injury to above named abdominal structures. 4,14,15

“So we need to stretch the hip?”

Maybe, but more so, just remember that your sports hernia was not an accident. It was not bad luck, because it is a preventable injury.

We can test hip range of motion and strength.

We can test abdominal strength and endurance.

We can look at how well or poorly you move. How well you squat, lunge, and change directions on the field.

Sports hernias, like most “overuse” sports injuries, are in theory preventable if we correct your “problem areas” before the injury begins.

Entheseopathies (inflammation of the tendinous attachment to the bone) can also be found in many groin pain patients. This means this is not a “new” condition. It happens over a period of time and taking preventative steps should not be neglected.

Imaging Can Assist in Proper Diagnosis of a Sports Hernia

These tests can assist greatly in ruling out some of the other possible conditions, but they do not always confirm a sports hernia. Some imaging options are listed below with the pros and cons of the imaging type:

Plain radiograph (x-rays)

Computed Tomography Scan (CT Scan)

Magnetic Resonance Imaging (MRI)

Magnetic Resonance Arthrogram (MR Arthrogram)

Musculoskeletal Ultrasound (MSMU or MSKUS)

Plain radiograph (x-rays)

X-ray is the typical beginning step in the imaging series for a variety of reasons.

X-rays are great at assessing the cortical surface of the bones (the shell) and the alignment of the boney structures. They can reveal suspicion of soft tissue damage, but they only reveal a small fraction of what other types of imaging can see.

For complete assessment of the regions muscles, tendons, ligaments, fascia, cartilages and other structures, we need to use images better equipped to key in on the specific densities of each.

 

In groin pain cases, x-ray is great at confirming findings such as:

  • Pubic symphysis widening and erosions
  • Local fractures
  • Bone disease
  • Healing of possible stress fractures

Computed Tomography Scan (CT Scan)

CT scans are extremely useful at more in-depth evaluation of bone injuries. A CT scan will show everything an x-ray did, but in more detail.

Why do we not start with the CT in the first place then?

Cost is one factor. In the medical field, we do make every attempt to keep cost as low as possible for each patient. Imaging can be one of the most costly things done in the process of diagnosing the cause of your groin pain.

Second, the machinery to create the image is very expensive and much more complex than an x-ray. X-ray will reveal useful findings and you will get one done much faster than a CT.

Third, is the issue of radiation exposure. This is one of the major hang-ups of using CT scans. Too much radiation exposure is not good. When x-rays were invented, they were found to be helpful for some skin conditions and were used as treatment for them.

Long story short, we found decades later that was a bad idea. Now, there are restrictions of how much radiation is allowed for each patient to have in a year. Some estimates say CT scans have around 100 times more radiation exposure than x-rays, but don’t quote me on that exact number.

For groin pain, CT scans can be useful in seeing:

  • Stress Reactions (note: they differ from stress fractures)
  • Inflammatory processes
CT Scan Sport Hernia

Magnetic Resonance Imaging (Sports Hernia MRI)

A sports hernia MRI is very useful in the evaluation of the soft tissue in the groin area. Using MRI, we are also better at predicting recovery time. MRIs can also help to narrow down a more precise treatment plan. With this type of image, we can really start to understand the nature of your groin pain: is it simple or more complex? A sports hernia MRI can assist us in ruling out some aspects of the injury and confirming others.

MRI can assist us in confirming:

  • Muscle strains
  • Stress reactions
  • Labral tears
  • Osteitis pubis
  • Iliopsoas bursitis
  • True hernias
  • Occult stress fractures
MRI Groin Pain

Some negatives about using a sports hernia MRI are cost and speed of obtaining the procedure. Cash is king; and if you are ready and willing to shell out some big bucks to know more about your injury, you can have the image performed today.

Do you need the other types of imaging?

Probably not. X-rays and CT scans are great at bony evaluation but a sports hernia MRI is very good at evaluation of the soft tissues that can’t be seen on those types of imaging and it’s pretty darn good at evaluation of bone as well.

If you have been waiting for an insurance company to approve an MRI, I would not hold your breath. In some cases, it can be fast, but in others it can take months.

Months of down time, uncertainty and pain are huge downsides to waiting on your insurance to cover an MRI.

Are you willing to wait this long?

How badly do you want to know about your groin pain?

How badly do you want to play again this year?

Again, if you want a sports hernia MRI, just pay the money. If the largest barrier to your happiness and sanity is money, just spend it. It will be money well spent.

Is a sports hernia MRI the most cost-effective type of imaging for a sports hernia?

Not really. So, don’t think I am pressing you to pay for an MRI. Musculoskeletal Ultrasound is a fraction of the cost and very diagnostic. However, a timely image can cost money. Again, just allocate the money from other luxuries like cell phones, movies, dinner, and drinks so that you can have direction in your rehab. I have had to have the hard talk about priorities with many patients.

What do you value most in life? Your health or your belongings?

Sorry, we got off topic. Let’s get back to the imaging!

Magnetic Resonance Arthrogram (MR Arthrogram)

MR Arthrogram is the gold standard for evaluation of the internal structures of the hip. If we ordered this type of image, we would be looking for a possible hip labral tear.

Pain can refer from the hip/labrum and create the presentation of a sports hernia. The correct diagnosis would assist in formulating a treatment plan or possibly recommending surgery.

Labral tears and sports injuries require very different surgeries. If a surgeon corrects the wrong thing, you will leave surgery with the same pain that brought you in to begin with.

An MR Arthrogram is more expensive than a standard MRI because we are working with contrast dye now. The dye inflates the joint spaces and creates a great visualization of the internal structures of the hip joint.

Does this mean a MR Arthrogram can confirm a sports hernia?

No. But, it can rule out a major injury that presents like a sports hernia.

MRI Arthrogram Groin

Sports Hernia Musculoskeletal Ultrasound (MSUS or MSKUS)

Last, but not least, is the Musculoskeletal Ultrasound. It is a newer technology in comparison to the previous ones we’ve discussed.

One important thing to point out is that it is the most cost-effective, best bang-for-your-buck type of image for groin pain, but it lacks the ability to see any bony damage that may be there as well.

What can it see?

  • Muscle strains
  • Hip joint effusion (helpful in ruling in a possible labral tear)
  • Osteitis pubis
  • Iliopsoas bursitis
  • True hernias
  • Stress fractures

Here’s an Ultrasound of a Sports Hernia. With this high school soccer player she had experienced groin pain for the past 6 months. Pain was on the left pubic bone. She said it comes and goes with activity level.

The imaging reports stated, “Athletic pubalgia is strongly suggested.”

Note on the obvious difference to the pubic bone on the left side vs the right. This abnormality is at the insertion of the adductor tendon and seems to have been going on for a long time. This was not a new injury at all.

Note on the obvious difference to the pubic bone on the left side (first image) vs the non-painful side (the second image).

This abnormality is at the insertion of the adductor tendon and seems to have been going on for a long time. This was not a new injury at all.

Ultrasound Sports Hernia
Ultrasound Sports Hernia

“What I would recommend as a comprehensive study package for groin pain would be an x-ray series, to rule out bony injury, and MSUS to rule in any soft tissue damage including a sports hernia.”

Sebastian Gonzales DC, DACBSP®, CSCS, RMSK®

Musculoskeletal Ultrasound is the only image of the bunch that is a dynamic assessment study, meaning that we can see a sports hernia in action.

As the patient actively strains, the ultrasound probe sees real-time bulging and ballooning of the inguinal canal. It can also see posterior inguinal wall deficiency.

However, the education and experience of the person performing the exam is a major variable. MSUS is very user-dependent and you must find someone qualified to perform the examination.

Don’t know how to find someone qualified?

Ask around. Finding a good musculoskeletal ultra sonographer is tough, and basic education in sonography school is normally not enough to perform the exam, although schools are beginning to add musculoskeletal examination into the curriculum.

Two great people in Southern California who I personally respect very much are Dr. Michael Meng, in the San Diego area and Michael Jablon in Beverly Hills.

Sports Hernias Treatment & Rehab

Advanced sports hernias have a low success rate in traditional conservative care, so it is extremely important to prevent an injury like this.

I personally have worked with a number of sports hernia cases, and one of the hardest parts is seeing the patient’s frustration in the rest period. Understandably, they want to play when their pain decreases with rest.

I always urge them know the plan.

Know the reason for the plan.

And follow the plan.

Emotions will only get in the way of your rehab. Think logically about why you are rehabbing.

Typical rehab will include:

  • 6-8 weeks rest
  • Ice/heat
  • Sports massage
  • Electrical stimulation
  • A progressive hip strengthening protocol
  • Hip stretching exercises
  • Correction of movement patterns
  • Incorporation of sports motions starting slow to quick
  • Gradual return to play
MRI Arthrogram Groin

Do I agree with these sports hernia treatment & rehab styles?

Not 100%. My person opinion after reading about the consistent failure of “traditional sports hernia therapy,” I can’t help but think… what’s missing?

Hear me out; there’s a ton of research on how to rehab a disc injury (as well as many other types of torso/ groin conditions), so most rehab experts have great results with these types of cases. I personally feel very confident that if a disc injury or sciatica case came into my facility that I can help his person, at least a strong majority of the time.

How long it takes to return to full function is dependent upon the person and the severity of the condition, but regardless, I KNOW if I can help this person beyond reasonable doubt.

 

Why can’t we say this about hernia treatment & rehab?

I think it’s because we are just addressing the symptoms of another issue. Based on my experience with other types of abdominal injuries, torso injuries, and the bottom side of the abdominal cavity (the pelvic floor), I can say with much confidence that these present themselves because there’s a lack proper function of the “supporting cast” in abdominal region (and ball/socket joints).

You may be thinking a sports hernia is groin pain, so my theory doesn’t apply. If you feel this way go back and read the section about what a sports hernia is and come right back…

With an oblique strain, we resolve this by allowing the oblique to remodel (mother nature’s work) and build endurance in the supporting regions: intra-abdominal pressure (think a bike inner tube within the belly), co-contraction of all of the abdominal and back muscles, diaphragm, pelvic floor and adequate deceleration of the hip via the muscles of the hip.

With a rotation intolerant spinal condition, like a lumbar spine pinched nerve or a disc injury, it’s the same thing. We’ve found reduced diaphragm motion in people with chronic low back pain. (Kolar et al 2012) Research has also started to investigate the correlation of poor hip rotation and sports hernia occurance. A lack of hip internal rotation seems to be connected to having a sports hernia (Rambani et al, 2015).

 

Why would rotation of the hip matter?

With a sports hernia being a rotational/ extension-based injury, we need to have our rotation & extension come from somewhere right? Perhaps a region where it’s intended to come from? The hip sounds like a good option to me (as well as sections of the thoracic spine).

The hip, being a ball and socket joint, is prime for the job so the fascia of the groin/ torso region doesn’t have to become torn up.

How can we increase hip rotation to decrease symptoms of a sports hernia?

Great question. Range of motion of the hip has been linked to having a stiff torso (McGill 2017). In fact, when we’re able to stiffen our torso (inflate the bike tire,co-contract all of the torso’s muscles and some of the ones that cross the torso from the shoulder) then our hip range of motion improves AND our ability to generate power from the hip improves too!

Amazing right?! So you can’t just sit there and stretch when you’re watching Lost because you really have to pay a bit more attention to the quality of torso stiffness that will improve your hip internal rotation… then MAYBE you’ll get to play sometime this year!

That’s the theory I base my rehab around and I haven’t had to send a single groin pain case to surgery yet (at least of the people who followed through with my rehab recommendations). I’d be lying if I told you that current level one research supported my rehab for sports hernias, but the theory is certainly supported for hip impingement, low back pain, adductor strains, glute strains, hamstring strains, sore backs, sciatica and much more. Since the research is starting to venture into figuring out WHY the transversalis fascia tears in the first place, they have to investigate hip and mid back rotational deficits and postural endurance within the torso… so I’d like to think they will validate my concepts soon. However, the practices of Dynamic Neuromuscular Stabilization and perhaps Karl Lewit, and many active care sports physical therapist and chiropractors will probably be on board with me here.

I’ve been asked by many people, via email, to share my programming and I was hesitant for many years but I finally decided to do so. I was hesitant because the research was lagging (it takes time and funding) and I was kinda sacred to share with my fellow docs. I wish I could say I was the smartest person I know, but I’m not. I feel like I’m learning more and more about how to help people with many different conditions daily… but I guess I’ll share what I’ve found to work well so far. You can find it here for a small fee.

 

Wonder when you could return to your sport? How long does a sports hernia to heal?

Typically, 12-16 weeks after the start of your care, as long as you continue to be pain free, is a good time frame to attempt activity. It also depends on if you’ve keep some conditioning up. Just because the groin feels better doesn’t mean your conditioned to play the sport.

Want to know what rehab exercises we use?

We use a variety of rehab exercises to promote muscular balance of the hip and the trunk. Again, the main goal is torso stiffness with the ability to SLOW rotation (anti-rotate) from the hip and the mid back (amongst other parts of the body). Remember the body is a single unit. Some people may use the term muscular balance.

What do I mean by muscular balance?

Muscular balance refers to functionality of the muscles, not just muscle size. Are they all working together in a synergistic fashion? Can they properly propel you forward when you’re changing directions during your sport? To properly progress you to that point, we often have to start with the basics.

I read a great technical description of what our goals are in a study recently:

“The rehabilitation emphasis should be placed on resolving core strength, endurance, coordination and extensibility deficiencies and imbalances at the hip and abdominal muscles and on dynamically stabilizing the pelvic ring.” 13

Notice we don’t see a lot on stretching in this quote. We need to focus on improving function from many different angles and not just stretching, so don’t run for the foam roller too quickly.

Here are our progressions:

  • Isometric to Concentric/Eccentric (safe contractions to less safe)
  • Non-loaded to Loaded (i.e.: floor exercises then advance to standing, no weight to weighted)
  • Endurance to Strength to Power
  • Two feet to one foot
  • Stable footing to unstable footing

Here are a few of our exercises:

TIP: Don’t understand these terms? Listen to this podcast

Here are a few of our exercises we use when indicated but if you want our step by step for the first 8 weeks you can buy it HERE.

Notice that all of the exercises require some try of abdominal/ torso effort. Without building stabilization from the center first the hip range of motion won’t carry over to the field or daily motion.

Hip Adduction

Remember the Thigh Master? Perhaps they weren’t too far off for sports hernia prevention. But this is an open chain exercise, meaning your foot is not on the ground.

When the foot is on the ground and we are using ground contact to move us, everything changes.

This is what makes the squats, deadlifts and lunges so important later in sports hernia rehab. A simple adduction exercise to start with is an isometric one, like a plank.

Side lying hip adduction is a gravity loaded motion we will often start someone with.

Here’s how you do it:

  1. Lay on your side with the affected side on the ground
  2. Split your legs and bring the bottom leg forward just enough so the top leg is not on top of it
  3. Obtain a stable trunk with proper breathing and bracing methods
  4. Bring the bottom leg toward the ceiling to a comfortable position
  5. Hold this position for 5 seconds
  6. Lower the leg to the ground
  7. Repeat
Hip Adduction Exercise

Multiplanar Trunk Stabilization

Here is one of the basic exercises we use for multiplanar trunk stabilization. You may have heard of it.

It’s called the Birddog.

The Birddog exercise is awesome for strengthening and stabilizing the trunk as well as the hips at the same time. We often test before we recommend this exercise. If the client is weak in this pattern, we need to strengthen it.

This exercise is used to rehab a number of conditions including, low back pain, hip impingement, and knee pain to name a few, BUT it is also used to create power in athletic movements.

I know it is not a power move itself, but creating a rigid trunk is necessary to transfer power from the legs to the rest of the body.

Here is how we do it:

  1. Hands and knees. They should be right below your shoulder and hip sockets
  2. Exhale and dress the rib cage as in the Lewit Exercise queues. This is a stable trunk exercise. Find this stable trunk and stick it
  3. Slide the leg out. Lead with the heel and drive it through the wall behind you. Note: You’re making yourself “long.” Don’t raise your heel to the ceiling.
  4. Contract the glutes and hold the leg parallel to the ground
  5. Slide the opposing arm out, making yourself long. Thumb up.
  6. Hold this position for 5-10 seconds and slowly switch sides.

We recommend doing this for at least a minute or two.

Some things we use to get the form right are balancing a cup of water or a stick on your back. I like the water method. It really slows people down and makes them pay attention to maintaining a “stable trunk” throughout the exercise.

Multiplanar Trunk Stabilization

Step Back Lunges

Step back lunges are a great way to safely add in a lunge pattern to a rehab program because even if you have knee issues, these exercises expose the knee to less impact than walking lunges.

They can be done with or without weight. We often use kettle bells and barbells in a front rack position.

  1. Obtain a stable trunk with proper breathing and bracing methods
  2. Step back as far as you can
  3. Bring the back knee towards the ground, but don’t contact the ground
  4. With a tall chest, the front knee should bend as well and be positioned just above the ball of the front foot.
  5. At the bottom, you should pause for 2 seconds to make sure you are stable
  6. Drive up using the front leg’s gluts.
  7. Alternate legs
Step Back Lunge

Proprioception Exercises

Proprioception exercise can vary greatly. Rather than write about a specific example it is best to watch this video.

Change of Direction/Plyometric

This is similar to an ACL prevention course, which we also have on our paid courses, so I cannot give that out here, but there are some sources on YouTube you can use as an idea.

This training should take place later in your rehab, so you have time to research a bit before you get here. Know all of the other parts first, and then take our course to learn about change of direction training.

We have found conservative care of sports hernias is not exactly a standardized process as of yet. We feel we have an idea of what is needed for an athlete to work on and improve based upon the structures involved in this injury. Currently, studies giving guidance for evidence-based rehab are definitely lacking. 3,6,7,9

Want to know what we do in our facility for sports hernia rehab?
We have the first 8 weeks of our rehab process step-by-step available for purchase HERE.

Sports Hernia Surgery Success Rates

Surgery success rates for sports hernias can vary just like any other surgery. Let’s compare some of the success rates of the two types of sports hernia surgeries: Open and Laparoscopic.

Open Sports Hernia Surgery

The average success rate for an open repair has been found to be around 92.8% (SD 9.9). 8

35% of open procedures require mesh to be used. 13

83.3% of open surgery athletes are required to be relatively inactive for the first 4 weeks after surgery. After these first 4 weeks, they are allowed to walk in pools and do light stretching. At 6 weeks, they are allowed to return to play fully, and are at full activity within 6 months. 11

Laparoscopic Sports Hernia Surgery

The average success rate for a laparoscopic repair has been found to be around 96.0% (SD 4.5). 8

100% of laparoscopic procedures require mesh to be used. 13

87% of laparoscopic surgery athletes are able to return to play partially within 4 weeks, and fully return within 6 weeks. They had no reoccurrence of the injury from a symptomatic standpoint at follow-up 12.1 months later. 1

What Does Post Surgical Rehab Look Like for 6 Weeks?

This is what open repair rehab looks like: 5

Week 1:

  • Isometric abdominal and hip exercise
  • Walking 5min/day

Week 2:

  • Active hip exercise
  • Transverse and oblique core exercise
  • Stationary bike

Week 3:

  • Mobility work
  • Resistance hip exercises
  • Transverse and oblique core exercise
  • Jogging
  • Swimming

Week 4:

  • Running forward
  • Increased load on core exercise
  • Upper-body resistance training

Week 5:

  • Sprinting
  • Change of direction drills
  • Sports specific drills (kicking and ball handling)
  • Increase the load on core work again
  • Return to play lightly

Week 6:

  • Unrestricted exercise
  • Full return to play

This is what laparoscopic repair rehab looks like: 12

Week 1:

  • Walking 5min/hr

Week 2:

  • Power walking (20 – 50 min.)
  • Stationary bike intervals (4x10 min at 80-90 rpm)
  • Isometric abdominal training
  • Step-ups, speed training and lunges
  • Aquatic training

Week 3- 5:

  • Resistance training
  • Normal activities if pain-free

Week 6:

  • Unrestricted exercise
  • Full return to play
Rehab Sports Hernia
  1. Ahumada LA, Ashruf S, Espinosa-de-los-Monteros A, et al. Athletic pubalgia: Definition and surgical treatment. Ann Plast Surg 2005;55:393–6.
  1. Emery, Carolyn A., Willem Meeuwisse H., and John Powell W. “Groin and Abdominal Strain Injuries in the National Hockey League.” Clinical Journal of Sport Medicine3 (1999): 151-56. Web.
  1. Farber AJ, Wilckens JH. Sports hernia: Diagnosis and therapeutic approach. J Am Acad Surg 2007;15:507–14.
  1. Harmon KG. Evaluation of groin pain in athletes. Curr Sports Med Reports 2007;6:354–61.
  1. Hemingway AE, Herrington L, Blower AL. Changes in muscle strength and pain in response to surgical repair of posterior abdominal wall disruption followed by rehabilitation. Br J Sports Med 2003;37:54–8.
  1. Holmich P, Uhrskou P, Ulnits L, et al. Effectiveness of active physical training as treatment for long-standing adductor- related groin pain in athletes: Randomised trial. Lancet 1999;353:439–43.
  1. Holmich P. Long-standing groin pain in sportspeople falls into three primary patterns, a ‘‘clinical entity approach’’: A prospective study of 207 patients. Br J Sports Med 2007;41:247–52.
  1. Meyers WC, Lanfranco A, Castellanos A. Surgical management of chronic lower abdominal and groin pain in high-performance athletes. Curr Sports Med Reports 2002;1:301–5.
  1. Nam A, Brody F. Management and therapy for sports hernia. Am Coll Surg 2008;206:154–64
  1. Paluska SA. An overview of hip injuries in running. Sports Med 2005;35:991–1014.
  1. Srinivasan A, Schuricht A. Long-term follow-up of laparoscopic preperitoneal hernia repair in professional athletes. J Laparoendoscop Adv Surg Tech 2002;12:101–6.
  1. Van Veen RN, de Baat P, Heijboer MP, et al. Successful endoscopic treatment of chronic groin pain in athletes. Surg Endosc 2007;21:189–93.
  1. Caudill, P., J. Nyland, C. Smith, J. Yerasimides, and J. Lach. “Sports Hernias: A Systematic Literature Review.” British Journal of Sports Medicine12 (2007): 954-64. Web.
  1. Verrall GM, Hamilton IA, Slavotinek JP, et al. Hip joint range of motion reduction in sports-related chronic groin injury diagnoses as pubic bone stress injury. J Sci Med Sport 2005;8:77–84.
  1. Verrall GM, Slavotinek JP, Barnes PG, et al. Hip joint range of motion restriction precedes athletic chronic groin injury. J Sci Med Sport 2007;10:463–6.

 

Kolar P, Sulc J, Kyncl M, Sanda J, Cakrt O, Andel R, Kumagai K, Kobesova A.
Postural function of the diaphragm in persons with and without chronic low back
pain. J Orthop Sports Phys Ther. 2012 Apr;42(4):352-62.

Rambani, Rohit. “Loss of Range of Motion of the Hip Joint: a Hypothesis for Etiology of Sports Hernia.” Muscles, Ligaments and Tendons Journal, 2015, doi:10.11138/mltj/2015.5.1.029.

McGill, Stuart. “Core Stability: “Fascial Raking” to Stimulate Abdominal Wall Activation for Ultimate Performance.” Http://www.dragondoor.com/pdf/331.pdf. N.p., n.d. Web. 2 Jan. 2017.

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