With the news of NFL running back Adrian Peterson undergoing surgery for a sports hernia, it is a good time to talk about this injury.
First, the term sports hernia is misleading, as it is not a true hernia. The clinical name is for this injury is “athletic pubalgia.” Unlike a hernia, which involves a weakening of an abdominal wall, a sports hernia is an injury to one of multiple soft tissue structures the pubic bone and does not necessarily result in a bulge over the inguinal ligament.
(Modified From Original at Wikimedia Commons)
The injury is often caused by a hip extension with hip adduction and possible trunk rotation. The injury occurs because the rectus abdominis, external oblique, and adductor longus all attach at the pubic bone. During an action involving both adductor and abdominal action, these three distinct forces pull in different directions (see image), causing tissue damage at the pubic bone.
An athlete with a sports hernia will complain of pain in the groin, often radiating down the adductor longus muscle.
There are two common assessments for a sports hernia. First, the therapist provides resistance to the athlete’s torso during a sit-up, resulting in increased pain at the pubic bone. Alternatively, the therapist may instruct the athlete to squeeze their knees together and apply resistance, also resulting in increased pain.
Unfortunately, this is a difficult injury to heal. Conservative treatment involves rest, ice, soft tissue massage, and gentle stretching to relieve tension in the area. Increasing core strength is also employed, as a strength imbalance between the core and leg muscles is thought to contribute to the risk of injury.
Massage therapy should focus on releasing tension in the adductor longus muscle, gentle friction at the attachment site at the pubic bone, and addressing any muscle imbalances at the hip. Correcting anterior pelvic tilt may also be helpful, as this postural condition increases tension on the external oblique and rectus abdominis muscles.
If conservative treatment is unsuccessful, surgical treatment is often recommended, where they may insert a flexible mesh to strengthen the abdominal fascia and/or remove the ilioinguinal nerve. If the injury is to the adductor muscle, they will perform an adductor tendon release, where the adductor longus tendon is cut from it’s attachment on the pubic bone and attach it to the adductor brevis muscle underneath it. The surgeons I have heard present on this procedure stated they can have athletes back to competition in 6 weeks post-surgery.
For more information: