SPORTS HERNIA – ATHLETIC PUBALGIA
Chronic groin pain is a problem that athletes, professionals or amateurs, face quite often. It usually occurs in sports where the athlete runs and makes sudden accelerations and decelerations, sudden changes of direction, rotational movements or kicks. It is usually observed in football or basketball players. The area the pain appears and the symptoms it causes are similar to those of an inguinal hernia and for this reason, for several years, the incorrect name “athletes’ hernia” prevailed.
In Greece, the most common name is “abdominal-adductor syndrome” while internationally it is called “athletic pubalgia” and recently (2014) the name was defined internationally as “inguinal disruption”.
Sports hernia (inguinal disruption) occurs as a result of strain and wear of the muscles and tendons of the groin and perineum. The pubic bone of the pelvis is the place where both the abdominal muscles (rectus abdominis and lateral abdominis), as well as the adductors of the lower limb overran.
Inguinal disruption syndrome symptoms include pain in the groin, perineum, and the attachment of the adductor to the pelvis (pubic bone). The pain appears itself, either gradually worsening from continuous strain, or suddenly without prior “warning”. It usually subsides with rest and taking anti-inflammatory drugs, but recurs with the resumption of athletic activity.
The diagnosis is made primarily from the athlete’s history and clinical picture, while an ultrasound or MRI of the area is also necessary. Regarding the clinical picture, if the athlete shows 3 of the 5 signs below then inguinal disruption syndrome can be diagnosed with relative certainty.
- Localized tenderness at the pubic tubercle over the common cataphyseal ligament
- Tenderness on palpation of the internal inguinal opening
- Pain or distension of the external inguinal opening without hernia
- Pain at the insertion of the adductor longus muscle
- Dull diffuse pain in the groin area that radiates to the perineum and the inner surface of the thigh.
Conservative treatment includes physiotherapy, rest and abstinence from sports and the administration of analgesics. In recent years, other methods have been applied with encouraging results, such as
Ultrasound therapy, or radiofrequency (RF), as well as the injection of local anti-inflammatory steroids or prp (platelet rich plasma).
In the case that conservative treatment fails, or symptoms appears again, surgery is necessary. Surgical treatment aims to strengthen the abdominal walls and restore the balance of forces exerted on the groin.
Surgical repair of inguinal disruption may resemble a common inguinal hernia, however, it is not always the same. My personal preference is laparoscopic TEP reconstruction because it combines very good results with a faster return to athletic activity.
It is the technique that has been most widely used in the last decade in most specialized centers abroad. What makes it stand out is that it is performed not inside the abdomen, but in the space between the abdominal wall muscles and the peritoneum that surrounds the abdominal organs. This space is created through a special balloon that is inserted through a small incision in the navel and then withdrawn. Then, using very fine instruments, the affected area is anatomically prepared and a mesh is placed in the ideal position, leaving the intra-abdominal organs unaffected.
Among the main advantages of the minimally invasive method of treating hernia in athletes are:
- Short duration of surgery
- Less blood loss
- Reduced postoperative painloss
- Absence of scars and marks
- Immediate return to daily life and sports
- Only one day of hospitalization
It should be noted that the patient must necessarily follow a specific postoperative rehabilitation program with physiotherapy and gradual increase in the intensity of the muscle load.