Sports Hernia in Football Players

Introduction

Football is a physically demanding sport that places significant stress on the body, including the lower abdomen and groin area. An injury that football players may encounter in this region is a sports hernia, also known as athletic pubalgia or inguinal disruption. In this blog, we will discuss the causes, assessment and treatment of sports hernia to help football players understand and manage this condition effectively.

What is a Sports Hernia?

Sportsman’s hernia is a condition characterised by chronic groin pain in athletes, particularly football players. It is not a true hernia involving a protrusion of intestines through the abdominal wall but rather a soft tissue injury or tear in the muscles, tendons, or fascia of the lower abdomen and groin region. There may also be irritation or entrapment of nerves in the inguinal region. The term inguinal disruption is often used to describe this condition as it encompasses the complex nature of the injury, involving a disruption or tearing of the structures within the inguinal region.

Image by Vuckovic et al, (2022) depicting different components of ‘inguinal disruption’.

Sports Hernia Symptoms

While the symptoms may vary from person to person, here are some common signs associated with sportsman’s hernia:

Groin pain: Footballers with sportsman’s hernia typically experience chronic, persistent pain in the groin area. The pain is often localised to the lower abdomen, groin crease, or the adductor muscle region. It may worsen with physical activity, particularly activities that involve twisting, kicking, or sudden changes in direction. Pain may also be brought on with coughing, sneezing or straining of the abdominal muscles.
Pain during sports-specific movements: The pain associated with sportsman’s hernia is often exacerbated during football-specific movements, such as kicking, cutting, sprinting, or rapid changes in direction. These movements place stress on the affected area, leading to increased discomfort.
Tenderness: Footballers with sportsman’s hernia may experience tenderness in the groin area. The affected area may feel tender to touch, and localised swelling or a bulge may be present.
Muscle weakness: Sportsman’s hernia can lead to weakness in the lower abdominal or adductor muscles of the inner thigh. Footballers may experience difficulty with movements such as resisted sit ups or adductor squeeze tests.
Limited range of motion: Due to pain and discomfort, footballers with sportsman’s hernia may have a limited range of motion in the hip and groin area. Movements that require hip flexion, extension, or rotation may be restricted and cause discomfort.
Pain relief with rest: Resting and taking a break from physical activity may provide temporary relief from symptoms. However, the pain often returns or worsens with resumption of sports or strenuous activities.

Causes of Sports Hernia

The exact cause of sportsman’s hernia or inguinal disruption is not fully understood. However, it is believed to be multifactorial and related to a combination of factors such as:

Muscle imbalances: Weakness or imbalance between the abdominal muscles, hip adductors, and hip flexors can put excessive stress on the groin area, leading to injury.
Repetitive movements: The repetitive and forceful twisting, turning, and kicking motions involved in football can contribute to the development of sportsman’s hernia.
Poor core stability: Insufficient core stability and inadequate pelvic control may contribute to increased strain on the groin area.
Previous injuries: Prior history of groin strain, osteitis pubis, hip injury, or other lower abdominal injuries can predispose individuals to sportsman’s hernia or inguinal disruption.

Assessment of Sports Hernia

Accurate assessment is crucial in diagnosing sportsman’s hernia or inguinal disruption and ruling out other possible causes of groin pain. A comprehensive assessment may include:

Medical history and physical examination: A thorough discussion of symptoms and a physical examination, including palpation of the groin area to identify tender spots or potential sites of disruption.
Clinical tests: Specific clinical tests, such as resisted adduction tests, resisted sit ups, hip range of movement and provocation tests, may be performed to reproduce the pain and help differentiate sportsman’s hernia or inguinal disruption from other groin pathologies.
Diagnostic imaging: Imaging techniques such as magnetic resonance imaging (MRI) or dynamic ultrasound may be utilised to assess the soft tissues, identify any tears or abnormalities, and confirm the diagnosis.

It is important to note that it is common to have other co-existing groin injuries alongside a sports hernia such as osteitis pubis or problems with the adductor tendons. For further information on groin injuries click on the image below.

Treatment Options for Sportsman’s Hernia

The management of sportsman’s hernia or inguinal disruption typically involves a combination of conservative measures and, in some cases, surgical intervention. The treatment options may include:

Conservative Management:

Rest and activity modification: Temporary modification or cessation of activities that exacerbate symptoms.
Physical therapy: A structured rehabilitation program designed to strengthen the core, hip muscles, and improve flexibility.
Anti-inflammatory measures: Nonsteroidal anti-inflammatory drugs (NSAIDs) or other pain-relieving modalities may be prescribed to manage pain and inflammation.
Injection therapy: In some cases, platelet-rich plasma (PRP) injections may be considered to reduce pain and promote healing.

Surgical Intervention:

Inguinal canal repair: Surgical repair of the inguinal canal structures may be performed to address the underlying disruption or tear.
Mesh reinforcement: In cases where a true hernia is present, the use of mesh reinforcement during surgery may be considered for added support.

The decision regarding the choice of treatment option should be made in consultation with groin specialist and experienced football physio, considering the severity of symptoms, duration of pain, and individual goals and expectations.

Products that may help

Foam roller with mini bands – Available here

The foam roller can be used for self massage on the adductors, IT band, quadriceps, and hamstrings. The mini bands are useful for strengthening or muscle activation work.

Injury Recovery Supplement Pack – Available here

Injury Recovery Pack includes collagen and key vitamins, scientifically formulated to support the joints, tendons, and ligaments of football athletes.

Rehabilitation Techniques for Sportsman’s Hernia

Rehabilitation plays a crucial role in the management of sportsman’s hernia or inguinal disruption, whether it is used as the primary treatment approach or following surgical intervention. The goals of rehabilitation include:

Pain management and inflammation control: Initially, the focus is on reducing pain and inflammation through the use of ice packs, anti-inflammatory medications as prescribed, and rest.
Proprioception and balance training: Enhancing proprioception and balance can improve stability and reduce the risk of recurrent injury. Balance exercises, stability ball exercises, and proprioceptive training drills may be included in the rehabilitation program.
Flexibility and stretching: Maintaining or improving flexibility of the hip muscles, groin, and lower abdomen through regular stretching exercises can help prevent muscle imbalances and reduce the risk of reinjury.
Core and hip muscle strengthening: A comprehensive rehabilitation program should target the core muscles, including the abdominal muscles, hip adductors, hip flexors, and gluteal muscles.
Gradual return to sport: As symptoms improve and strength and flexibility are restored, a gradual return-to-sport program can be implemented under the guidance of a qualified sports physiotherapist. This may involve progressive reintroduction of football-specific drills, movements, and eventually full training and match play.

Conclusion

Sportsman’s hernia or inguinal disruption can be a challenging condition for football players, causing chronic groin pain and impacting performance on the field. Understanding the nature of the injury, seeking early medical assessment, and following a comprehensive management plan are vital for a successful recovery.

Treatment options may include conservative measures such as rest, physical therapy, and anti-inflammatory measures, or surgical intervention if necessary. Rehabilitation techniques focusing on core and hip muscle strengthening, flexibility, proprioception, and balance training play a crucial role in the recovery process.

By following a tailored rehabilitation program and allowing sufficient time for healing, football players can increase their chances of returning to the field stronger, more resilient, and ready

Disclaimer

The information provided in this article is for educational purposes only and should not substitute professional medical advice. Always consult with a qualified healthcare professional for diagnosis, treatment, and personalised recommendations based on your specific condition. Some affiliate links may also be used in this article, these are from products we have specifically selected to display based on our own experience.

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