Sports Hernia

What is a sports hernia (athletic pubalgia)?

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.

Where do sports hernias occur on the body?

Sports hernias happen in the soft tissue of your lower abdomen or groin area. Specific soft tissues that are commonly affected include:

• Your oblique muscles in your lower abdomen.
• Your tendons that attach your oblique muscles to your pubic bone (part of your pelvis).
• Your tendons that attach your thigh muscles to your pubic bone (part of your pelvis).

What is the difference between a sports hernia and a hernia?

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.

Which sports cause sports hernias?

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:

• Ice hockey.
• Soccer.
• Football.
• Wrestling.
• Rugby.
• Skiing.
• Tennis.
• Hurdling.

How common are sports hernias?

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.

Who do sports hernias affect?

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.

What causes a sports hernia (athletic pubalgia)?

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:

• Forceful and repetitive hip movements, like twisting, kicking, jumping and cutting/slicing.
• Vigorous and unsafe abdominal and hip exercises.
• Weakness in the abdominal muscles and a lack of proper sports conditioning.
• An imbalance in strength between your hip and abdominal muscles.

What are the symptoms of 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:

• You experience sudden and intense pain at the time of the injury.
• The pain is ongoing (chronic) and feels dull or burning.
• It’s difficult to pinpoint the exact area of the lower abdomen and groin that the pain is coming from.
• The pain radiates downward to your scrotum and/or inner thigh.
• You feel pain when you’re exerting yourself, especially when sprinting, twisting, kicking or sitting up.
• You feel pain in your groin when you cough or sneeze.
• You have to stop participating in your sport or significantly cut back on your physical activity because of the pain.
• The pain may go away after you’ve rested, but it comes back during sports activities.

How is a sports hernia (athletic pubalgia) diagnosed?

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.

What tests are used to diagnose a sports hernia?

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:

• MRI.
• X-ray.
• Ultrasound.
• CT scan.
• Bone scan.

These imaging tests will help your healthcare provider determine if you have a sports hernia (athletic pubalgia) or something else.

How is a sports hernia (athletic pubalgia) treated?

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:

• Rest: Within the first seven to 10 days after the initial injury that caused the sports hernia, rest and ice can help.
• Physical therapy: Two weeks after your injury, your healthcare team may have you do physical therapy. These exercises will help to improve your strength and flexibility in your abdominal and inner thigh muscles.
• Anti-inflammatory medications: Anti-inflammatory medications such as ibuprofen and naproxen help reduce swelling and pain. Your healthcare provider may suggest taking this kind of medication for your treatment.
• Corticosteroids: Commonly referred to as steroids, corticosteroids are a type of anti-inflammatory drug. Your healthcare provider may recommend a cortisone injection if standard anti-inflammatory medications are not working.

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:

• Laparoscopic surgical procedure: Laparoscopic surgery involves small cuts (incisions) and a slender tool that has a tiny camera at the end of it. The surgeon is able to insert the camera tool into a small incision to “see” inside the body. They will insert other surgery tools into other small incisions to perform the surgery. Laparoscopic surgery is minimally invasive.
• Open surgical procedure: Open surgery involves cutting the skin and tissues open so that the surgeon can see the area that they are performing surgery on.
• Surgical rehabilitation: After surgery, your healthcare team will develop a physical therapy and rehabilitation plan specific to your needs to help you regain your strength and stamina.

Do sports hernias heal on their own?

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.

What type of physical therapy is needed for a sports hernia?

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:

• Core exercises.
• Stretching.
• Swimming.
• Yoga.
• Posture stability.
• Using medicine balls.
• Using resistance bands.

Can I prevent a sports hernia (athletic pubalgia)?

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:

• Abdominal and core strengthening exercises.
• Exercises to strengthen the hip muscles.
• Exercises to improve flexibility and minimize strain across the lower abdominal area where core muscle injuries often occur.

How long does it take to recover from a sports hernia?

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.

When should I see my healthcare provider?

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.

What questions should I ask my doctor?

It may be helpful to ask your healthcare provider the following questions after you’ve been diagnosed with a sports hernia (athletic pubalgia):

• What kind of sports hernia (athletic pubalgia) do I have?
• What is my treatment plan?
• Will I need surgery?
• How long will it take to recover?
• When can I resume exercise and sports?
• How can I prevent this from happening again?

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.