The Myth of the Sports Hernia

By: Dale J. Buchberger, PT, DC, CSCS, DACBSP

Athletes like Donovan McNabb of the Washington Redskins have been said to suffer from sports hernias, when their problem is in fact an abdominal muscle tear condition called athletic pubalgia syndrome.

You can’t watch a professional sporting event today or an episode of ESPN SportsCenter without hearing the term sports hernia. Donovan McNabb, Jeremy Shockey, Dave Harris and the list goes on of professional athletes who have had to deal with the pain and disability that this elusive disorder brings. Considering the notoriety this injury brings, you would think its diagnosis and treatment would be more commonplace. In fact, the athletic population and general population alike does not know what a sports hernia really is. It is not uncommon for patients to equate a sports hernia with the more common inguinal hernia. In plain terms, a sports hernia is not a hernia of any type. This is why experts in the field are trying to get away from using the term sports hernia and replace it with athletic pubalgia. Unfortunately, we will need sports announcers such as Trey Wingo and Chris Berman of ESPN fame to stop using the phrase sports hernia before the name will change. Let’s answer the question: What is a sports hernia?

A sports hernia, or athletic pubalgia syndrome, (APS) is actually a tear of the rectus abdominis (abdominal six-pack) muscles off of the pubic bone and/or a tearing of the conjoined tendon of the abdominal oblique muscles. It can occur in athletes or non-athletes. It can be the result of severe trauma, such as an automobile accident or sports collision. It can also occur from the rigors of intense athletic training. It can be seen in males and females alike. It is common in older athletes trying to revive or maintain athletic careers. Sports having a notorious association with sports hernia are ice hockey, soccer, football, sprinting, lacrosse, baseball, golf, swimming, etc.

The athletic pubalgia syndrome commonly presents with one-sided lower abdominal and/or groin pain. The pain may radiate down the front of the thigh to the knee. Unlike the common inguinal hernia, there is no bulge or herniation of anything. There may be pain with coughing, sneezing, turning over in bed at nighttime, sprinting, kicking, sidestepping, weight training and performing certain maneuvers specific to your athletic activity. The condition will settle down with rest and discontinuing the athletic activity. However, return to the athletic activity usually brings a return of the symptoms and athletic frustration. The elusive ability to diagnose the condition results in an average of 14-20 months before most athletes are diagnosed and effectively treated for APS. Part of the elusiveness of APS is that 17 different variations of the same condition have been identified.

There are several things required for an appropriate diagnosis: First, a practitioner that is familiar with the condition and understands the exam procedures necessary to diagnose it on physical exam. Once an MRI is performed, the radiologist must be experienced and knowledgeable in reading and recognizing APS on the MRI. A specific APS MRI protocol has been developed and is helpful in the accurate diagnosis of APS. Depending on the grade or severity of APS, surgical repair may be necessary for adequate correction and may be the most efficient management strategy. In less severe cases of APS, a non-operative therapeutic approach may be effective. Non-operative treatment of APS is focused on soft tissue treatment of the involved muscles and restoring balance in strength and flexibility to the muscles of the thigh, hip and pelvis also referred to as the core. Athletes need to be retrained in their way of training, and traditional exercises such as sit-ups should be removed from the workout plan. The process can be tedious and frustrating.

Athletes suffering from hip, groin or lower abdominal pain should be examined to establish the presence of athletic pubalgia syndrome or sports hernia. Please keep in mind that while sports hernia is being diagnosed at a higher rate, due to our increasing familiarity with its presentation, there are more severe conditions that can result in hip and groin pain. Seeing your sports medicine health care provider is the first step in ruling out one of the more severe conditions and getting to the most efficient management of the injury.

Photo by The Associated Press/Nick Wass