Groin pain is common in sporty individuals and athletes. There are many causes of groin pain, ranging from osteitis pubis, tendonitis, stress fractures, inguinal hernia, and hip impingement. One of the more notorious causes of groin pain in athletes is sports hernia, also known as the sportsman’s hernia. So, what is a sports hernia, and how do we diagnose and manage it?
What is a Sports Hernia?
A sports hernia is a painful soft tissue injury in the groin or lower abdominal region, often affecting athletes involved in high-intensity sports. Unlike a traditional hernia, a sports hernia does not include a visible bulge or hole in the abdominal wall. Instead, it results from weakness or tearing of the muscles and fascia in and around the inguinal wall.
We see this condition in sports that involve sudden changes in direction, twisting, and kicking, such as football, ice hockey, rugby, and tennis.
Sports Hernia Symptoms
The main symptom of a sports hernia is localised groin pain that worsens with exercise and improves with rest. Athletes may describe a sharp, burning, or aching pain in the lower abdomen area just above the side of the pubic symphysis joint, where a true hernia usually occurs. However, unlike a traditional hernia, there is no visible bulge. Sometimes, pain can move to the adductor muscles or the lower rectus abdominus muscles.
Other symptoms include:
- Pain when twisting, sprinting, or kicking. Generally, pain can last for 1-2 days after a sport.
- Discomfort when coughing or sneezing
- Pain during sit-ups or core exercises
How to Diagnose a Sports Hernia?
Diagnosing a sports hernia can be challenging as its symptoms overlap with those of other groin injuries, and sometimes, more than one problem can be present.
Your doctor must perform a thorough assessment to exclude other causes.
Generally, on examination, an athlete has the following features:
- Pin-point pain and tenderness in the inguinal area where a true hernia usually occurs
- No noticeable bulging of the abdominal wall with coughing or sneezing
- No signs of other pathologies such as osteitis pubis, adductor tendonitis, hip impingement or stress fractures.
It is also critical to exclude other causes of groin pain from bladder, prostate and bowels.
Imaging Studies
Generally, we use tests to confirm the diagnosis and exclude other conditions.
- MRI (Magnetic Resonance Imaging) with dynamic images can detect posterior inguinal wall damage or weakness.
- Ultrasound can help rule out a true inguinal or femoral hernia and shows bulging of the posterior wall of the inguinal canal.
- X-rays are helpful to rule out other conditions like hip impingement, osteitis pubis or a stress fracture.
Sportsman’s Hernia Treatment
Initial treatment typically involves conservative management, including physiotherapy and pain management. However, in chronic cases, surgical repair may be necessary.
Rest and Activity Modification
We advise athletes to reduce or modify activities that worsen symptoms, such as sprinting, kicking, or core exercises. Concurrently, a structured rehabilitation plan can help strengthen the wall while maintaining fitness.
Pain Management
- NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) such as ibuprofen can help reduce pain and inflammation.
- Ice therapy can be used after activity to ease discomfort.
- Injections may provide temporary relief in some cases while physiotherapy is undertaken. We often use nerve blocks targeting the ilioinguinal and genitofemoral nerves.
Sports Hernia Physiotherapy
A structured physiotherapy program is essential for strengthening core stability, improving flexibility, and correcting biomechanical imbalances contributing to a sports hernia. Key rehabilitation exercises include:
- Core Stability Training: Plank variations, dead bugs, and pelvic tilts to activate deep core muscles.
- Hip and groin Strengthening: Banded lateral walks, Copenhagen adductor exercises, and isometric holds to support pelvic stability.
- Flexibility and Mobility Work: Hip flexor and groin stretches to improve range of motion.
- Gradual Return to Sport: Before full return to competition, a stepwise progression of running, cutting, and agility drills is introduced.
Sports Hernia Surgery
If conservative treatment fails, surgical repair may be necessary. However, before considering surgery, other causes of groin pain must be excluded, such as osteitis pubis, adductor tendonitis and hip joint damage. Otherwise, the surgery will not be successful.
The surgery aims to reinforce the lower abdominal wall and repair torn soft tissue structures. Open repair or keyhole surgery with or without mesh reinforcements strengthen the wall. Success rates are 60-80%, with no difference found between open or keyhole surgery. Generally, it takes three months to recover from surgery for a sports hernia.
Other Frequently Asked Questions about Sportsman’s Hernia:
Is a Sports hernia without surgery successful?
Non-surgical treatment can be effective in some cases, especially if diagnosed early. Physiotherapy and core strengthening can help stabilise the affected area. Sometimes, we use injections to help rehab. However, in persistent cases, surgery may be the only long-term solution. A recent randomised study comparing surgery to physiotherapy found that surgery was better at getting athletes back to sport.
Can a sports hernia heal itself?
A sports hernia can sometimes heal on its own with proper rehabilitation and treatment. So, all patients with sportsman’s hernia should undergo rehab, as some cases may improve.
Sports hernia vs Inguinal hernia: How can you tell the difference?
An inguinal hernia is a distinct condition caused by a hole in the abdominal wall leading to the protrusion of fat or bowel through the hole. Generally, people with an inguinal hernia report pain with coughing or sneezing and a lump or bulge in the inguinal area.
On the other hand, in a sports hernia, there is no hole in the abdominal wall. However, the wall is weak or disrupted, causing pain with sports activity.
Your sports doctor should be able to differentiate between these two conditions as treatments differ.
Final Word from SportsDoctorLondon About Sports Hernia
A sports hernia is a treatable condition that commonly affects athletes involved in high-intensity sports. Early diagnosis and targeted rehabilitation can help many athletes recover without surgery. However, some cases may require surgical intervention. If you think you have a sports hernia, it is essential to seek assessment from a sports medicine doctor.
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