DR HQ: Anatomy 101—Sports Hernias

Baseball is a game of cycles and includes injuries, or so it seems. Some seasons we’ll get a bunch of oblique strains, hamstring pulls or sore elbows. One injury that we haven’t heard much about recently is hernias—specifically sports hernia. That doesn’t mean sports medicine types have found a magic cure (there isn’t one) or major league team strength and conditioning coaches now have the workout program that prevents this type of injury. We are in a down part of the cycle and this injury will resurface in numbers in the future.

First off, let’s look at how WebMD describes a hernia.

What is a hernia?
“A hernia is a bulge of intestine, another organ, or fat through the muscles of the belly. A hernia can occur when there is weakness in the muscle wall that allows part of an internal organ to push through.

You may have a hernia if you can feel a soft lump in your belly or groin or in a scar where you had surgery in the past. The lump may go away when you press on it or lie down. It may be painful, especially when you cough, bend over, or lift something heavy.

Types of hernias include: Inguinal hernia, femoral hernia, umbilical hernia, incisional hernia, epigastric hernia, hiatal hernia and sports hernia.”

Here is the breakdown of two kinds of hernias we see in sports – the inguinal hernia, and sports hernias courtesy of WebMD.

“An inguinal hernia (say "IN-gwuh-nul HER-nee-uh") occurs when tissue pushes through a weak spot in the groin muscle.

Most inguinal hernias happen because an opening in the muscle wall does not close before birth as it should. This leaves a weak area in the belly muscle. When tissue pushes through the muscle, it creates a bulge.

The main symptom of an inguinal hernia is a bulge in the groin or scrotum. It often feels like a round lump. The bulge may hurt or burn. It may form over a period of weeks or months. Or the bulge may appear all of a sudden after you lift heavy weights, cough, strain, or laugh.

If you have an inguinal hernia, it won't heal on its own. Surgery is the only way to treat it.

About.com’s Orthopedic page does an provides an excellent primer on Sports Hernias.

“A sports hernia (aka Athletic pubalgia) occurs when there is a weakening of the muscles or tendons of the lower abdominal wall. This part of the abdomen is the same region where an inguinal hernia occurs, called the inguinal canal. When an inguinal hernia occurs there is sufficient weakening of the abdominal wall to allow a pouch, the hernia, to be felt. In the case of a sports hernia, the problem is due to a weakening in the same abdominal wall muscles, but there is no palpable hernia.

Courtesy:  www.haskestrength.com

What is the inguinal canal?
The inguinal canal is a region in the lower abdomen, just above the groin. The canal is formed by the insertions of abdominal muscles and tendons, as well as several ligaments. Within the inguinal canal travels the spermatic cord (in males) or the round ligament (in females). This area of the abdomen is prone to weakening of the abdominal wall, allowing an outpouching, or hernia, to form.

I have strong abdominal muscles, how can I have a sports hernia?
The problem with the abdominal wall in people with a sports hernia is not a muscle strength issue. Rather, the abdominal wall in a particular region is too thin, allowing the hernia to form. The sports hernia does not occur in the area of the large, thick part of the muscle.

What are the symptoms of a sports hernia?
A sports hernia typically begins with a slow onset of aching pain in the lower abdominal region. Symptoms may include:

  • Pain in the lower abdomen
  • Pain in the groin
  • Pain in the testicle (in males)

Typically the symptoms are exacerbated with activities such as running, cutting, and bending forward. Patients may also have increased symptoms when coughing or sneezing. Sports hernias are most common in athletes that have to maintain a bent forward position, such as hockey players. However, sports hernias are also found in many other types of athletes such as football and soccer players.

How is a sports hernia diagnosed?
The diagnosis of a sports hernia is determined based on the combination of the patient's history, physical examination, and diagnostic tests. Recently, the use of MRI tests has become more common in looking for signs of a sports hernia. Previously, the MRI was primarily used to look for other causes of groin pain, but recent research has found some characteristic findings on an MRI in patients with a sports hernia.

What is the treatment of a sports hernia?
There are no treatments that have been shown to be effective for sports hernia other than surgery. That said, the initial treatment of a sports hernia is always conservative in hopes that the symptoms will resolve. Resting from activity, anti-inflammatory medications, ice treatments, and physical therapy can all be tried in an effort to alleviate the patient's symptoms.

If these measures do not relieve the symptoms of a sports hernia, surgery may be recommended to repair the weakened area of the abdominal wall. In number of studies have shown between 65% and 90% of athletes are able to return to their activity after surgery for a sports hernia. Rehabilitation from surgery for a sports hernia usually takes about eight weeks.”

Baseball player examples with sports hernias: Grady Sizemore and Scott Podsednik are two of the better-known players who suffered the injury. Donovan McNabb when he was with the Eagles struggled with the malady. Lastly, the injury is more common in hockey players than any other sports, likely due to the repetitive motions of the sports.

The Future
We’ve seen baseball players improve their overall conditioning in the past few decades. This includes a focus on the athlete’s core. The downside there appears to be more injuries involving soft tissue, ligaments, tendons and muscles in the core area. Sports hernias and injuries in general are more common now that in the 70s-80s. The good news is the injury is repairable and one has to wonder if we will see improvements in the near future involving this injury.

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  For more information about the terms used in this article, see our Glossary Primer.