Last Updated on Thursday, 25 October 2012 11:00
By Dr. Rob LaPrade
http://drrobertlaprademd.com
Question: I had a nagging groin pain much of last season. What can I do to try to prevent it from acting up again this year?
Answer: Most true adductor strains, commonly called groin strains, resolve within a couple weeks after injury. True adductor strains most commonly occur at the junction between the muscle and the tendon and resolve with rest, icing, stretching, and hip adductor exercises.
What you are describing sounds like a “sports hernia”. Groin strains which linger more then a few weeks are commonly sports hernias or femoroacetabular impingement. This article will focus on sports hernias.
Insufficient core stability can result in a “sports hernia,” or an abdominal muscle wall tear involving a structure in the groin known as the superficial inguinal ring. The symptoms of a sports hernia can sometimes be indistinguishable from those of a groin strain; therefore, any groin strain which lingers more than a few weeks should be evaluated for the presence of a sports hernia. Unlike inguinal hernias, where a portion of the intestines has slipped into the inguinal ring, sports hernias are small tears in the abdominal wall muscles that attach around the inguinal ring. Sports hernias have only been recognized by physicians and trainers in the last 10 years, so it is not uncommon for an athlete with a sports hernia to see several physicians before the correct diagnosis is made.
The most common complaint of hockey players with sports hernias is that they cannot transition for on-ice activities and have difficulty twisting or turning on the affected side. On exam, almost everyone will have pain to palpation of the inguinal ring region. Additionally, it is common to have pain with performing an abdominal crunch or with performing a resisted one legged straight leg raise.
The athlete with a sports hernia should rest the affected area, and may attempt a gradually progressive physical therapy regimen in hopes that it will heal, but often surgery is required for full recovery. A general surgeon who specializes in this area can address the injury by reattaching the abdominal muscles and sewing in a plastic reinforcing mesh in order to inhibit re-tearing of the muscles. Depending upon the surgeon, their experience, and their protocol, most athletes can return to on-ice activities within 2-4 weeks after sports hernia surgery.
When one does have lingering groin pain, it is important to see a physician to make sure that the proper diagnosis is obtained. There can be many different causes of groin pain in athletes to include femoroacetabular impingement (FAI), which is especially common in goalies, stress fractures, infections, nerve entrapments, and other causes. Therefore, any lingering “groin strains” should be carefully evaluated if they do not resolve within a couple of weeks.
In summary, “sports hernias” are not true hernias but are actually abdominal muscle wall tears. When one has a groin strain which lasts more than a few weeks, a careful evaluation should be performed to determine the cause and proper treatment for it.
Robert F. LaPrade, M.D., Ph.D. is a complex knee surgeon at The Steadman Clinic in Vail, Colorado. He is very active in research for the prevention and treatment of ice hockey injuries. Dr. LaPrade is also the Chief Medical Research Officer at the Steadman Philippon Research Institute. Formerly, he was the team physician for the University of Minnesota men’s hockey team and a professor in the Department of Orthopaedic Surgery at the U of M. If you have a question for the Hockey Doc, e-mail it toeditor@letsplayhockey.com.
