Chronic Groin Pain That Worsens Over Time

In 2005, few in the sporting world had ever heard of “sports hernia.” After experiencing debilitating groin pain and five corrective surgeries, NFL quarterback Donovan McNabb put the condition on the radar. Since then, the careers of several professional athletes have been interrupted by chronic groin pain that worsens over time. The good news is that with surgery, many of these pro athletes have been able to return to play full force.

Although groin injuries account for a small percentage of sports injuries, they are responsible for more time away from competition and training, compared to other injuries. Seen most often in professional football, hockey and soccer players, sports hernia can be tricky to diagnose.

Sports hernia, known as athletic pubalgia, is chronic pain due to weakness of the posterior inguinal wall, often without a clinically recognizable hernia. The inguinal canal region is prone to weakening because the tissue is naturally thin. Symptoms begin with a slow aching pain in the lower abdomen, groin or hip area, and do not generally get better on their own. If the condition does not improve with conservative treatment, surgery may be needed to correct the problem.

"Pro athletes have strong abdominals and they often ask, ‘How can I possibly have a sports hernia?" It can be a matter of overuse and leaning forward during play in football or hockey, causing excessive strain on an area of the body that is naturally weak.

Repetitive twisting and shear forces encountered during high-level athletics can lead to injury of the lower abdominal wall. Typically strong thigh abductors can exacerbate the problem, and whenever there’s pain, the body often compensates, which can cause strains and pulls in other areas of the body.

Pain in the groin and pelvis can be caused by a number of different problems, including injury to the lumbar spine, hip joint, sacroiliac joint, abdominal muscles or the genito-urinary system.

With the confluence of tissues, tendons, ligaments, muscle structures and organs coming together in this small area of the body, isolating a single cause is the challenge.

Skillful diagnosis combines the use of MRI imaging, radiographs, bone scan and physical examination, but the true causes may not be fully evident until corrective surgery is undertaken.

The sports hernia is not a true hernia. Hernia in this area of the body is a protrusion of abdominal cavity contents through the lower abdominal wall. The term hernia persists in part because many of the effective surgical treatments used to repair hernias also work well for this condition.

Treatment may begin conservatively with rest from all athletic activity and gentle stretching until pain and inflammation subsides. If a condition of sports hernia, athletic pubalgia or inguinal hernia is present, conservative treatment may help. Non-invasive laparoscopic surgical techniques can be used to treat and correct sports hernia problems.

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