Athletic Pubalgia/ Sports Hernia

Melissa LeBlanc, Jordan Utley & Jenn Ostrowski Introduction to Athletic Pubalgia/Sports Hernia A soft tissue injury is a strain or tear in the lower abdomen or groin region ("Sports hernia (athletic," 2010). It is most commonly caused by sports requiring sudden changes in direction or twisting movements. Athletic pubalgia is also called sports hernia, sportsmans hernia, and Gilmores Groin (MendMeShop and Rabe & Olliver, 2010). Incidence of Athletic Pubalgia/Sports Hernia The incidence of athletic pubalgia is much higher in men than in women athletes, 9:1 ("Athletic pubalgia," 2013). The large discrepancy has been attributed to not only the relatively low number of females participating at the professional sports level as well as a difference in pubic anatomy. The differences in pubic anatomy is thought to be the most likely reason. Sports hernias are not limited to professional or elite athletes, even the recreational athlete can develop a sports hernia ("What is a," ). Etiology Athletic pubalgia is not a hernia as it is medically described it is most commonly an overuse injury ("What is a," ). Activities that involve planting of the feet and twisting at maximum effort can cause a tear in the soft tissues of the groin and/or lower abdomen called a sports hernia or athletic pubalgia. Sports hernia most commonly occurs in sports like running, soccer, football, ice hockey and wrestling.

Photo Credit: http://www.wasatchandbeyond.com/2013/05/andreas-athletic-pubalgia-surgery.html

Primary tear of the external oblique aponeurosis. The tear is 2-3 inches long and separated by a full thumb's width. The arrows show where the tissue should be attached. That entire area between the arrows is torn.
Anatomy and Physiology of Athletic Pubalgia/Sports Hernia Anatomy Sports hernia most commonly affects the tendons that attach the abdominal muscles and the thigh muscles (adductors) to the pubic bone. There are a number of small muscles that insert on the inferior aspect of the pubic girdle. These include the gracialis, adductor muscles, orbturator internus and a series of tendinous arches. There are a number of larger muscles that attach to the pelvic girdle specifically the gluteus muscles, the quadratus femoris, the rectus abdominus, internal and external obliques, and the transvere abdominus. The bony anatomy in this region is composed of some moveable joints and a number of immovable joints. The main bones that are of concern are the ilium, ischium and pubis. There are also a number of bursae, some of which are large and irregularly shaped ("Athletic pubalgia," 2013).

Photo Credit: http://www.mendmeshop.com/groin/athletic-pubalgia.php

Physiology Sports hernia usually produces pain more lateral and proximal. The pain associated with athletic pubalgia has not only been associated with tears of the soft tissue but with anatomical dysfunctions such as abdominal hyperextension and thigh hyperabducation with the pivot point being the pubic symphisis ("Athletic pubalgia," 2013). The joints in between the pelvic bones are immovable in most people but it is thought that in the elite athlete there is some amount of movement in these joints due to their high level of activity ("Athletic pubalgia," 2013). Evaluation of Athletic Pubalgia/Sports Hernia Evaluation of the sports hernia is often more difficult that that of a traditional hernia. This is due to the location of the injury and the many different injuries that can occur in this very compact area. Sports hernias do not typically occur in the superficial depth of

musculature but at a deeper level. There is usually point tenderness and pain that increases with activity. The activities that may exacerbate the pain include: cutting, twisting, rotation, bending, running or any activity where the injured muscles are stressed. Evaluation and diagnosis are most effective when x-ray films and MRI is combined with traditional evaluation of the regional muscles. (text, p 447-448) Signs and Symptoms Signs and symptoms include point tenderness and an increase in symptoms with activity, especially those activities which are dynamic in nature ("Sports hernia (athletic," 2010). The patient will commonly indicated pain when the adductor muscle group is challenged. Additional signs of a sports hernia are: pain in the groin or lower abdomen, pain when bending, cutting or performing lateral movements, radiating pain to the testicles, pain in the lower abdomen/groin when sneezing or coughing, and/or a tearing sensation at the point of injury ("What is a," ). Special Tests Valsalva maneuver (text, p 448): patient is asked to bear down or to pop ears like in an airplane. http://www.youtube.com/watch?v=SC29GbWbN-M Associated Differential Diagnoses Tendinitis, bursitis, osteitis pubis, fracture of one of the associated bones, hip and musculoskeletal related pathologies, adductor strains, snapping hip syndrome, ilioposas tendinitis, iliotibial band syndrome, sacroiliac sprain, arthritis, or tumor. Other differential diagnoses also include irritable bowel syndrome, pelvic inflammatory disease, herpes, prostatitis, or cancer of the rectum or testicles. In women additional factors should be ruled out. Those include cystic ovarian disease, endometriosis, Crohns Disease and any mensturaly related discomfort with no know cause ("Athletic pubalgia," 2013). Prognosis and Recent Evidence Informing Best Clinical Care

Photo credit: http://www.alpfmedical.info/femoral-head/athletic-pubalgia.html

("Athletic pubalgia," 2013) Best care practices currently indicate that rest and strengthening of the core and affected muscles are one method of treatment. If that course of treatment is ineffective then surgical repair is indicated. Massage has also been shown to be effective in reducing the recurrence of athletic pubalgia. The prognosis of athletic pubalgia is good. Athletes typically return to play as early as two weeks and up to six weeks with on going therapeutic practices. Recent Research Athletic Pubalgia: Recognition, Treatment and Prevention http://hhpr.uark.edu/biomechanics/KINS/atshc_athletic_pubalgia.pdf Athletic Pubalgia http://www.alpfmedical.info/femoral-head/athletic-pubalgia.html References: Athletic pubalgia. (2013, July 25). Retrieved from http://www.alpfmedical.info/femoralhead/athletic-pubalgia.html MendMeShop. (n.d.). What is athletic pubalgia. Retrieved from http://www.mendmeshop.com/groin/athletic-pubalgia.php

Sports hernia (athletic pubalgia). (2010, Sept). Retrieved from http://orthoinfo.aaos.org/topic.cfm?topic=A00573 Rabe, S., & Olliver, G. (2010). Athletic pubalgia: Recognition, treatment, and prevention. Retrieved from http://hhpr.uark.edu/biomechanics/KINS/atshc_athletic_pubalgia.pdf What is a sports hernia?. (n.d.). Retrieved from http://www.ncsf.org/enew/articles/articles-sporthernia.aspx