A New Look at Sports Hernias

Ab Pain 298I 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.

Your feedback is encouraged and appreciated.

How Bad Can a Groin Strain Be?

I have to laugh when friends ask me, “what’s the big deal about a simple groin strain?!”  My reply is always the same and their answer is always “No“.

I simple ask them, “You’ve never strained your groin before have you?

If they had ever experienced either a groin strain or had an M80 explode in their front pocket, they’d have no need to ask such a question.

A groin strain is a painful injury and a troubling problem for skilled athletes who’s sport or position requires them to change directions quickly.  If you’re looking to ink that huge fantasy football trade this week with your friend in the marketing department, you might want to avoid the star running back or the speedy wide receiver with the bad hip adductor strain.

The Five Muscles of the Groin

Most people assume “the groin” consists of one (1) muscle when it is actually formed by the following five (5) muscles:

  • Adductor Brevis
  • Adductor Longus
  • Adductor Magnus
  • Gracilis
  • Pectineus

Understanding the Groin

The main role of the groin, commonly referred to as the hip adductors, is to both pull the leg inward.  This inward motion is also referred to as adduct the lower extremity.  Based on the position of these muscles, they also control the speed and direction the leg is allowed to move outward.  In other wards, when any combination of the groin muscles contract and shorten, the leg is pulled inward towards the midline of the body.  When any combination of the groin muscles are contracted and lengthen, the leg is allowed to move away from the midline in a controlled manner.

To complicate it even more, the varying angles and attachments of these five (5) muscles also directly or indirectly controls rotation of the entire lower extremity.

If you’re saying to yourself, “these muscles sure do just about everything”, you’re correct!  Vision a defensive back or a running back on any given play changing direction and aggressively rotating over their leg.   Now you can get a better understanding of the important role these muscles have and how debilitating an injury it is for such an athlete to have a weak and painful groin strain.

Does this give you more insight as to why my answer to the question; “what’s the big deal about just a groin strain?” is so easy?

Not All Groins are Created Equal

As a runner, triathletes and adventure racer, most of my training and racing is done in a straight line.  I learned this fact the hard way.  In 1996, I ran in the Empire State Building Run-up in NYC, the New Zealand Ironman Triathlon in Auckland, NZ and the Boston Marathon in my home-state of Massachusetts….all withn 6 1/2 weeks.  During the historic 1ooth running the Boston marathon I was position in the very back with my Dana Faber Cancer Marathon teammates.  Because of the large number of runners and my position in the back of the pack, I started weaving and zig-zagging through the 42,000 or so runners.  Based on my finishing time of 3:13, I had weaved around approximately 20,000 runners.

By the time I reached the base of the famous Heartbreak Hill at mile 18, both of my groins were in spasm and extremely painful.  I had not trained to move side-to-side nor weave like I was doing and my groins made that point loud and clear.  Although I had already completed two other extremely intense races in the previous 45 days, my groins were by far the most painful part of my body after the race.

Hockey players and soccer players tend to have the strongest hip adductors based on the demands of their sports.  They rely on their groin muscles so they address them with their strength work, their flexibility and their preventative rehabilitation.  If I suffer a strained groin in a marathon, I’m slowing down.  If they suffer a pulled groin in a hockey game, they’re game is over and they start rehab 5 minutes later.

The Lingo

A muscle “pull” or “tweak”, the non-medical terms, is the same as a “strain”, the proper medical terminology.   So the next time you hear someone say, “it’s not a pull, it’s just a tweak” know that’s someone just trying to make their coach feel better.

The Solution

Depending upon how badly it’s injured, the length of time for return to play will vary.  After suffering a hip adductor strain, the two key steps to take immediately are:

  • Ice your groin for 10-15 minutes no less than 5 times per day.
  • Do not stretch the groin muscles for at least 3 days.

I list these two sports medicine rehab tips on their own for one simple reason: If you implement them immediately after you suffer a pulled groin, you can literally cut your rehab time in half!  Think about that for a minute.  In other words, if you accidentally do the opposite and put heat on the injury and start aggressively stretching a tweaked groin, the bleeding will worsen and the downtime will be lengthened.  No one wants that to happen.

Bike riding, pool running, elliptical trainer, single/double leg balance drills, flexibility work around the injured muscles, massage and aggressive core stability should be included in every rehab plan that involves a lower extremity soft tissue injury.

As for returning to their sport, the athlete should initially start with straight ahead running and then progress with more side-to-side movements.  Progressing with speed, intensity and the number of reps can all be used to both evaluate and rehab an injured groin.

The next time you read about athlete with the “bad groin”, now I hope you show him some love!