Over the last several years, more and more publicity has emerged around professional athletes undergoing surgery for a “Sports Hernia”. In fact, the condition is perhaps more accurately labeled as Athletic Pubalgia (pain in the pubic region), or any one of a number of other names. The condition is actually not a hernia at all, but is thought to involve a disruption of connective tissue in the pelvis, in or near the inguinal region, which is caused by an imbalance of muscular and tendinous forces focused in the groin. It occurs most commonly in athletic activities, which require certain motions of the hip, thigh, and abdominal muscles. Soccer and hockey players seem to be most at risk, but any activity that places stress in this area can produce symptoms of a sports hernia, especially when conditioning is somewhat out of balance.
Professional athletes are not the only ones at risk. In fact, it is likely that non-professional athletes and “weekend warriors” produce more injuries.
Diagnosis can be challenging, as diagnostic imaging studies such as MRI, CT scan, and ultrasound are often normal or inconclusive. Careful evaluation including analysis of the athletic mechanisms which produced the pain, and targeted physical examination, is usually the only way to accurately diagnose this condition.
Experts in the field argue about the appropriate treatment of this condition, and there is no clear-cut consensus as to which type of surgery is preferable.
Our approach is to avoid application of the “one surgery fits all” mentality, and devise a treatment plan that is suitable for the patient, his condition, and the urgency of returning to similar athletic activity. Clearly, professional athletes need to be “back in the game” as soon as possible, but it is important to allow adequate healing, whether surgery is involved or not, before allowing resumption of a full level of participation.
For some, surgery is not required. Quality physical therapy with a competent and knowledgeable therapist, combined with gradual strengthening exercises, can yield excellent results.
Surgical options for sports hernia include minimally invasive laparoscopic repair with lightweight mesh, and minimal incision “open” bilayer mesh repair with the Prolene Hernia System or UltraPro Hernia System. Release of the adductor muscle tendon in the groin is occasionally advised, but is employed very judiciously.
Professional athletes can usually be expected to return to the field of play in as little as two weeks, but 3-4 weeks is average. Others, depending on the level of conditioning and need for therapy after surgery, can require up to 6-8 weeks for adequate recovery.