Sports Med U | Educating Minds, Elevating Potential

Sports Hernia: Definition, Evaluation, and Treatment

Hopkins, J.N., Brown, W. and Lee, C.A., 2017. Sports hernia: definition, evaluation, and treatment. JBJS reviews, 5(9), p.e6.

In today’s letter

• A quick overview of how to diagnose & treat sports hernias

• A fun infographic for you to save and use in the future

• Rapid Results =

Sports hernia is a complex condition often involving soft tissue damage without a visible bulge, and it can coexist with other pathologies like femoroacetabular impingement.

• 3 resources to check out to further your knowledge about hernias

• Meme of the week: Oh the good old days 😄 👀

Aim of the study

To discuss sports hernias and provide guidance on assessment & treatment options in athletes

The Diagnosis

When looking at groin pain in athletes, a thorough and full assessment is non negotiable

Why?

Because the groin area is extremely complex and it has many varieties of complicated conditions that can mimic its symptoms

Unlike inguinal hernia, sports hernia does not present with a visible bulge, and because its symptoms overlap with other conditions like:

• Hip joint dysfunction

• Adductor pain

• Nerve entrapment

it’s often diagnosed by exclusion.

This means that a detailed patient history and physical exam are the most reliable ways to diagnose it.

Conditions such as femoroacetabular impingement (FAI), osteitis pubis, and even pelvic floor dysfunction can also contribute to groin pain and may coexist with sports hernia, complicating diagnosis further.

In fact, studies suggest that up to 33% of athletes with groin pain have multiple contributing factors.

Taking the time to listen to the patient’s history thoroughly and observing how their pain responds to different movements is going to be the first step in treating this condition.

Athletes with sports hernia often report worsening pain with explosive movements like kicking or sudden direction changes.

These patterns, along with the localised pain around the pubic symphysis and any radiating pain into the adductors or thighs, will be your main diagnostic indicators.

Coughing, which reproduce the pain, can also help differentiate sports hernia from other causes of groin discomfort.

The Rehab

When it comes to addressing the pain, nonoperative rehab is the first-line treatment. The goal of rehabilitation is to stabilise the pelvic region, strengthen the whole hip musculature involved in movement, and address any biomechanical issues that might be contributing to the injury.

Core strengthening, such as exercises targeting the gluteus medius, transversus abdominis, and hip flexors, is essential, to help the pelvis stabilise during movement as this can reduce the strain placed on the groin area and improve overall functional movement, helping athletes recover without the need for surgery.

Step by step

1. Rehab programs typically begin with rest and non-weight-bearing exercises, to allow for healing without exacerbating the injury.

2. From there, athletes progress to upright functional training, with resistance and plyometric exercises introduced once they can perform basic movements like a supine crunch without pain.

3. Sport-specific drills are reintroduced gradually, allowing the athlete to build confidence and return to their activities safely.

This approach can be highly effective, with many athletes seeing significant improvement within 2-6 months of consistent therapy.

However, if pain persists beyond this period, more invasive treatments like laparoscopic surgery or nerve decompression may be considered.

Clinical Tips

Progress Activity Gradually: 

Little by little is the approach when progressing an athlete’s activity to ensure safe recovery and avoid reinjury.

Start with non-weight-bearing exercises such as isometric holds, gentle stretching (if needed), and core stabilisation exercises that help maintain strength without placing excess load on the hip.

As the patient begins to show improvements and is able to complete these exercises without pain, you can move on to more functional standing movements that mimic the sport , such as standing balance exercises or controlled movements that replicate the demands of their sport.

Gradual increases in resistance should be introduced next, always monitoring the patient’s response to ensure that they’re not experiencing any discomfort.

Lastly, speed and plyometric exercises should only be introduced once foundational movements, such as crunches or controlled squats, can be performed without pain. This gradual progression helps the body adapt to increasing loads and stresses in a safe and controlled way

Top 3 Resources to Check Out

And learn more about hernias

1. Simple exercises to try in the early stage (PDF) - LINK

2. Sports Hernia - What do the specialist think? (Blog) - LINK

3. Sports Hernia - Explained

Meme of The Week

When You’re Ready to Learn More

We have great resources for you to devourer

1. Killer Articles —> Literally everything you need to know about a specific injury

2. Tendinopathy 4 phase rehab frame work - My book that walks you through a step by step process of treating tendons

Thank you for reading this weeks edition!

Have a browse through our articles to sharpen you diagnostic skills