Physical Therapy: Dealing with sports hernias

One injury that hockey players, in particular, should be familiar with is the sports hernia.

Hockey and indoor soccer are ramping up for the season and so too are the injuries from these physically demanding sports.

One injury that hockey players, in particular, should be familiar with is the sports hernia.

It can be very disabling for the athlete and proper treatment is often delayed because vague symptoms can make diagnosis difficult.

The term sports hernia, which is a relatively new concept, has been used as a diagnosis for some of the more difficult cases of groin and abdominal strains.

A hernia occurs when an organ or body part protrudes through the structure meant to contain it.

This can happen just about anywhere in the body (for example, herniated disk in the back).

The groin is the most common place for a hernia to develop.

In the groin, there is a space known as the inguinal canal that allows the spermatic cord in males and the round ligament in females to pass out of the abdominal cavity.

Occasionally, some of the lower intestine can push into this space, creating pain worse with lifting, coughing and pushing movements.

A sports hernia is different from a regular hernia in that technically it is not a hernia at all.

There is no protrusion of an organ through its usual confines. This sports hernia is a disruption of the groin or lower abdomen characterized by weakening of part of the inguinal canal, which leads to unilateral groin or lower abdominal pain.

Unfortunately, the diagnosis isn’t given until after a groin or abdominal strain doesn’t seem to get better in a “normal” period of time.

The athlete that has this condition will often present with groin pain, which has been very slow, or non-healing over a number of months.

Their pain usually increases when accelerating, twisting and turning, cutting and kicking and sometimes coughing and sneezing.

Hockey and soccer require repetitive twisting and turning at high speed. The action of the adductor muscles (muscles along the inside of your thigh) are very important in these sports and the frequent contraction can cause shearing forces across the front of the hip/groin causing stress to the inguinal canal.

A 1996-97 National Hockey League study found that nearly 20 per cent of their players suffered from groin and abdominal injuries.

Treatment for these types of injuries has improved a lot over the last decade as we have learned more about the importance of the trunk and pelvic stabilizing muscles.

Often, weakness in the trunk stabilizers or inflexibility across the hips and pelvis can lead to poor mechanics that cause increased shearing on the lower abdominal and groin areas. Proper muscle balance must be restored to this area to allow the injury to heal.

If you believe that you have a sports hernia, you should have your health care provider perform a thorough exam.

Your physician should be able to rule out other more serious pathology and order tests that may help with the diagnosis.

A skilled physiotherapist should be able to assess all aspects of pelvic flexibility, strength and stability and design a program for you that will address the weaknesses that may be making you prone to this injury.

Since preventing this condition is easier than treating it, any athlete who participates in recreation or competitive hockey or soccer should be on an off-ice or field-prevention program.

Pelvic and hip inflexibility, instability or imbalance may all contribute to the development of injuries to this area so exercises to increase flexibility of the hip flexors, abductors, adductors, abdominal and pelvic stabilizing muscles should be a staple of this program.