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 a 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 abdomen, 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 of the inguinal wall. 

Studies suggest that injury to the abdominal wall can lead to irritation of small nerves and tearing of ligaments, resulting in pain in the inguinal area. 

We see this condition in sports that involve sudden changes in direction, twisting, and kicking, such as football, ice hockey, rugby, and tennis. This condition is much more common in men than in women. Generally, women with groin pain have hip joint and hip flexor problems. 

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 spread to the adductor muscles or the lower rectus abdominis. 

Other symptoms include:

  • Pain when twisting, sprinting, or kicking. Generally, pain can last 1-2 days after a sporting event. 
  • 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 

It is also critical to exclude other causes of groin pain from the 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 and surrounding hip muscles 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 an 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. These blocks are performed with accuracy using ultrasound and can provide pain relief from weeks to months. However, they should not be the sole treatment and should always be combined with a good rehab programme. 

Sports Hernia Physiotherapy

young man performing groin rehab for sports hernia

A structured physiotherapy program is essential for strengthening core stability, improving flexibility, and correcting biomechanical imbalances contributing to a sports hernia. Studies suggest that about 50-70% of athletes respond to sports hernia rehab and return to sport. 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 after 2-3 months, 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 strengthens the wall. Success rates are about 90%, with little difference found between open and keyhole surgery. However, we usually favour keyhole surgery due to faster recovery and a slightly higher success rate according to studies. 

However, not all surgery is successful. In addition, surgery has risks, including infection, post-surgical nerve pain and injury to the bowels or bladder during the procedure. 

Generally, it takes 3 months to recover from surgery for a sports hernia fully. 

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. Studies suggest that about 50-70% of athletes with sports hernia respond to a good structured rehab programme. Physiotherapy and core strengthening can help stabilise the affected area. Sometimes, we use nerve block injections to help with rehab. However, in persistent cases after 2-3 months of rehab, 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 50-70% of cases improve and return to sport. One study found that 65% of athletes responded to a structured rehab programme. 

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 tissue through it. Generally, people with an inguinal hernia report pain with coughing or sneezing, along with 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, leading to pain during physical activity. 

Your sports doctor should be able to differentiate between these two conditions, as treatments may differ at least initially. 

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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