Groin pain is common in sporty people and athletes, with causes ranging from osteitis pubis and tendonitis to stress fractures, inguinal hernia, and hip impingement. One of the more notorious causes is a sports hernia — also called a sportsman’s hernia. So what is a sports hernia, and how do we diagnose and treat it?
What is a sports hernia?
A sports hernia is a painful soft-tissue injury of the groin or lower abdomen, usually in athletes in high-intensity sports. Unlike a true hernia, it involves no visible bulge or hole in the abdominal wall. Instead, it results from weakness or tearing of the muscles and fascia of the inguinal wall, which is thought to irritate small nerves and tear ligaments, causing inguinal pain.
It’s seen in sports involving sudden changes of direction, twisting, and kicking — football, ice hockey, rugby, and tennis — and is much more common in men than women. Women with groin pain more often have hip joint or hip flexor problems.
Sports hernia symptoms
The main symptom is localised groin pain that worsens with exercise and eases with rest. Athletes describe a sharp, burning, or aching pain in the lower abdomen, just above the side of the pubic symphysis — where a true hernia occurs — but without a visible bulge. Pain can spread to the adductor muscles or the lower rectus abdominis. Other features include:
- Pain when twisting, sprinting, or kicking — often lasting 1–2 days after a game
- Discomfort when coughing or sneezing
- Pain during sit-ups or core exercises
How is a sports hernia diagnosed?
Diagnosis is challenging because the symptoms overlap with those of other groin injuries, and more than one problem can be present. A thorough assessment is needed to exclude other causes. On examination, an athlete typically has:
- Pinpoint tenderness in the inguinal area, where a true hernia occurs
- No bulging of the abdominal wall on coughing or sneezing
- No signs of other conditions such as osteitis pubis, adductor tendonitis, hip impingement, or stress fractures
It’s also essential to exclude causes from the bladder, prostate, and bowel.
Imaging
- MRI with dynamic images can detect posterior inguinal wall damage or weakness.
- Ultrasound helps rule out a true inguinal or femoral hernia and can show bulging of the posterior wall of the inguinal canal.
- X-ray helps exclude hip impingement, osteitis pubis, or a stress fracture.
Sportsman’s hernia treatment
Treatment starts conservatively with physiotherapy and pain management; surgery is reserved for chronic cases that don’t respond.
Rest and activity modification
Reduce or modify the activities that flare symptoms — sprinting, kicking, core work — while a structured rehab plan strengthens the abdominal wall and hip muscles and maintains fitness.
Pain management
- NSAIDs such as ibuprofen reduce pain and inflammation.
- Ice after activity eases discomfort.
- Injections can provide temporary relief while rehab continues — we often use nerve blocks targeting the ilioinguinal and genitofemoral nerves, placed accurately under ultrasound guidance, which relieve pain for weeks to months. A nerve block shouldn’t be the sole treatment — it always sits alongside a rehab programme.
Physiotherapy
A structured physiotherapy programme is essential for building core stability and flexibility, and correcting the biomechanical imbalances that contribute to a sports hernia. Around 50–70% of athletes respond to rehab and return to sport. Key elements include:
- Core stability: plank variations, dead bugs, and pelvic tilts
- Hip and groin strengthening: banded lateral walks, Copenhagen adductor exercises, isometric holds
- Flexibility and mobility: hip flexor and groin stretches
- Gradual return to sport: a stepwise progression of running, cutting, and agility drills before full competition
Sports hernia surgery
If conservative treatment fails after 2–3 months, surgery may be needed — but only once other causes of groin pain (osteitis pubis, adductor tendonitis, hip joint damage) have been excluded, or it won’t succeed.
Surgery reinforces the lower abdominal wall and repairs the torn soft tissue, via open or keyhole repair, with or without mesh. Success rates are around 90%, with little difference between open and keyhole — though we usually favour keyhole for faster recovery and a slightly higher success rate. Surgery isn’t always successful, and carries risks including infection, post-surgical nerve pain, and injury to the bowel or bladder. Full recovery from sports hernia surgery usually takes about 3 months.
Frequently asked questions about sportsman’s hernia
Can a sports hernia be treated without surgery?
Often, yes — especially if caught early. Around 50–70% of athletes respond to a structured rehab programme, with physiotherapy and core strengthening stabilising the area. In persistent cases after 2–3 months of rehab, surgery may be the long-term solution — one randomised study found surgery to be better than physiotherapy for returning athletes to sport in such cases.
Can a sports hernia heal itself?
It can improve with proper rehabilitation. Everyone with an athlete’s hernia should try rehab first, as 50–70% improve and return to sport — one study found 65% of athletes responded to a structured programme.
Sports hernia vs inguinal hernia: what’s the difference?
An inguinal hernia is a genuine hole in the abdominal wall, allowing fat or bowel to protrude — usually with a lump or bulge and pain on coughing or sneezing. A sports hernia has no hole: the wall is weak or disrupted, causing pain with activity but no bulge. Your sports doctor should distinguish them, as the treatments differ, at least initially.
How long does it take to recover from a sports hernia?
With rehab, many athletes return over several weeks to a few months. After surgery, full recovery usually takes about 3 months.
Which sports cause a sports hernia?
Sports with repeated twisting, cutting, and kicking — football, ice hockey, rugby, and tennis — and it’s much more common in men than women.
Final word from Sport Doctor London about sports hernia
A sports hernia is a treatable condition that mostly affects athletes in high-intensity sports. Early diagnosis and targeted rehabilitation help many athletes return to sport without surgery, though some cases require surgery. If you think you have a sports hernia, see a sports medicine doctor for an accurate diagnosis — getting that right is what makes treatment work.
To book a hip and groin assessment with Dr Masci in London, contact the team here or call +44 (0) 203 488 0350.
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