Hernia: Inguinal Hernia Symptoms – A Runner’s Approach

2

It was not a very long time ago when if someone heard about a hernia injury, the common assumption was that grandpa lifted a box from the attic that was too heavy. However, while hernias commonly affect the elderly, this is no longer the only type of hernia injury in our vernacular, especially as more athletes of all ages are diagnosed with a sports related hernia injury. Chances are that you will likely hear about a professional athlete becoming sidelined because of a sports hernia if you haven’t already. That same ailment that we used to believe only affected the elderly may be the reason your weekend tennis or golf partner is now unavailable for the next few weeks.

Today, when the topic of hernias and runners is addressed, the focus is on a sports hernia. Still, there are a number of forms that a hernia can take, and many of them can hinder runners of all ages and genders. This article focuses primarily on sports and inguinal hernias.

A sports hernia will often cause runners, athletes, and other active people to feel an achy or dull pain in the groin and abdominal region. While running, twisting or stretching, the pain of a sports hernia tends to become even sharper and more debilitating. Because of this, the first recourse for many runners is to stop training entirely in order to find some comfort.

Even though avoiding workouts may help bring some level of well-being, everyday movements can also trigger the pains of sports hernia which makes it important for runners to understand the complications of this injury.  The information contained in this article will help runners become more acquainted with sports hernias: their symptoms, treatment methods, and preventive measures to avoid it from occurring in the future.

What is a Sports Hernia? Different Types of Hernia

By definition, a hernia is when fatty tissue or an organ squeezes through a weakened area in the surrounding muscle or fascia (connective tissue). There are many different forms this injury can take, all with different causes, at-risk individuals, and treatment methods. For instance, an inguinal hernia, when the bladder or intestine protrudes through the abdominal wall, is the most common hernia. It is estimated that nearly 96% of hernias in the groin for men are of the inguinal variety. Men are eight times more likely to develop an inguinal hernia compared to women. On the other hand, a sports hernia is an overuse injury that leads to a weakened, strained, and sometimes torn wall of the lower abdomen. Overuse of the hip muscles or abdominal muscles commonly causes this injury to occur. The stress placed at the juncture between the muscles connecting the pubic bone and the hip abductor is usually the focal point of this painful injury.

Inguinal Hernia

Contrary to popular opinion, there is no bulge associated with a sports hernia. An inguinal hernia is the type of hernia that causes a bulge in the abdomen, groin or scrotum, and it is the kind of injury people most likely associate with the term. An inguinal hernia can also be acquired from rigorous athletic endeavors, but it is still different from common sports hernias. In this injury, a portion of the affected individual’s intestine protrudes through a soft spot or a tear in the abdominal muscles. When this happens and the bulge appears, it will often hurt and may cause a burning sensation.

The main symptom of an inguinal hernia is the aforementioned bulge in the groin or scrotum. The bulge will feel like a round lump but the bulge’s appearance from the time of the specific injury can vary over months, weeks or days. Once the bulge appears, it isn’t always painful, but other lingering sensations may be present. A person suffering from an inguinal hernia may feel tugging or burning near the bulge and find comfort from these symptoms by lying down. Intestinal problems resulting from a hernia may cause vomiting and nausea.

Most inguinal hernias happen because an opening in the muscle wall does not close as it should prior to birth. This leads to a weak area in the belly muscle that can eventually be the spot where tissue pushes through and bulges out. This can happen at any time in an individual’s life, seemingly without warning. Overweight people are at high risk of getting an inguinal hernia due to increased pressure in their abdomen. Other causes include lifting, coughing and straining. Pregnant women may encounter this hernia because of the pressure on the belly wall.

Sports Hernia

Being a soft tissue injury, sports hernias don’t necessarily involve any muscle tears or bulging points, but this has been known to occur in some cases. However, improper treatment of a sports hernia could lead to an abdominal hernia or other negative ancillary effects in the groin/hip region, so the threat of bulging and tearing is consistently present. While all athletes are at risk of a sports hernia, it most commonly occurs to those participating in a vigorous activity which requires quick planting of the feet and twisting of the core. Those most susceptible to this injury are soccer, football, baseball, tennis, hockey and basketball players.  That is why sports hernias are also referred to as Athletic Pubalgia, hockey hernia, sportsman’s hernia, or Gilmore’s groin. For runners, this type of hernia could come into play for those who run on trails and must quickly avoid branches, limbs or rocks.

Other Types of Hernia

For females, the most common type of hernia is a femoral hernia. This hernia transpires when the intestine enters the canal carrying the femoral artery into the upper thigh. A femoral hernia, when the intestine is in front of the blood vessels, is known as a Velpeau hernia.  Women who have had children can also be afflicted by an umbilical hernia. This type of hernia occurs when a portion of the small intestine travels through the abdominal wall near the navel. Similar to that condition is an incisional hernia which can occur when an intestine pushes through the abdominal wall near an area that was operated on in a previous time, such as during a Caesarean delivery.

Another type of abdominal hernia is the Spigelian hernia, also known as lateral ventral hernia. A Spigelian hernia occurs along the semilunar line (located between the abdominal muscles and obliques) which causes a herniation between the muscles of the abdominal wall. These are rare and can be both acquired and congenital.  A hiatal hernia, while not normally associated with physical activity or running, is the result of the upper stomach squeezing through the hiatus: the opening in the diaphragm through which the esophagus passes.

While these hernias affect different parts of the body and are caused by different events, all of these hernias have one thing in common: they are extremely painful and must be addressed by a doctor in order to prevent further damage. If a hernia is unable to be pushed in, the contents of the hernia will be trapped in the abdominal wall where it is considered incarcerated in that area. This incarcerated hernia runs the risk of becoming strangulated, which cuts off the blood flow to the trapped tissue. A strangulated hernia must be immediately attended to by a physician since it can be life-threatening.

To reiterate, here are the different forms of hernia mentioned above:

  • Inguinal Hernia: Commonly occuring among men, this is when the bladder or intestine protrudes through a tear in the abdominal muscles near the groin.
  • Sports Hernia: This is tearing in the abdominal wall caused by excessive repetitive movement from the lower body, such as twisting the hips.
  • Femoral Hernia: The cause of this injury is tearing in the leg muscles which allow small portions of intestine to poke through.
  • Velpeau Hernia: This is a form of femoral hernia where the protuberance is located in front of the blood vessels.
  • Umbilical Hernia: Exclusive to women is this form of hernia, where intestine protrudes from the abdominals near the belly button.
  • Incisional Hernia: Commonly affecting women, this injury can be caused by Caesarean section or other incisions near the stomach.
  • Spigelian Hernia: This type of hernia is rare and affects an area between the abdominal muscles and the obliques.
  • Hiatal Hernia: In this form of hernia the stomach protrudes upward toward the diaphragm near the esophagus.

Symptoms

The most common symptom of a sports hernia is the presence of aching pain in the lower abdominal region or groin during physical activity. This pain is triggered or intensified most often during lifting, cutting or twisting movements. For runners, this painful sensation can be triggered with the impact of the foot on a loose surface. It can also be felt by runners during pre and post-run stretching routines, with excessive stretching even being considered a potential risk factor for the injury’s onset. Performing abdominal exercises such as sit-ups intensifies the pain of a sports hernia. These types of symptoms often make it difficult to distinguish a sports hernia from a regular case of abdominal strain or pulled groin. This is why consulting a doctor and obtaining a proper diagnosis is essential for individuals suspected of having this injury.

When it comes to measurable pain, a sports hernia can often be as painful as or even more painful than an inguinal hernia. If the pain tends to be centralized to just one side of the body, it should be an indicator of a sports hernia instead of another potential lower-core physical ailment. For men, pain can be experienced in both or just one testicle. Rest may alleviate these symptoms but once running is resumed, they will return if a sports hernia is present.

Breakdown of Symptoms:

  • Pain in lower abdomen or groin
  • Pain for men in one or both testicles
  • Pain on one side of the lower trunk region
  • Increased pain during workouts that involve twisting, lifting or cutting
  • Lingering pain while rolling over or sitting up
  • Pain that continues to increase during workouts and subsides during periods of rest

Causes

There is no scientific consensus about the exact causes of a sports hernia. However, the common theory is it results from the overuse of lower abdominal and thigh muscles. When this area of the body is weakened it can become prone to injury from repetitive and quick movements. These movements include sprinting, twisting, kicking or bending, all of which are common to runners at an intermediate or above level. It is not just overuse of this area which could cause injuries, but improper training or stretching as well.

Essentially, excessive moving and twisting of the abdominal area can foster an imbalance of the pubic bones and the pubic symphysis (joint between the two pubic bones) that stresses the back wall of the inguinal canal. When there is a disturbance of the inguinal canal, it can lead to muscles, tendons, and ligaments pulling away from the pubic bone. The likelihood of this occurring increases if an individual exercises unhealthy habits when it comes to diet, sleep, and breaks in between workouts.

It is estimated that men are ten times more likely to experience a sports hernia than women. Besides the athletic overuse of the abdominal area, other causes for sports hernias can include age associated degeneration of the muscles and bones, previous medical exploration in the area, poor posture, and birth related defects in the groin and thighs.

Breakdown of Causes:

  • Overuse of abdominal muscles
  • Poor posture with anterior pelvic tilt
  • Repetitive and quick movements within a weakened abdominal/groin area
  • Short periods of strenuous actives without consistent exercise or stretching
  • Soft tissues found in the lower abdomen and pubic area are torn or injured

Risk Factors

There are many potential risk factors for developing a sports hernia. Some of these risk factors are out of an individual’s control, such as if they have some genetic predisposition towards this kind of injury. Other risk factors are within an individual’s control, such as dietary choices and lifestyle habits. The purpose of this section is to help an individual identify which, if any, of the following risk factors apply to them. If so, it is recommended that they avoid those that are in their control and work around those that are out of their control in order to prevent this painful injury from occurring to them.

  • Gender: Sports hernias affect men more often than women. Men are affected by inguinal hernias roughly ten times more than women are, mainly due to spaces created in the abdominal muscles due to development of the testicles. Some other forms of hernia are more common in women, such as incisional hernias, and others only affect women, such as umbilical hernias.
  • Muscle Imbalances: A strong core is important for an active body. If an individual engages in physically demanding activity such as distance running, sprinting, or weightlifting, many of the compound movements used in these activities will engage the core muscles. If the abdominal muscles aren’t as strong as the other muscles involved in the movement, excessive strain from exercise is more likely to lead to the development of a hernia.
  • Repetitive Movement: Engaging in repetitive movement without an adequate resting period will result in muscle strain. This is true of any form of movement and can affect any muscle in the body. Running, weightlifting, and sports such as soccer and hockey all involve repetitive movement to an individual’s core. Failing to practice good resting habits can lead these movements to cause strain in the abdominal muscles, which can eventually worsen into a sports hernia.
  • Pregnancy: There are a few ways that pregnant women can develop a hernia. Excessive stretching around a woman’s core during child development puts a great deal of strain on the surrounding muscles. This strain can turn into an umbilical hernia if a pregnant woman is too physically active. Another way a hernia can develop from pregnancy is from an incision, such as when a doctor performs a Caesarean section to deliver a child. Incisional hernias affect women more often than men as a result of this phenomenon.
  • Obesity: Much like pregnancy and repetitive movement, obesity can cause excessive strain in the abdominal muscles. With extra weight and fat built up on the body, an individual’s core has to bear more strain constantly. This can make an obese person more susceptible to developing a hernia: a combination of weaker muscles and excessive pressure.
  • Constipation: An individual’s core muscles are involved when performing a bowel movement. Having to strain when passing waste can put more strain on these muscles, with the strain increasing if it is a frequent occurrence. A diet lacking in fiber or adequate amounts of water can lead to constipation, and excessive strain from constipation can lead to a hernia developing as a result.
  • Cystic Fibrosis: There have been a few recorded instances of people developing hernias as a result of cystic fibrosis. This genetic disorder causes a great deal of mucus buildup in the lungs, which can lead to frequent hard coughing. Because coughing engages the core muscles, too frequent instances of rough coughing fits can cause strain and eventually lead to a hernia.

Complications

It is vital that an individual suspecting they are suffering from a hernia consult a doctor as soon as possible. The reason for this is that only a medical professional is qualified to diagnose and treat a sports hernia. Consequently, they will be the most effective at treating any cases of this injury and the individual will recover faster. Failing to seek proper treatment in time can result in even worse conditions developing as the injury complicates. Remember to seek treatment from a doctor in order to avoid your injury worsening into one of these conditions:

  • Ulcers: When suffering from a hiatal hernia, stomach acid can begin to damage the esophagus due to leakage and close proximity. The likelihood of this happening increases the longer an individual goes without seeking treatment. In some cases, the damage caused by this leakage of acids into the body will cause ulcers to develop, potentially leading to internal bleeding and vomiting.
  • Anemia: Another common complication when dealing with bleeding as a result of a hiatal hernia is an iron deficiency in the body. This can lead to anemia, which will cause fatigue and general feelings of weakness. For a period of time during treatment, an individual may need to supplement his or her diet with additional iron if this condition develops.
  • Constipation: Hernias that affect the groin and lower body such as inguinal hernias and Spigelian hernias have the potential to cause blockage in the lower intestine. If this occurs, one potential complication many sufferers of these conditions face is constipation. Without a clear path for the lower intestine, passing waste becomes much more difficult and painful and the constipated individual may need to take laxatives to ease this pain.
  • Peritonitis: Another effect that can occur to the body when suffering from an abdominal-based hernia is peritonitis. This is when the peritoneum, a sterile membrane surrounding the abdominal wall, becomes exposed to foreign elements and develops an infection. This is a very serious condition that can cause drastic health issues if not treated properly. The best way to avoid peritonitis if an individual is suffering from an inguinal hernia is to seek treatment as soon as possible.
  • Lung Failure: For any kind of hernia that obstructs the breathing passages, such as hiatal hernias, the potential for respiratory failure is present. One study showed that around 14% of hiatal hernia cases resulted in gastroesophageal reflux, which is correlated to lung failure. Quick and effective treatment for a hernia is the best preventative measure in order to avoid this complication.
  • Gangrene: Whether it is an inguinal hernia, a hiatal hernia, or any other form of a hernia that ends up blocking off other essential organs, the most debilitating complication possible is gangrene. Sometimes, protrusions that affect important bodily organs such as the intestines, lungs, or esophagus can cut off blood flow to areas of that organ. If that happens, the tissue in that organ can start to die, leading to extremely dangerous conditions such as gangrene and necrosis. These complications can quickly become life-threatening, so the importance of prompt treatment for these conditions cannot be overstated.

False Positives

It cannot be overstated just how important it is to seek the opinion of a medical professional before beginning treatment. This is to ensure that injured people don’t waste time and money attempting to treat one condition when in actuality they are suffering from another. There are a few injuries that resemble a sports hernia, often exhibiting similar symptoms and affecting similar areas of the body. However, attempting to treat these conditions in the same way as a hernia will not solve the problem. Before beginning treatment, it is important to rule out the following false positives:

  • Osteitis Pubis: This is a medical condition that often occurs from groin surgery, but has been known to afflict athletes. In osteitis pubis, a particular bone in the pelvis called the pubic symphysis becomes irritated and inflamed. This can cause swelling and pain in the lower abdomen or groin, especially during twisting movements. This injury can be ruled out with the use of imaging techniques such as a nuclear bone scan.
  • Muscle Strain: Groin strain is fairly common among runners and simply involves excessive muscle tearing around the hips and pelvis. Since the symptoms muscle strain exhibits are almost identical to early cases of a sports hernia, it is common for individuals to confuse one condition for the other. The presence of a bulge can indicate whether or not a hernia is present, as well as the presence of non-muscle strain related symptoms such as difficulty going to the bathroom.
  • Hip Dislocation: If severe pain is experienced after sudden impact or trauma, such as a collision with a vehicle, it is possible that pelvic pain and bulging is related to a dislocated hip. This is a much more serious condition and can be differentiated from a sports hernia due to the fact that it hinders mobility drastically.
  • Slipped Capital Femoral Epiphysis: Similar to hip dislocation, this is a bone issue rather than a muscle or intestinal one. Pain and swelling in the groin can be observed in cases of slipped capital femoral epiphysis, or SCFE for short. Treating SCFE involves surgery, much like many forms of a hernia, but the surgical procedure conducted is obviously quite different.

Diagnosing a Sports Hernia

The first step for a runner or athlete suffering from symptoms related to a hernia is to have a physical exam conducted by a doctor. The best time to have this done is as soon as symptoms are noticed; it is always possible that the condition has been present in the body before noticeable symptoms have developed, and a hernia will cause more damage to the body the longer it is untreated. When consulting a doctor or medical professional, most will have his or her patient perform some physical activities such as sit-ups, trunk twists, and resistance stretching. These tests are important for determining the patient’s overall health and muscle condition and can be used to pinpoint painful areas where a hernia may have developed. For individuals suffering from a sports hernia, this exam will most likely be very painful.

The next diagnostic step for a sports hernia is a scan of the body using imaging technology. This can include X-rays, ultrasound, CT scans or MRI scans, which are useful in finding injuries to the bone, nerves and soft tissue. An MRI tends to be the most effective imaging tool, since it is an effective method of identifying soft tissue tears. This is due to the fact that an MRI scan offers more detail than other forms of imaging scans. However, some doctors will still use different types of scans depending on an individual’s insurance, or if his or her body is sensitive to certain forms of imaging. In some cases, a doctor may perform a bone scan as well, in order to rule out other possible causes that could be related to bone damage instead of muscle tearing.

Breakdown of Diagnostic Practices:

  • Patient interview with questions regarding medical history and average physical activity
  • Physical exam with focus on muscle groups located near injured area
  • Physical tests on the affected area in order to determine strength and pain levels
  • Imaging scans to provide greater information on the affected region, often implementing MRI scans

Treating a Sports Hernia

Doctors who regularly diagnose cases of a sports hernia include pediatricians, general family practitioners, and internists. If surgery is needed, that will be done by a general surgeon. In the case of an umbilical hernia, an OBGYN will likely be involved. After performing a thorough diagnosis of the patient, a doctor is then able to determine whether or not they are suffering from a hernia. If they are, the doctor will know by this point what kind of hernia the patient has and how best to treat this injury. The most common method of treating a hernia is through surgery, but there are some other forms of treatment a doctor may recommend. Whatever the doctor’s specialty, he or she is first going to recommend ice and rest to patients as the initial steps. These standard sports injury remedies will hopefully bring some pain relief and recovery.

Physical Therapy

It is rare that a hernia will not require surgical treatment, but there have been some milder cases of a sports hernia that can be treated in this way. The initial course of action a doctor will take is to have the patient rest and refrain from running or performing other athletic endeavors for an extended period of time. The rest period will usually last between 7-10 days and will often require the additional use of ice and compression applied to the point of pain. Some forms of mild pain relief medication such as aspirin and ibuprofen can be effective in treating the pain and inflammation of these minor cases.

Once the rest period has concluded, the doctor will often recommend physical therapy and a rigorous stretching routine. Usually, this physical therapy is simple and can be performed at home with minimal additional equipment; however, some patients may wish to visit a physical therapy clinic in order to more fully rehabilitate. The exercises involved in this physical therapy process will aim to improve strength and flexibility of the inner thigh and abdominal muscles. Some of the best stretches that assist with the hips and abdomen include side bends, lunge stretches and sitting groin stretches. Additional information on these stretches and on other physical therapy exercises can be found in the Prevention section of this article further below. Patients who take the physical therapy treatment route often see improvements within 4 to 6 weeks, and a full recovery within 3 months.

Breakdown of Physical Therapy Methods for Treatment:

  • RICE protocol (Rest, Ice, Compression, Elevation)
  • Strengthening exercises targeting the abdominals, groin, and hips
  • Stretches to increase flexibility in the abdominals, groin, and hips
  • Gradual return to regular activity with walking and light jogging

Medication and Orthotics

A surgical belt or a truss can be worn to help stabilize the injured person’s midsection and create support around the bulge created by a hernia. Something like a truss is a short term solution and not a long term remedy, but it can provide pain relief and compression that will aid with recovery. Some doctors will tell their patients to wear a truss in preparation for surgery. For individuals looking to obtain a truss or surgical belt in order to recover from a hernia, they are commonly available at any drug store or pharmacy.

According to the Mayo Clinic, there are some reports of alternative health professionals curing hiatal hernias by gently pushing the stomach back into its normal area under the diaphragm. This procedure doesn’t involve surgery in any way: just manipulation and calculated pressure. This method has not been supported by any reputable scientific studies, and it is not recommended within the professional health community.

Unfortunately, there is no magic pill that will cure a hernia. However, a doctor may prescribe certain medications to alleviate specific symptoms if they threaten to make the patient’s condition worse or if they interfere with his or her overall quality of life. Strong cough medicine such as codeine may be prescribed in order to prevent heavy coughing which can irritate the abdominal and groin muscles. Stool softeners are also commonly prescribed, as they can prevent unwanted movement, tension, and pressure in these areas as well. An increased consumption of water and high-fiber food before and after the onset of a hernia will also help prevent and ease the pain associated with bowel movements for individuals with a hernia.

When a hiatal hernia is involved, doctors will often have patients take antacids to deal with stomach acid. Successfully regulating levels of stomach acid in this way can prevent the development of painful and potentially life-threating complications such as ulcers and internal bleeding. Over-the-counter products like Tums, Rolaids, and Maalox tend to provide some passing relief. If even more reduction of stomach acid is needed, then a doctor may prescribe Zantac, Pepcid and Tagamet. If those still aren’t strong enough, doctors may prescribe stronger medicines such as Prilosec and Prefaced.

Medications
Source: Christine Dela Cerna 

For those suffering from more significant forms of a hernia with unbearable levels of pain, doctors will sometimes prescribe narcotics to the ease the suffering. Additionally, the use of narcotics is almost universally implemented after hernia surgery to combat postoperative discomfort. There is a wide range of narcotics that can be used in hernia cases: acetaminophen with codeine, Vicodin, Lorcet, and opioids like hydrocodone and oxycodone.

These narcotics will ease the pain of a surgical procedure exceptionally well, but they do come with side effects. Some side effects of chronic narcotic use include nausea, vomiting and dizziness. The side effects of opioid use include constipation, which can exacerbate pain in the area affected by a hernia, and physical dependency. These symptoms have the potential to be detrimental in the healing process for those coming off a hernia surgery. Because of this, it is imperative for hernia patients to inform their doctors of any side effects history with narcotics.

The use of heavy painkillers should only be needed for 2-3 days following surgery, unless the patient has a unique situation that necessitates expanding the time frame to 1 week. After that time, milder pain relievers such as Tylenol or aspirin should be enough to handle any residual pain. It is common to be back at work in slightly less than a week’s time following an abdominal hernia surgery.

Breakdown of Medication Used for Treatment:

  • NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) for reducing swelling and relieving pain
  • Cough medicine to prevent excessive coughing that can irritate abdominal muscles
  • Stool softeners and laxatives to prevent intestinal stress
  • Narcotics and opioids to relieve pain after surgery

Surgical Treatment

If the patient’s hernia is severe and physical therapy is not enough to treat it, or if the patient wants to be treated as soon as possible due to an athletic event, surgery is the best option. Those who undergo a surgical procedure for a sports hernia are typically fully healed within 6 to 12 weeks and are able to resume their regular sports activity without any complications.

According to the American Orthopaedic Society for Sports Medicine, 90 percent of individuals who undergo hernia surgery are able to return to sports activity. Operations for sports hernias can be conducted by the use of local, regional or general anesthesia. When conducting the surgical procedure, surgeons can perform an open operation or laparoscopic procedure with the implementation of a mesh piece. The open procedure allows for the opportunity to evaluate and repair any damaged nerves, muscles or tissue. In this scenario, the insertion of a mesh into the injured area is not needed. Mesh is associated with a laparoscopic procedure conducted under general anesthesia. The thin, pliable mesh inserted by the surgeon repairs the injured area and helps support the inguinal canal and floor in cases where structural integrity has been compromised in the affected area. The incision required to conduct this surgery is usually 4-5 centimeters in length.

Mesh used in hernia surgery

Treatment for an inguinal hernia can also include both rehabilitation and surgery. The surgical option also commonly employs the insertion of a mesh to the injured area. In some cases, a surgeon may perform an inguinal neurectomy. This procedure involves cutting a small nerve in the groin area; this will relieve any instances of chronic pain, but it will also have the side effect of a loss in sensitivity. If there is still pain after the initial surgery and a neurectomy won’t work, another procedure may be needed. The procedure commonly prescribed at this point is an adductor tenotomy when a surgeon cuts the tendon that connects the inner thigh muscles to the pubis. This cut tendon will then heal at a longer length, releasing tension and increasing the patient’s range of motion.

Following surgery, a patient will usually be prescribed strict rest and relaxation for at least one week. In the second week, patients will start with a light rehab that includes 20 minutes of walking on a treadmill. After three weeks and a check-up visit with the doctor, the patient will be given a wider rehab routine involving more intensive physical therapy. Some competitive runners may be tempted to bypass the treadmill for a light run on a road or trail. However, this would be a significant mistake and is strongly discouraged by medical professionals. The instability of a road or track can lead to further pain and injury, as the body will be much more sensitive when recovering from surgery. A treadmill is helpful early in the rehab process due to its flat, even surface. Light treadmill exercise works to alleviate any stiffness or tension, assisting in the overall healing process.

Implanted mesh used during inguinal hernia surgery

Preventing a Sports Hernia

A runner can find relief from a mild sports hernia with a combination of rest, ice, aspirin/ibuprofen, and stretching rehab. Relieving minor cases in this way will help to prevent the development of an existing hernia into a much more serious medical emergency. However, if those techniques don’t help, it is imperative to stop with a running program and make an appointment for an exam. The best way to prevent a surgical procedure for a mild sports hernia is to see a doctor before the condition worsens and more muscles, tendons, and tissues are impacted. Keep these techniques in mind to prevent future occurrences.

For individuals who have not experienced a sports hernia and wish to prevent it from occurring in the future, there are many ways to accomplish this. A combination of adequate nutrition and hydration, strengthening exercises, proper rest, and flexibility enhancing stretches will go a long way toward preventing the vast majority of running exercises, including a sports hernia.

Warming Up

Many studies have been conducted into the benefits of performing specific warm-up exercises before running. In addition to preventing strains and cramps, stretches and light jogging can prevent the development of a sports hernia. Any pre-run workouts should include hamstring stretches, abdominal stretches, planking, and bridging. It may also be necessary for sensitive runners, or runners with prior injury history, to self-massage troubled or tender areas in the abdomen or groin. This can be done with a foam roller, tennis ball, lacrosse ball or massage stick to help release the knotted area.

Here are some warm-up exercises to use in order to help prevent a sports hernia. These exercises can also be used for physical therapy when rehabilitating from one.

  • Pillar Bridge: Start by lying on your stomach with your forearms on the floor under your chest. Push your forearms away from your chest so that only your feet and forearms are on the ground and supporting your bodyweight. Hold this position for a decent amount of time: beginners should start at thirty seconds, while more experienced individuals can hold it for up to a minute and a half. The goal of the Pillar Bridge is to push the neck and sternum as far from the forearms as possible with a tight stomach, engaging and strengthening the abdominal muscles.
Pillar Bridge
  • Lateral Pillar Bridge: If you are comfortable holding a pillar bridge for longer than two minutes without difficulty, lateral pillar bridges can increase the resistance of the exercise. This variation on the standard pillar bridge time requires you to lie on one side, with your lower forearm on the ground under your shoulder and your feet split. In this position, keep your body in a straight line and your elbow under your shoulder by pushing your hip off the ground, creating a straight line from ankle to shoulder. Keep your head in line with your spine, and hold this position for thirty seconds to a minute.
Lateral Pillar Bridge

warm-up routine should also include dynamic movement stretches. Here are some dynamic stretches to regularly include during warm-ups.

  • Hand Walks: Begin by standing upright. From this position, bend over at your waist and walk your hands out into a pushup position. While keeping your knees straight, walk your toes toward your hands in a similar manner until a stretch is felt in your lower back. Walk your hands back out away from your toes and repeat.
  • Single Leg Glute Bridge: Begin by lying on the floor face up, with your right knee bent to a 90 degree angle and your heel on the ground. Hold your left knee toward your chest. Flex your right glute in order to form a bridge with your hips pointed upward so that your body weight is supported only by your right heel and shoulders. Hold for thirty seconds to a minute and return to start position. Repeat this movement one or two more times, then switch legs and perform an equal amount of reps.
  • Inverted Hamstring Stretch: Begin by standing upright on one leg, with your arms spread away from your torso, pinching your shoulder blades together. Then bend over at the waist and kick your opposite heel upward. When the stretch is felt, hold for ten to twenty seconds, then slowly return to the standing position. Step back with your other foot and repeat. Alternate reps with each leg.
Inverted Hamstring Stretch
  • Kegels: Kegel exercises should be done by both men and women. Despite popular belief, men can do Kegels, and they should do them to prevent an inguinal hernia. Pelvic floor exercises for men can also help with urinary and erectile issues. Properly performing Kegel exercises will support pelvic organs such as the urethra, bladder, and bowel, as well as help to keep them in place. In order to start with Kegels, both men and women need to identify their pubococcygeal (PC) muscles. These PC muscles can be identified as the muscles used when urinating. When urinating, stop the process and you will feel these PC muscles tightening. Exercising these PC muscles is done by contracting and holding them for about 10 to 20 seconds per set. Repeat this for at least 10 times in a row multiple times throughout the day. Just like any exercise, you can gradually increase the number of contractions and the amount of time. It is important that you do not perform these exercises while urinating, as bladder damage can occur. Don’t hold your breath during these exercises either, and try not to tighten your abdomen or thigh muscles.

In a running warm-up workout, it is a good idea to incorporate different exercises aimed at strengthening the abductor muscles in the hips and core. Here are some ways to target these abductor muscles:

  • Shallow knee bends: While standing, bend your knees a quarter of the way down to a seated position. Make sure your knees are aligned with your big toes; it should look like you are sitting on an invisible chair. Hold this position for ten to twenty seconds, then return to the starting position.
  • Leg lifts: Begin by lying on one side of your body, similar to the Lateral Pillar Bridge starting position. Bend the knee closest to the ground at a 90-degree angle and lift the other leg straight upwards. Repeat this ten to twelve times, then switch legs and repeat the movement.
  • Side steps: Including a few minutes of a grapevine run into your warm-up is an excellent way to activate your hip muscles before a run. To perform a grapevine run, quickly step sideways alternating between placing your foot in front of and behind your other foot.
Grapevine
  • Standing leg swings: Begin by facing a wall or a pole. Rest one hand on the wall or pole for balance, and swing one leg behind your body from side to side. Be sure to use your muscles to perform this and not just momentum and keep the hips square to the wall/pole.

 

Standing Leg Swings

Additional Tips

  • Keep on Pace: Avoid dramatic fluctuations in intensity within your overall running regimen. Sudden increases in your training level may be the instigator that turns weakened muscles or tissues into a sports hernia. Never increase training intensity, duration, and frequency by more than 10 percent a week.
  • Be Flexible: Yoga and Pilates will improve a runner’s flexibility and balance. Increased flexibility will help prevent awkward twisting movements widely considered to be a root cause of a sports hernia. Muscle balance will help create tissue loading which then builds tissue tolerance.
  • Don’t Weight Yourself Down: A runner’s weight is something that must be constantly monitored. Any sudden weight changes that result from periods of inactivity or injury will add stress to the joints and muscles near the abdomen and groin. In addition to a sports hernia, runners with fluctuating weight run the risk of developing shin splints and joint pain.
  • Give it a Rest: Taking a day off or occasionally reducing the intensity of a workout or run could be the remedy to heal weakened abdominal muscles. A sports hernia is an overuse injury, so a runner must always be wary of overusing their abdominal and groin muscles. Failing to do so is the most common way in which runners sustain this injury.

Conclusion

A sports hernia is a painful and gradual injury that arises from stress placed on weakened abdominal and groin muscles. A hernia of this variety can be easily treated and not take a runner too far off a regular routine if it is treated immediately. However, if not treated properly at first, or if too much time has passed before undergoing treatment, it can worsen to the point where surgery is needed to implant a mesh into the injured area. Understanding the early signs of a sports hernia is vital to limiting the effect it can have on the body. With the information presented in this article, you should be able to identify the symptoms of a sports hernia, and prevent it from becoming a serious injury. Keep your eye out for any lingering abdominal or groin issues and keep on running!

Sources

These are the sources cited in this article with additional information on a sports hernia. While these are reputable sources with information from medical professionals, you should not take the information in this article as professional medical advice. Always consult a doctor before attempting anything listed in this article.

Sources

  1. Staff Writer, Sports Hernia , American Academy of Orthopaedic Surgeons, May 05, 2017
  2. Brown, Jim, Sports Hernia 101, Exos Knowledge, Oct 18, 2017
  3. William Brown, MD, Sports Hernia Symptoms When Running, , Sports Physiotherapist , Oct 18, 2017
  4. Brown, William, MD, Sports Hernia Surgery An Effective Treatment, Sports Hernia.com, May 05, 2017
  5. Caucci, Desirea, Preventing the Dreaded Sports Hernia, Philly.com, Oct 18, 2017
  6. Howard, Dan, Sports Hernia & Running, AZ Central, May 05, 2017
  7. Staff Writer, Sports Hernia , Johns Hopkins, May 10, 2017
  8. Mayo Clinic Staff, Inguinal Hernia, Mayo Clinic, May 10, 2017
  9. Staff Writer, Understanding Hernia -- the Basics, Wed MD, May 09, 2017
  10. Web MD Staff, Common Types of Hernias - Topic Overview, Web MD, May 05, 2017
  11. Greub G, Liaudet L, Wiesel P, Bettschart V, Schaller MD, Respiratory complications of gastroesophageal reflux associated with paraesophageal hiatal hernia., Journal, Aug 01, 2003
  12. Reiss JE, Garg VK, Bowel gangrene from strangulated Petersen's space hernia after gastric bypass., Journal, Feb 01, 2014
  13. Schweigert M, Dubecz A, Ofner D, Stein HJ, Gangrene of the oesophago-gastric junction caused by strangulated hiatal hernia: operative challenge or surgical dead end., Journal, Jun 01, 2014
  14. Fletcher IM, Jones B, The effect of different warm-up stretch protocols on 20 meter sprint performance in trained rugby union players., Journal, Oct 18, 2004
  15. Gregory R. Waryasz, MD, CSCS, Exercise Strategies to Prevent the Development of the Anterior Pelvic Tilt: Implications for Possible Prevention of Sports Hernias and Osteitis Pubis, Journal,
  16. MedScape, Osteitis Pubis, Article, Dec 29, 2015