I got the call last week and his stress level was obviously high. “They think she has a sports hernia!” my good friend said. “Her physical therapist says they may have to cut her groin muscle” he expressed regarding his very athletic 17-year-old daughter.
I get calls like this with questions on sports hernia 4-5 times a month because of both the high incidence of upper groin/lower abdominal pain and the cloud of mystery associated with sports hernia.
Sports Hernia’s New Name
For the experts who manage this significant injury, the term “sports hernia” is being phased out. The new term, “core muscle injury”, is much more appropriate because of the significant involvement of the many muscles which make up the core. The leading surgeon in the US focussed on core muscle injuries is Dr. William Meyers in Philadelphia. I’ve sent at least 25 of my professional football players and countless other physical therapy patients of mine to be examined by Dr. Meyers with outstanding success. I have tremendous respect for Dr. Meyers. I have personally learned more about this injury from Dr. Meyers than I have from anyone else in my career.
Core Muscle Injury Defined
Often the many varying definitions of this injury is the main reason why this injury remains confusing. It’s not really a hernia and it typically does not involve just one muscle or tendon. Of the 70+ NFL players I’ve rehabilitated with a core muscle injury in the past 25+ years, they all had varying symptoms and limitations.
Often the diagnosis of a sports hernia is made based on a process of elimination: “It’s not a high groin strain and it’s not a significant Ab tear and it’s not hip flexor strain so it must be a sports hernia.” In many ways this is true, based on the level of testing the athlete has been given. An MRI with specific techniques to evaluate all the muscles impacting the pelvis.
What Do I Need to Know About a Core Muscle Injury?
History is Key – For both you as the athlete, the physical therapist and the doctor, knowing your pain/symptoms/workout history is very important. Answering my favorite evaluation question is a great start: “What makes the pain better and what makes it worse?”
No Two Creases Are Alike – As you’ll notice from the often-varying symptoms and limitations, the anatomy of the Abs/pelvis/hip/groin area will vary as well. Certain muscles are stronger than others while the many joints in this area will have different degrees of motion. In addition, even one side of the body will vary from the other based on the athlete’s sport(s) and the common finding of a leg length differential.
Think Above and Below the Pelvis – Your “core” muscles include your quads, hamstrings and the many groin muscles below the pelvis as well as your Abs, low back extensors and hip flexors above the pelvis. They all come into play so take the blinders off and focus on more real estate instead of just looking at the area of pain.
Tighten What’s Loose – Either with the rehabilitation or with the surgery, when a muscle or tendon is loose, tightening it up will typically improve the symptoms. Weakened and lengthened abdominal muscles above the pelvis are a common source of this problem.
Loosen What’s Tight – When a muscle is too tight, it needs to be loosened up to allow for better pelvis control when lower Ab/high groin pain is a problem. Overly tight groin muscles below the pelvis are a common factor with a sports hernia.
In closing, I hope this info helps clarify some of the common mysteries associated with core muscle injuries. Empowering you as an athlete to take control of your body and your sports injuries is a key focus of MikeRyanSportsMedicine.com.
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