When it comes to athletic injuries, the mind imagines broken bones and torn tendons. Yet one of the more common injuries I see in my practice as an orthopedic sports surgeon is sports hernias. The name misleads many athletes. The true name of a sports hernia should be core muscle injury or athletic pubalgia.

Probably the least understood of all the injuries experienced by pro, collegiate and high school athletes, as well as active adults, the sports hernia is a whole different ballgame than the commonly known hernia with the tell-tale bulge.

What is a Hernia?

A traditional hernia stems from a weakness or hole in the muscular wall that keeps abdominal organs in place. With these hernias, a visible bulge or pooch sticks out in the lower abdominal region, making the diagnosis fairly straightforward. Most primary care physicians are able to diagnose and treat these hernias without surgery.

What is a Sports Hernia?

Sports hernias most often occur during activities that require sudden changes of direction or explosive twisting movements, such as in football, hockey, soccer and tennis. The outcome can be a tear in the muscles in the lower abdomen, especially where the tendons attach the oblique muscles to the pubic bone. The tendons that attach the thigh muscles to the pubic bone (adductors) are also often stretched or torn. This group of muscles is responsible for stabilizing the pelvis and moving the leg toward the midline of the body.

What are the Symptoms of a Sports Hernia?

With a sports hernia, groin pain becomes more pronounced when straining in the abdominal area, especially in explosive-type activities or twisting. Doing a Sit-Up or flexing the trunk against resistance will be painful.

Any athlete—or extremely active adult, even in workouts—whose chronic groin pain is aggravated by sports or aggressive workouts, but relieved by rest, should be strongly considered to have a sports hernia.

Why are Sports Hernias Difficult to Diagnose?

Sports hernias mimic the symptoms of a traditional hernia, but without the visible bulge or pooch under the skin. This makes a definitive diagnosis more difficult.

It is not uncommon for athletes with sports hernias to be diagnosed with a groin strain and be told to rest until the problem goes away. And it does awhile. But the pain associated with a true sports hernia will return with a vengeance once the ibuprofen wears off and activity resumes.

What is the Solution?

Some sports hernias can be treated with physical therapy or injections. However, with athletes or active adults, I recommend surgery.

The procedure repairs the torn tissue through a small incision in the upper part of the groin. The acquired adductor contracture is released, and the lower rectus muscle is reattached to the pelvis. This restores normal biomechanical movement to the pelvis. In essence, the procedure rebalances the disruption that has taken place in the pelvis to compensate for the loss of support from the injured area.

More than 90 percent of patients who go through non-surgical treatment and then surgery are able to return to sports activities. At our clinic, we’ve had football players return to the rigors of full play four to six weeks after surgery. Without treatment, this injury can result in chronic, disabling pain that prevents you from resuming sports activities.