Groin pain is a common complaint in athletics and a source of frustration for many athletes and clinicians alike. The incidence has been reported as high as 5% of all athletic injuries1 and often is poorly understood due to its potential complexity of etiologies. One of the most difficult causes of chronic groin pain to identify is a combination of signs and symptoms referred to as the sports hernia. A sports hernia is defined as injury or weakness of lower abdominal attachments and the posterior inguinal wall and an underlying source of groin pain.
Injury can occur from a specific incident usually associated with cutting and planting of the lower extremities at speed or with contact activities. However most often groin pain is of a chronic nature, occurring insidiously and is related to repetitive stresses incurred across the pelvis and associated muscular attachments. Common subjective symptoms may include pain with strenuous activity, resolution of or minimal pain with rest, and unilateral or bilateral inguinal (groin) and adductor (inner thigh) pain.
In a recent case report, six collegiate athletes were diagnosed with a sports hernia using five classic signs and symptoms which the authors referred to as the “cluster of five”. These include: complaints of deep groin/lower abdominal pain, exacerbation of pain with sports activity which is relieved by rest, tenderness with palpation of the pubic ramus, pain with resisted hip adduction, and pain with resisted sit-up test.
Conservative treatment has been found to helpful for numerous NHL players who suffer from sports hernia. I have found this particular treatment protocol to be very effective in treating this condition. The rehabilitation program can be described in three basic phases: Phase 1 – pain management/initiation of flexibility and stabilization, Phase 2 – strength and stability progression (including core stabilization) Phase 3 – functional progression and return to sport.
A thorough warm up routine followed by a stretching routine performed before exercise is a good habit to instill in athletes to prevent injuries. Stretching should include the following muscles: adductors and hip flexors.
Hip flexibility and strength are specifically critical in prevention of sports hernias and recurrence. When weight training, it is imperative to use a sensible routine for both flexion and extension muscle groups. Finally, core stability and strength will assist with balance and can help prevent sports-related injuries.
Here are some groin stretches to try: Hold each stretch for 20 seconds, slight discomfort should be felt, but no pain. If pain is felt try loosening up slightly on the stretch.
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1. Int J Sports Phys Ther. 2012 February; 7(1): 85–100. NON-SURGICAL TREATMENT OF A PROFESSIONAL HOCKEY PLAYER WITH THE SIGNS AND SYMPTOMS OF SPORTS HERNIA: A CASE REPORT J. Scott Woodward, PT, MSPT, SCS, ATC,1 Andrew Parker, MD,2 and Robert M. MacDonald, MD, F.A.C.S.3,,4