Athletic Pubalgia (Sports Hernia)
What is Athletic Pubalgia?
Athletic pubalgia, also known as sports-hernia and Gilmore’s groin, is a condition characterized by chronic pain due to damage or strain to the soft tissues in the groin and pelvic region. This condition is mostly observed in athletes undergoing vigorous movements where there is twisting or a sudden change in direction. Although this condition is not a true hernia, it can lead to one.
Causes of Athletic Pubalgia
Athletic pubalgia is mainly caused by intense twisting or repetitive movements that are seen in sports such as hockey, soccer, football, tennis, skiing, or similar activities. Men are at higher risk, since they have a narrower pelvis, thus making it less stable and therefore more susceptible to injury. Aside from athletic pubalgia, groin pain can also be caused by the following:
- Nerve compression
- Genitourinary disease
- History of the previous injury
- Rectus adductor syndrome
Symptoms of Athletic Pubalgia
Symptoms of athletic pubalgia vary, and can include:
- Unilateral pain in the groin or lower abdomen during physical activity
- Chronic pain which can affect a return to sports
- Sharp pain associated with the initial injury which later subsides and is aggravated by certain activities
- Tenderness in the groin, upper thigh, or lower abdomen
- Bruising
- Groin stiffness
- Muscle weakness which can lead to a true hernia
Diagnosis of Athletic Pubalgia
As groin pain can have several causes, diagnosing athletic pubalgia can be tricky. Your doctor will carefully review your symptoms and medical history and perform a physical examination. Diagnostic tests for athletic pubalgia include:
- MRI Scan: This study uses a large magnetic field and radio waves to produce images that help in detecting damage to soft tissue, muscles, tendons, and ligaments. This test is the most definitive for athletic pubalgia.
- CT Scan: This scan uses multiple X-rays to produce detailed cross-section images of the pelvic and groin regions.
- X-rays: This study uses electromagnetic beams to produce images of the bones and can detect fractures.
- Ultrasound: To assess surrounding tissues and rule out the possibility of inguinal hernia.
- Bone scan: This study uses a radioactive substance to detect any damage to the bones.
Treatment for Athletic Pubalgia
Treatment for athletic pubalgia varies based on age, health, type of damage, and severity. Your doctor will initially recommend conservative treatment to help relieve the symptoms. This may be sufficient for mild cases of athletic pubalgia.
Conservative treatments
- Anti-inflammatory medication: Your doctor may recommend non-steroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation in the tissues.
- Rest: Avoiding sports or strenuous activities for 4-6 weeks can help heal the damaged tissues.
- Ice: Applying ice helps to relieve pain and swelling in the groin.
- Injections: Your doctor may recommend steroid injections or platelet-rich plasma (PRP)injections to reduce pain and promote healing
- Physical therapy: After a rest period, exercises are recommended to help strengthen the groin and abdominal muscles.
Surgical treatment
If conservative treatment methods are ineffective, or in cases of severe tissue injury, surgical methods will be recommended, which include the following:
- Open surgery: This involves making a large incision to provide complete access to the internal tissues of the affected area.
- Laparoscopic surgery: This is a minimally invasive procedure performed using a laparoscope, a specialized thin, fiber-optic tube fitted with a camera which is inserted through a small incision. This enables your surgeon to view the damaged tissues and perform repairs with instruments inserted through other similar incisions.
- Inguinal neurectomy: Chronic pain may be associated with a damaged inguinal nerve. This nerve may be excised during surgery if it is found to be scarred or damaged.
Rehabilitation following surgery usually takes about 6-8 weeks.
Persistent pain following surgery may require a further procedure known as an adductor tenotomy, which is performed to lengthen the tendons of the adductor muscles of the inner thigh in order to relieve tension.