Consultant – Orthopaedic Surgeon
Speciality interests include:
Lower extremity: trauma, sports surgery, knee, patella dislocation, tendon problems, foot and ankle surgery, and the management of degenerative joint disease in younger patients.
Visiting on Sep 21-22, 2019Request an Appointment
Athletic pubalgia, also known as a sports hernia, is a groin injury that presents as pain with athletic activity, is one-sided and gradually getting worse (Yuill et al, 2012) This injury happens more frequently in athletic males in their 20s who are involved in sports that require: cutting, pivoting, kicking and sharp turns (i.e. football) (Yuill et al, 2012). During these movements, our hip adductors contract to stabilize the planted leg.
The thought is that overuse paired with a strength imbalance of one’s overdeveloped hip adductors (groin muscle) and weak lower abdominal musculature (core) is the root cause. This then leads to deficiencies in hip and leg strength, coordination and functional balance, causing an increase in shear forces across the pelvis.
Take a second and breathe. I may have gone a bit scientific for you too quickly. Let’s simplify. Think of kicking a soccer ball with a tug of war going on between your leg and your core. See that? Good. Now think if one is much stronger than the other. There will be a breaking point. Most often, this breaking point is at the weakest of where our internal oblique muscle connects to our skeleton- the inguinal ligament and pubic tubercle.
Rehabilitation of this type of injury can take up to 10-12 weeks. Even still, the success rate is still very low and there is a high occurrence of re-injury. It usually begins with 6-8 weeks of rest then onto rehabilitation to resolve muscle imbalances between the hips and the core (Caudil et al, 2008).On the other hand, operative treatment has a relatively higher success rate with 83% of patients reporting excellent post-surgical results (Caudil et al, 2008). In 2008, Caudill et al designed a 6-week post-surgical rehab program with a gradual pain relief and a return to injury. The key to success is to avoid and aggravation during the rehab component as it could potentially bring the athlete back to square one.
Kachingwe and Grech (2008) proposed an algorithm on how to proceed with treatment of athletic pubalgia for athletes and the general public:
A 2008 systematic review from Caudil et al., stated that in the National Hockey League (NHL), groin strains are 20 times more apt to occur during the preseason. It’s thought that off-season training programs may focus on overdeveloping leg strength, while core stability might take a bit of a back seat. So, for all you weekend warriors out there, in the gym you should be aiming to improve core stabilization and restore hip muscle imbalances. Toss in a few sumo squats and side lunges into your program. It may help!
Caudill P, et al. Sports hernias: a systematic literature review. Br. J. Sports Med. 2008;42;954-964
Kachingwe AF, Grech S. Proposed algorithm for the management of athletes with athletic pubalgia (sports hernia): a case series. J Orthop Sports. 2008; 38(12); 768-81
Yuill, E., Pajaczkowski, J., Howitt, S. Conservative care of sports hernias within soccer players: a case series. Jbodyw Mov Ther. 2012; 16(4); 540-8