Physical Therapy for a Sports Hernia

A sports hernia is a soft tissue injury that occurs in the groin area, involving a strain or tear in a muscle, tendon, or ligament deep in the abdominal wall. A sports hernia is often due to intense repetitive or explosive twisting movements or sudden changes in direction and commonly affects soccer, football, rugby, and hockey players. Physical therapists play a critical role in helping an athlete recover from and return to sport safely after a sports hernia. Physical therapists guide athletes through an active rehabilitation program involving therapeutic exercise, progressive strengthening of the hip and abdomen, core stabilization exercises, and manual therapy.

What is a Sports Hernia?

A sports hernia is a soft tissue injury that occurs in the lower abdominal and groin area, most often occurring in sports that require sudden changes of direction or intense repetitive, explosive twisting movements, like soccer, rugby, hockey, football, and track. In the United States, sports hernias have been seen in 46% of patients who play soccer, 17% hockey, 13% football, and 24% other sports (tennis, basketball, golf).

A sports hernia is distinct from an inguinal hernia. A hernia generally refers to a body part or tissue that squeezes through a weak area of muscle or fascia. In an inguinal hernia, part of the intestine pushes through the injured lower abdominal wall. This does not occur with a sports hernia, which is also referred to as an athletic pubalgia.

With a sports hernia, a strain or tear occurs in a muscle, tendon, or ligament in the deep abdominal wall in the lower abdomen and pelvic area. The tendons that attach to the oblique muscles and the adductor muscles that attach to the pubic bone are especially vulnerable to injury from repetitive and explosive movements.

Symptoms of a sports hernia include:

• Severe pain in the groin area at the time of injury

• Groin pain that subsides with rest but returns during sports activity

• Pain that occurs during twisting movements, pivoting, kicking, or running

• Tenderness or bruising in upper thigh/lower abdomen

• Groin pain that gradually increases from intermittent to constant pain

Physical Therapy for a Sports Hernia

Physical therapists can help an athlete recover from a sports hernia safely, reducing pain and targeting the hip and abdominal muscles with strengthening and stretching exercises. Initially, the physical therapist conducts an evaluation, assessing symptoms and history of injury, performing motor strength and range of motion testing of the hip and thigh muscles, and palpating the injured area. Based on the evaluation, the therapist designs a customized treatment program to help the athlete heal and return to sport safely.

Active rehabilitation is effective for sports hernia management, helping to decrease pain and return to sport. Studies have shown that rehabilitation for a sports hernia should involve core stabilization, therapeutic exercise, strengthening of the abdominal muscles and hip adductors, and balance and posture training exercises. One study involved 40 soccer players with sports hernias, half of whom received active rehabilitation involving core stability, balancing exercises, and progressive resistance exercises. The active group had reduced pain levels, improved range of motion, and a greater majority of this group returned to sport than those that received conventional treatment. 

Physical therapy treatment for a sports hernia can include:

• Ice and compression during the early part of the injury when an athlete experiences intense pain

• Stretching of hip and low back to improve muscle flexibility

• Muscle retraining and progressive strengthening exercises of hip and abdominals

• Core stabilization exercises

• Balance and posture training

• Manual therapy to mobilize affected soft tissues and joints to improve hip-joint mobility, range of motion, and flexibility

• Return-to-sport drills once progressed through strengthening exercises

The physical therapist focuses on improving the strength and flexibility of the hip, abdominal, and groin muscles to ensure a stable pelvis during intense activity and prevent the re-occurrence of a sports hernia.