physical therapy patient holds their abdominal muscles in pain after asking what a sports hernia is

If you are experiencing terrible groin pain, there is likely only one question on your mind: what is a sports hernia and do I have one?

Simply put, it is a deep groin hernia that does not produce any visible bulge and is difficult to diagnose and treat successfully without the use of a surgeon who specializes in the injury.

This is often caused by a sudden twist or explosive athletic movement; in these cases a tearing sensation can be felt. The strain or tear affects the soft tissue of the groin:

  • Muscles
  • Tendons
  • Ligaments

While it can happen to anyone who is highly active, athletes in a handful of sports more susceptible to the injury given the level of twisting, stress, and pressure applied to the hip and groin area:

  • Soccer
  • Football
  • Track and Field
  • Strength Training Sports (Powerlifting, Bodybuilding, Olympic Weightlifting)
  • Tennis
  • Hockey
  • Golf

A sudden sporting or recreational event isn’t always the case though.

You can also develop over time as you develop muscular imbalances and weaknesses—placing increasing levels of stress on your abdominal wall.

The medical and scientific community prefers to use the name Athletic Pubalgia to describe the injury so it isn’t mistaken for a much more common and simpler to treat direct hernia.

Groin pain is no laughing matter, and often times it can be a cause for panic. However, making sure you truly have a sports hernia should be your top priority. Because the groin and hip area are made up of many different connective tissues and muscles, it is a complex region that requires a proper diagnosis by a trained specialist (a sports hernia mri is not the best way to pinpoint the injury, despite popular belief).

What is a Sports Hernia and How Does it Differ from an Inguinal Hernia?

A sports hernia is a specific, different type of hernia than a traditional direct inguinal hernia that produces a visible bulge.

It is referred to by the medical collective as an indirect hernia or athletic pubalgia. It doesn’t produce a bulge that you can feel or see on the outside of your body, making it difficult to diagnose.

The injury goes by several different names:

  • Sports Hernia
  • Athletic Pubalgia
  • Gilmore’s Groin
  • Indirect Hernia
  • Groin Hernia
  • Footballer’s Groin

However, they all refer to the same thing: a tear in the deep abdominal wall (fascia transversalis).

Your abdomen is made up of several layers. These layers work together to provide your muscles and the surrounding tissues structure and support.

  • First is your external and internal obliques that reside on either side of your trunk
  • The next layer is your rectus abdominis—these are your actual abs
  • The third layer is the transverse abdominal muscle which helps to provide your spine and pelvis with stability
  • Fourth deepest is the transversalis fascia—this is where the actual injury develops in the form of a tear or what doctors refer to as a “posterior inguinal wall deficiency”
  • Finally, the peritoneum makes up the last layer—this is your abdominal lining membrane, the “sack” that pushes through the abdominal lining to create a visible bulge in the case of a direct inguinal hernia
posterior inguinal wall
The Transversalis Fascia is a common place of tearing in sports hernia injuries.

In the case of a sports hernia, the deepest abdominal layer sustains an injury (the fifth layer described above isn’t a part of your abs—it’s the membrane holding your organs together inside of your body).

What is a Common Sports Hernia Symptom: Do I Have The Injury?

While Gilmore’s groin has one distinct symptom—sharp, dull, or aching pain in the groin and pubic area that doesn’t seem to go away no matter how much you rest—there are several to be aware of:

  • Pain focused around the inguinal ligament and immediate surrounding areas
  • Pain while moving about in bed or changing positions from lying down to sitting
  • Pain that increases with more activity and gets worse as they day goes on

Unfortunately, another common symptom that doesn’t have to do with pain specifically is multiple failed doctor or physical therapy visits without a successful diagnosis. This happens because general doctors simply don’t understand how to treat this complex injury.

In the worst cases, these doctors will even agree to perform surgery on you to do an “exploratory operation” to figure out the problem. Do not become a guinea pig.

You can avoid this altogether by making sure to pick from an approved sports hernia specialist or surgeon who is trained in the revolutionary minimal repair technique. Even if you don’t need surgery, only a doctor knowledgeable on the injury will be able to perform the proper ultrasound physical examination protocol.

What is a Good Sports Hernia Treatment Plan?

The best treatment and rehabilitation programs focus on restoring strength and mobility to your core and the surrounding tissues of your lower body and posterior chain.

Treating it without surgery is a possibility, but it will depend on a number of factors:

  • How physically active are you? The only reported case of conservative treatment working successfully involved a professional hockey player.
  • How quickly did you visit a specialist and receive a diagnosis? The quicker you are able to receive the proper diagnosis and begin treatment, the higher your chances are for success using physical therapy methods.
  • Which treatment plan did you follow? Making sure to follow an approved sports hernia rehabilitation protocol will guarantee you don’t miss critical aspects of the recovery process.
  • How consistent are you with your rehab? If you skip days with planned physical therapy sessions, you will be unable to adequately heal within the limited post-injury time frame.

If you reach week six of the 10-week rehab program and find that you are unable to experience a drop in your pain levels or symptoms, surgery will likely be your only option to relieving your pain completely.

Above all else, make sure to avoid receiving surgery from anyone who specializes in the much less preferred style of operation: mesh (which also has a much lower success rate compared with the minimal repair technique).

All approved specialists, surgeons, and doctors follow best medical practices and have the proper knowledge to successfully treat the injury.

And next time you visit your physical therapist, you will not longer have to ask the question: what is a sports hernia?