Treating a Sports Hernia with Physical Therapy
A sports hernia is an injury that happens when there is a weakening or tear in the muscles, tendons, or ligaments of the lower abdominal and groin area, causing acute pain and limited movement. A sports hernia typically occurs in sports that 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, leading to weakening of the muscles, tendons, and ligaments of the pelvic, hip, and abdominal area. Physical therapy can help athletes manage and recover from a sports hernia safely, addressing underlying muscular imbalances that contributed to injury through targeted exercise, core strengthening, and manual therapy.
How Sports Hernias Occur
A sports hernia is an injury that happens when there is a weakening or tear in the muscles, tendons, or ligaments of the lower abdominal and groin area, causing acute pain and limited movement. A sports hernia is not a hernia in the traditional sense. A traditional hernia involves an internal organ pushing through an opening in surrounding muscle or connective tissue. A sports hernia, on the other hand, occurs where the abdominal muscles (like the transverse abdominus) attach to the pelvis, with tears in the tendons and muscles surround the hip (hip adductors), but with no protrusion of organs.
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A sports hernia typically occurs in sports that 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 muscles, tendons, and ligaments and lead to a subsequent sports hernia. Sports hernias are more common among male athletes who play basketball, soccer, ice hockey, rugby, tennis, wrestling, football, and hurdling. In fact, one research study found that sports hernias were present in 46% of patients studied who played soccer, 17% of hockey players, 13% of football players, and 24% of sports like swimming, golf, tennis, or basketball. A sports hernia is also referred to as an “athletic pubalgia.”
Factors that can contribute to the development of a sports hernia include muscle imbalances between the hip and abdominal muscles, abdominal weakness and lack of conditioning, poor warm-up and stretching exercises before activity, lack of hip adductor flexibility, impairment of the hip’s range of motion, and previous injuries in the area that may have damaged the overall stability of the affected muscles. Engaging in a vigorous off-season conditioning program that emphasizes strengthening the lower limbs but ignores the abdominal muscles can lead to a pelvic balance disturbance and shortening of the hip flexors and adductors, increasing the risk of developing a sports hernia.
Most sports hernias develop over time due to repetitive stress on the deep abdominal and groin muscles and soft tissues. Chronic groin pain is a hallmark sign of a sports hernia. Common signs and symptoms of a sports hernia include:
Sharp or stabbing pain in the groin region that occurs when running, sprinting, cutting, pivoting, kicking or twisting
Pain when doing an abdominal sit-up or that worsens when coughing or sneezing
Pain that is isolated to one side of the groin
Pain that radiates into the inner thigh
Minimal to no pain in the groin when resting, sitting, or sleeping
Tenderness to touch or when pressure is applied to lower abdominal area
Treating Sports Hernias with Physical Therapy
Physical therapy can help athletes manage and recover from a sports hernia safely, addressing underlying muscular imbalances that contributed to injury through targeted exercise, core strengthening, and manual therapy. Conservative treatment with physical therapy is recommend for 4-6 weeks. If groin pain persists and symptoms continue, surgery may then be recommended followed by post-surgical rehabilitation.
The physical therapist first conducts a thorough evaluation, involving standard strength tests of the athlete’s hip muscles, flexibility tests of the hip and thigh muscles, and testing the athlete’s ability to move the hip and low back as well as discussing current symptoms and limitations. From there, the therapist designs an evidence-based, customized treatment program for the athlete’s specific injury.
Physical therapy treatment for a sports hernia can include:
Ice and compression to manage athlete’s pain
Gentle stretching of the hip and low back muscles to improve muscle flexibility
Muscle retraining to activate the hip and abdominal muscles followed by progressive strengthening of these muscles. The therapist may also address any muscular imbalances or weakness in the athlete’s thigh muscles, such as the quadriceps and hamstrings.
Targeted core stabilization exercises
Manual therapy involving hands-on stretching and soft tissue and joint mobilizations are performed to improve the athlete’s hip joint mobility and range of motion and to ease muscle pain
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. Most studies have found that between 65-90% of athletes return to sport after surgery for a sports hernia and that there is a higher return to sport rate among athletes who undergo surgery followed by physical therapy rehabilitation rather than conservative treatment alone.
A 2019 study assessed 40 soccer players with a sports hernia to determine whether an active rehabilitation program was effective in their sports hernia recovery. The active rehabilitation group (Group A) underwent treatment involving core stability training, balance exercises, progressive resistance exercises to strengthen the hip, abdominal, and pelvic muscles, and running activities along with conventional treatment. The conventional treatment group (Group B) received heat, massage, transcutaneous electrical nerve stimulation, and mobilizations. Both groups were also instructed to perform stretching exercises of the adductor, hamstring, and hip flexor muscles.
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. Researchers found a decrease in VAS in both groups at the end of treatment, 80.25% in group A and 41.93% in group B. The significant difference in VAS between the active and conventional group can be attributed to the effect of the active rehabilitation program that aimed to increase strength, pelvic stability, and coordination and correct biomechanical abnormalities.
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 signifiant 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!
