Sports hernia or athletic pubalgia may be what you are suffering from whenever you experience pain around your groin area. Even pain radiating in the inner thigh or the lower abdominal region after a sports type activity or other simpler activities like walking, getting out of bed or turning in bed.
What is it?
When there are organs protruding in the abdominal area, it means there is a hernia(inguinal hernia), but that is not what is going on. In this case, sports hernia occurs when there is weakening of muscles or tendons of the lower abdominal wall. It is the same region where an inguinal hernia occurs, but it only occurs when there is sufficient weakening of the abdominal wall to allow a pouch for the hernia to be felt. In sports hernia, the problem is due to weakness of the same abdominal wall muscles, but there are no organs protruding.
Mechanism of Groin Injury
It occurs as a result of intense twisting or changes in direction e.g. when kicking a ball. Muscle tendons or ligaments in and around your pubic bone can be torn when the kicking is done intensely. The pubic bone is the point where two pelvic bones meet at the front and give attachment to muscles of your abdominal wall (Rectus Abdominis, Transverse Abdominis) and it is the origin of inner thigh muscles (Adductors). In most cases the Adductor Longus (inner thigh muscle) tears first. 90% of the cases often occur without involving sports activity. Post delivery in women and poor biomechanics today may cause athletic pubalgia.
What Will You Feel When You Have This?
- Pain around the groin area mostly on one leg but can affect both.
- During exertion or coughing there is pain
- Sudden acceleration, twisting, turning or getting up from lying down provokes or increases the pain.
- The pain lasts for 1 – 2 days after exercise. The following day there is hardness in the groin and difficulty in getting up from bed.
- After resting for a while the pain diminishes and then re-starts immediately with intensity upon resuming sports activity.
Groin Pain, Back and Pelvic Floor
There is a gross dynamic relationship between athletic pubalgia, the back and the pelvic floor (muscles that cover the pelvis to hold internal organs in the pelvis) in that, they intertwine when affected.
Misalignments happening at the pelvic floor may cause frequent athletic pubalgia . Misalignments of the bones in this area can cause tension on the pelvic floor muscles hence engaging the abdominal muscles and overworking them. The abdominal muscles that are over working tend to be highly susceptible to injury over time from twisting actions.
An imbalance of the pelvis may cause muscle tension in the pelvic floor muscles. This may be over stretching the back and tightening the front muscles (abdominal muscles). This uneven pull can result in tension of the pelvic floor muscles, which can cause imbalances that make you more susceptible to athletic pubalgia.
Diagnosis
The diagnosis of this condition is very challenging. Therefore you are only going to be diagnosed of athletic pubalgia after a proper physical assessment by a skilled and experienced physical therapist or your doctor after ruling out other clinical causes of groin pain. Not forgetting the help of imaging(MRI), always as an added supportive investigation.
Treatment
After your diagnosis has been confirmed it is paramount to see a physical therapist unless muscle tears are significant for surgical repair. In the latter case, a surgeon will refer you to a physical therapist after reconstruction.
It is important that a holistic approach is observed during treatment in the rahabilitative process. This is because there is need to look at the body alignment (biomechanics) through spinal screening (by an Insight Subluxation Station machine).
A treatment plan will entail the following;
- Correcting muscle imbalances.
- Releasing any myofascial slings (muscles & its covering) creating bad alignment.
- Increase awareness and correct alignment through therapeutic exercises and hand on muscle work.
Written by:
Moses Katasi
Physical Therapist
Chiropractic & Physiotherapy Health Centre
