Despite its name, a sports hernia (athletic pubalgia) is not a hernia. It’s an injury to a tendon or muscle in your lower abdomen or groin that causes chronic pain. Sports hernias are often caused by repetitive and forceful twisting of your pelvis. Sports hernias are treatable with physical therapy, medication and/or surgery.
A sports hernia (also called athletic pubalgia, sportsman’s hernia and Gilmore’s groin) is an injury (usually a tear) in the muscles and/or tendons in your lower abdomen or groin that causes chronic pain. People who have a sports hernia can also experience nerve irritation from the injury, which can contribute to the pain and sensitivity of the affected area. The name “sports hernia” is misleading because there is no actual hernia involved. Healthcare professionals prefer to use the term “athletic pubalgia.”
A sports hernia most often happens to people who play sports that require sudden changes of direction or severe twisting movements, but you don’t have to be playing a sport to get a sports hernia.
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Sports hernias happen in the soft tissue of your lower abdomen or groin area. Specific soft tissues that are commonly affected include:
Despite its name, a sports hernia is not actually a hernia. Healthcare professionals prefer to call a sports hernia “athletic pubalgia.” Although a hernia and a sports hernia symptoms are similar, the pain of a sports hernia is caused by soft tissue damage, such as a tear, in the lower abdomen or groin. A muscle or tendon is usually torn. The pain from a hernia is due to a gap in your abdominal muscle that causes your intestine or other soft tissue to protrude through, creating a bulge under the skin.
A sports hernia (athletic pubalgia) can lead to a hernia, but in that case, the traditional hernia is considered a separate injury from the athletic pubalgia.
Sports that involve repetitive, forceful motions, especially twisting your pelvis, can damage or cause a tear in the soft tissue of your lower abdomen or groin (a sports hernia). Sports that are most likely to cause a sports hernia include:
Approximately 5% of adult athletes experience sports hernias every year. Sports hernias are more common in people who play sports that involve frequent and forceful twisting and turning.
Athletes who play sports that involve sudden, forceful movements, especially twisting of the pelvis, are most likely to get a sports hernia. Males are much more likely to get a sports hernia than females. Athletes between the ages of 26 and 28 most commonly develop a sports hernia. It is rare for older people and children to get sports hernias. You don’t have to be an athlete to get a lower abdomen or groin injury (sports hernia), but it is more common in athletes.
A sports hernia (athletic pubalgia) happens when the deep layers of your lower abdominal wall or the tendons that attach muscles to your pelvis weaken or tear. The following situations can cause or contribute to a sports hernia:
The main symptom of a sports hernia is ongoing (chronic) pain in your lower abdomen and/or groin. The following descriptions and situations of the pain more specifically apply to a sports hernia:
Sports hernias can be difficult to diagnose because many conditions and injuries can cause pain in your groin area, such as hip-joint osteoarthrosis, rectal or testicular pain, or a fracture of the pelvis. In addition, you can feel pain in your groin area from injuries that originate in other parts of your body such as your leg. This is known as referred pain. It happens because you have many nerves in your groin area that extend to other areas.
To diagnose a sports hernia, your healthcare provider will do a thorough examination of your symptoms and history and perform a physical exam. They may also have you undergo imaging procedures to either confirm athletic pubalgia or rule out other possible injuries.
Your healthcare provider will ask you questions about your symptoms and history to see if you could have a sports hernia. They will then give you a physical exam to assess your injury and pain. They will probably ask you to do a sit-up and/or flex your abdomen against resistance. If you have a sports hernia, these exercises will be painful.
Because a sports hernia is a broad condition and you could have other conditions that are causing your groin pain, your healthcare provider may have you undergo imaging tests. These can include:
These imaging tests will help your healthcare provider determine if you have a sports hernia (athletic pubalgia) or something else.
In general, the goals of sports hernia treatment and rehabilitation are to relieve pain, restore range of motion, restore strength, return function and return to sports and activities. Treatment plans for a sports hernia depend on many factors such as the severity of the injury, your age, your health, and what level of activity you want to return to. Sports hernias can be treated with non-surgical treatment or surgery. If you have a sports hernia, your healthcare provider will most likely have you go through non-surgical treatment first to see if that fixes your sports hernia before turning to surgery.
Types of non-surgical treatment for sports hernias include:
If you are still experiencing pain two to six months after non-surgical treatment, surgical treatment is usually needed to fix your sports hernia. The specific kind of surgery depends on which muscles or tendons are injured and the severity of the injury. General types of surgical treatment include:
A sports hernia usually requires formal treatment other than rest, so it is unlikely that a sports hernia will heal on its own. Physical therapy, anti-inflammatory drugs and/or corticosteroids are often needed to treat a sports hernia. In some cases, surgery is needed. A groin injury that is not a sports hernia, such as a mild muscle strain, could heal on its own.
The overall goal of physical therapy to manage a sports hernia is to improve strength and flexibility in your abdominal muscles and hips without making the injury and pain worse. Your healthcare team will tailor your physical therapy plan to be as specific to your sport and your injury as possible.
Common physical therapy methods for sports hernias include:
Sports hernias (athletic pubalgia) can be difficult to prevent because of the stress and strain placed on the pelvis and hips in certain sports. Your healthcare team may recommend a sports hernia prevention program if you are at high risk for a core muscle or tendon injury due to the type of sport you play. A sports hernia prevention program may include:
The treatment and recovery for a sports hernia (athletic pubalgia) depend on the type and severity of the injury. In general, people who have a sports hernia and go through physical therapy treatment experience significant improvement in their symptoms after six to eight weeks of physical therapy.
Approximately 90% of surgeries, both open and laparoscopic, to fix sports hernias (athletic pubalgia) are considered successful. With post-surgery physical therapy and rehabilitation, people with a sports hernia can usually fully return to their sport or activities between six and 12 weeks.
In some cases, the affected tissue can tear again once you return to sports activity. If this happens, surgical repair will most likely need to be repeated.
If you’re experiencing symptoms of a sports hernia (athletic pubalgia) be sure to contact your healthcare provider. Sports hernias do not generally heal on their own, so you’ll likely need treatment.
If you’re in the process of treating your sports hernia and experience new or worsening symptoms, be sure to contact your healthcare team.
It may be helpful to ask your healthcare provider the following questions after you’ve been diagnosed with a sports hernia (athletic pubalgia):
A note from Cleveland Clinic
While we all experience pain from time to time, chronic pain is not normal. Be sure to see your healthcare provider if you are experiencing ongoing pain in your lower abdomen or groin. Sports hernias don’t usually heal on their own, so you will likely need treatment in order to feel better. Even though it can be upsetting to have to take a break from playing your sport, it is important to follow your healthcare team’s instructions for sports hernia recovery and allow your body to heal before returning to sports and exercise.
Last reviewed by a Cleveland Clinic medical professional on 09/24/2021.
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