Managing Sports Hernias with Physical Therapy
A sports hernia involves weakening or tearing in the muscles, tendons, or ligaments of the lower abdominal and groin area that leads to chronic pain, often caused by repetitive and forceful twisting of your pelvis that places tremendous stress on the lower abdominal and groin areas. Sports hernias are most seen in soccer players due to the dynamic nature of the sport, rapid changes in direction, intense sprinting, and repetitive twisting and turning when kicking. Physical therapy can help athletes manage and recover from a sports hernia, addressing underlying muscular imbalances that contributed to injury through targeted exercise, core strengthening, and manual therapy.
Sports Hernia Anatomy
Sports hernias involve the muscles, tendons, and ligaments of the inguinal and pelvic regions. Key structures that can be affected by a sports hernia include the rectus abdominis, the adductor muscles, inguinal ligament, and pubic symphysis.
The rectus abdominis muscle is responsible for flexing the trunk while the adductor muscles bring the thigh towards the midline of the body, working together with the rectus abdominis during running, cutting, and kicking.
Soft tissues that may be affected by a sports hernia include your oblique muscles in the lower abdomen, tendons that attach the oblique muscles to the pubic bone in the pelvis region, and tendons that attach thigh muscles to the pubic bone.
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FAQ on Sports Hernia Injuries
A sports hernia involves weakening or tearing in the muscles, tendons, or ligaments of the lower abdominal and groin area that leads to chronic pain, often caused by repetitive and forceful twisting of your pelvis. Men are more susceptible to sports hernia, accounting for 90% of sports hernia cases.
Sports hernias are most commonly seen in athletes whose sports require repetitive twisting, turning, or abrupt changes in direction. These sudden movements place a tremendous amount of stress on the lower abdominal and groin areas, which can weaken these soft tissues and muscles and lead to a sports hernia.
Sports hernias are most seen in soccer players due to the dynamic nature of the sport, rapid changes in direction, intense sprinting, and repetitive twisting and turning when kicking. Other sports that increase the risk of a sports hernia include football, hockey, basketball, rugby, hurdling, and tennis. In the United States, research has found that sports hernias were observed in 46% of patients who participated in soccer, 17% of patients who played hockey, 13% of football player patients, and 34% of sports including swimming, tennis, golf, and basketball.
There are several factors that can increase the likelihood of an athlete suffering a sports hernia. One such factor is a muscular imbalance between the hip adductor muscles and the abdominal muscles; the stronger adductor muscles pull the pubic bone downward, causing the abdominal muscles to stretch and eventually tear.
Engaging in a vigorous off-season conditioning program that emphasizes strengthening the lower limbs and ignores abdominal muscular strengthening, can lead to a pelvic balance disturbance and shortening of the hip flexors and adductors, which can increase the risk of a sports hernia developing.
Other factors that can contribute to sports hernia development include abdominal weakness and lack of conditioning, lack of hip adductor flexibility, impairment of the hip’s range of motion, poor warm-up and stretching exercises before activity, and previous injuries to the area that may have damaged the overall stability of the affected muscles.
Sudden and intense pain at time of injury
Chronic pain that feels dull or burning
Difficulty pinpointing the exact area of the lower abdomen and groin from which pain is coming
Pain that radiates down the inner thigh or the scrotum
Pain felt when sprinting, twisting, kicking, or sitting up
Pain when cough or sneeze
Pain that subsides with rest but return with sports activity
Tenderness to touch or when pressure is applied to lower abdominal area
Physical Therapy Management of Sports Hernias
Physical therapy can help athletes manage and recover from a sports hernia, addressing underlying muscular imbalances that contributed to injury through targeted exercise, core strengthening, and manual therapy.
The physical therapist provides a comprehensive evaluation of the athlete’s muscular imbalances, pelvic alignment, and movement patterns that may have contributed to the sports hernia injury. The assessment may involve palpation of the injured area, functional movement tests, and pelvic floor muscle assessment. The therapist then designs a customized treatment program tailored to the athlete’s specific injury, impairments, and muscular imbalances to help them prepare for a full recovery and safe return to sport. Physical therapy treatment normally lasts 6 to 8 weeks.
Physical therapy treatment for a sports hernia can include:
Pain management using ice and compression
Targeted core stabilization exercises
Muscle re-training to activate the hip and abdominal muscles followed by progressing strengthening of these muscles.
Hip, pelvic, and thigh muscle strengthening to address muscular weaknesses and imbalances and improve coordination, balance, and endurance between hip and trunk muscles.
Manual therapy that involves hands-on stretching and soft tissue and joint mobilization to improve the athlete’s hip joint mobility and range of motion and to ease muscle pain.
Posture stability training to ensure proper posture during sports activity and improve the coordination of the trunk, hip, pelvic, and thigh muscles.
Aquatic therapy involves exercising in a warm water therapy pool to improve strength and balance before progressing to these exercises on land. Exercising in water allows athletes to build strength early in rehabilitation without placing undue stress on the injured area or joints.
Sport-specific functional training is essential as the athlete progresses in the rehabilitative process, helping prepare them for an effective return to sport by practicing sport-specific tasks and exercises to simulate a return to competition without aggravating the injured area.
Surgery is recommended only after an initial course of non-operative treatment with physical therapy for three months. A structured physical therapy program post-operation is critical to strengthen the lower abdominals and correct abdominal and thigh muscle imbalances for a safe return to sport.
Research has shown that an active exercise rehabilitation program after a sports hernia is effective and results in a higher rate of return to sport in athletes as well as reduced pain. One study assessed if an active rehab program involving core stability, balance exercises, progressive resistance training, and running was effective in sports hernia injury patients versus conventional treatment (heat, massage, TENs, and mobilization). Forty soccer players with sports hernias were divided into two groups: Group A, the active rehab program group, and Group B, the conventional treatment group.
Researchers found that athletes in the study who underwent active rehabilitation had decreased pain and a higher rate of return to sport than those who received conventional treatment.. While both groups saw decreases in VAS (visual analog scale) scores, the difference was significant: 80.25% in Group A and 41.93% in Group B. While both groups saw improvements in range of motion, the post-treatment outcome measures were much improved in Group A compared to Group B. Thirteen patients in Group A and only three patients in Group B returned to sports activities without groin pain. Researchers noted that core strengthening, and balance exercises played a significant role in the faster return of Group A athletes to full sports activity.
A sports hernia can lead to significant pain and limit an athlete’s ability to compete at the highest level. Work with a physical therapist to address your sports hernia and return to sport safely!
