What is a ‘Sports Hernia’?The term sports hernia is a misnomer because it is not a true hernia. A sports hernia is actually an injury to the core muscle of the abdomen and legs. This injury causes chronic groin pain, especially with strenuous physical activities. The medical term for this condition is Athletic Pubalgia.
The most common symptom is pain in the groin area that does not go away with rest. Most people do not have a sentinel event, meaning a sudden injury. The injury often occurs slowly over time. The majority of patients are quite physically fit, but it can occur in anyone who injures his/her core musculature. There are several nerves that are often injured in addition to the muscles. These nerves can cause electric shock or tingling pain in the groin and genital area.
What are the Core Muscles?
The abdominal muscles and adductor muscles in the legs make up the core muscles. These are the muscles that push and pull on the groin or pelvis. Injury to the abdominal (most common) and adductor (less common) muscles causes a disharmony of forces on the pelvis. This leads to chronic groin pain seen in Athletic Pubalgia.
Which Nerves can be Injured?
There are several nerves that can be injured with the muscles. The most common are the genitofemoral nerve, ilioinguinal nerve and obturator nerve. These nerve injuries may need to be treated at the time of surgery in order to alleviate the pain associated with sports hernia.
What is the Difference Between a True Hernia and a Sports Hernia?
A true hernia involves a weakening or a hole in the layers of the abdominal wall, with little to no pain or discomfort. A hernia is repaired by placement of mesh to repair the hole. Athletic Pubalgia, or sports hernia, is an injury to the core muscles which results in pain and discomfort to the groin area. There is no hole or weakening in the abdominal wall layers.
How is Athletic Pubalgia diagnosed?
Athletic Pubalgia, or sports hernia, is diagnosed with an MRI and physical exam.
How is it Athletic Pubalgia Treated?
Surgical repair of the core muscles is often required to treat Athletic Pubalgia. When there are injured nerves involved, they may require treatment as well. This can involve freeing the nerves from scar tissue (neurolysis) or repairing a damaged nerve (neurorraphy). This procedure is an outpatient surgery, followed by an immediate therapy protocol.
What is the Recovery Time after Surgery?
The surgery is done as an outpatient procedure. This means the patient goes home the same day as the surgery. A recovery protocol is started almost immediately. Most patients are fully recovered by six weeks and are back to normal physical activity by three months.
What is the Success Rate of Surgery?
We believe success is defined by a return to pre-injury physical activity. Almost all patients are able to return to their prior activities after surgery. Pain is relieved in most patients after surgery.
How Does this Surgery Address a Patient Who has had a Mesh Hernia Repair but Still has Pain?
Many patients have had their sports hernia, or Athletic Pubalgia, repaired with the traditional mesh hernia repair. Often times mesh hernia repair will not address the pain associated with Athletic Pubalgia. In these patients we need to address and repair the core muscles that have been injured to relieve the pain. These patients have good results as well with our surgery, but scar tissue can make it more difficult.
How is our procedure different?
There are a number of different sports hernia treatment options that you may have read about online. At The Institute for Advanced Reconstruction, we have pioneered several advances that have improved the standard treatment of sports hernia. Treatment of the nerves in the area of the injury is a key aspect in the treatment of sports hernia. These nerves are often overlooked at other centers. Failure to treat the injured nerves can lead to continued pain and shock feelings in the groin and genitals. Our surgeons repair these injured nerves to maximize the chances for success.
Another advance that we have pioneered is the use of bone anchored mesh reinforcement of the core muscles. After the repair of the muscle is done, it can be somewhat fragile due to the injury and weakened muscles. In order to reinforce the repair and guard against re-injury, a mesh is secured to the bone and placed over the repair. This technique differs from the standard hernia mesh, as our mesh is placed over the top layer of muscle, away from the nerves and structures in the inguinal canal. This allows for a very strong repair of the injured core muscles.
How are you Qualified as a Plastic Surgeon to Treat Athletic Pubalgia, or Sports Hernia?Dr. Adam Saad is board certified in plastic and reconstructive surgery as well as in general surgery. During his five-year general surgery residency he trained at one of the top centers for treatment of Athletic Pubalgia. In addition, his plastic and reconstructive surgery training focused heavily on musculoskeletal conditions. By combining these training experiences he is uniquely able to offer treatment for Athletic Pubalgia, or sports hernia, which is truly a core muscle injury.
Dr. Andrew Elkwood is board certified in plastic and reconstructive surgery and general surgery. He is recognized as an international leader in the field of peripheral nerve microsurgery. His experience in nerve surgery for pelvic pain and the treatment of complex hernias naturally led him to take on the challenge of treating complicated sports hernias.