What is Athletic Pubalgia?
Athletic pubalgia, often referred to as a sports hernia, is a condition characterised by a painful soft tissue injury in the groyne area. It commonly affects athletes involved in sports that require sudden direction changes or intense twisting movements.
Unlike a traditional inguinal hernia, where abdominal tissue protrudes through the abdominal wall, a sports hernia involves a strain or tear of the soft tissues (muscles, tendons, ligaments) in the lower abdomen or groyne. The medical term for this condition is athletic pubalgia, although the term sports hernia is more widely recognized.
Anatomy Involved
Athletic pubalgia typically affects the oblique muscles in the lower abdomen, especially the tendons that attach these muscles to the pubic bone. In many cases, the tendons that connect the thigh muscles to the pubic bone (adductors) are also strained or torn.
Causes
This injury often occurs during sports that involve high-intensity movements such as twisting or sudden changes in direction. Sports like football, rugby, ice hockey, and wrestling are particularly prone to causing sports hernias.
Symptoms
- Intense pain in the groin area at the moment of injury.
- Pain subsides with rest but returns with sports activity, especially movements involving twisting.
- Unlike inguinal hernias, sports hernias do not produce a visible bulge.
- Without proper treatment, the injury can lead to chronic pain that impedes sports participation.
Diagnosis
clinical Examination:
- Tenderness in the groyne area or above the pubis during a physical examination.
- Pain during specific movements, such as a resisted sit-up, is a common indicator.
Imaging Tests:
- X-rays or MRI scans may be used to confirm the diagnosis and exclude other potential causes of pain.
Treatment Options
Nonsurgical Treatment:
- Rest and Ice: Initial treatment involves resting and applying ice to reduce swelling and pain.
- PhysioTherapy: Starting approximately two weeks after injury, physical therapy exercises can help strengthen and increase flexibility in the abdominal and inner thigh muscles.
- Anti-inflammatory Medications: NSAIDs like ibuprofen or naproxen can help manage pain and reduce inflammation.
Surgical Treatment:
- Surgery: If nonsurgical treatments do not suffice, surgery may be necessary to repair the torn tissues. This can be done via a traditional open procedure or an endoscopic procedure using a small camera.
- Inguinal Neurectomy: In some cases, cutting a small nerve in the groin during surgery can alleviate pain.
- Rehabilitation: Post-surgery rehabilitation focuses on regaining strength and endurance, allowing most athletes to return to sports within 6 to 12 weeks.
Surgical Outcomes
- Over 90% of patients who undergo surgery following unsuccessful nonsurgical treatments return to their sports activities.
- Additional surgery, such as adductor tenotomy, may be required if pain persists in the inner thigh after the initial surgery. This procedure involves cutting the tendon that connects the inner thigh muscles to the pubis, allowing it to heal at a greater length and reduce tension.
Understanding athletic pubalgia and its treatment options is essential for athletes to manage their condition effectively and return to their activities safely. If you suspect a sports hernia, seeking prompt medical advice ensures the best possible outcome.
