Sports Hernia

Abstract

Patients with sports hernia present with pain in the lower abdomen and groin and are seen primarily in male athletes but can also be seen in recreational and female athletes. Due to the complicated anatomy and biomechanics of the pelvic region, the pain source of sports hernia is unclear, though there are various schools of thought regarding it. One proposed theory is that the pain is due to muscle/tendon tears including the external oblique aponeurosis, conjoined tendon, dehiscence between the inguinal ligament and the torn conjoined tendon, and rectus abdominis and/or adductors. Others think the etiology is an incipient posterior inguinal wall hernia. Yet another school of thought marries these two theories and attributes the pain to excessive forces applied through the pelvic attachments of the rectus abdominis and hip adductors resulting in posterior inguinal wall weakness. The patient typically complains of unilateral deep groin pain that is worsened with activity and relieved with rest. Pain can be reproduced with resisted sit-ups and adduction of the hip. MRI and ultrasound can assist with diagnosis by visualizing the inguinal canal and by excluding other etiologies of groin pain. Treatment should begin conservatively with relative rest, rehabilitation, NSAIDs, and possibly steroid or platelet-rich plasma injections. Patients with pain refractory to conservative management should be considered for surgical treatment.