Physical Therapy for a Sports Hernia
Last Update: 11 August 2021
Once a positive diagnosis is received, the next step to alleviating pain and recovering is to follow an effective plan of physical therapy for a sports hernia that includes a 3-step approach. These steps are designed to not only cure your pain, but target the true source of the injury as well to make sure your recovery is for the long-term.
3 Core Aspects of Physical Therapy for a Sports Hernia Injury
At its core, the sports hernia physical therapy plan consists of 3 different aspects:
- Myofascial release
- Stretching and mobility exercises
- Strengthening exercises
They all play an important role in the complete rehabilitation process. By skipping one or more, your likelihood of a successful recovery will be jeopardized significantly.
For a full description on how to perform all movements, review the full sports hernia treatment plan.
While the comforts and conveniences of modern life are great in countless ways, they also come with a price: extended periods of time sitting and slouching with poor pelvic posture.
As this happens, certain muscles become inhibited and turn off (your glutes and abductor muscles on the side of your hips) while others become extremely tight (your hip flexor and psoas major muscles). This, in turn, leads to even worse posture—it is a downward negative cycle.
However, all hope isn’t lost. By relieving this tightness and inhibition, you can restore proper positioning and posture to your pelvis, which will not only alleviate pain but help to remove tension and stress placed on your pelvic floor—allowing the area to finally begin to heal.
Myofascial is an effective technique that uses gentle, sustained pressure on the connective tissues of your muscles and surrounding areas. While some claim that myofascial release actually “breaks apart” knots and adhesions in your fascia (the thin lining of protective material covering your muscles), evidence has shown this to be false.
Instead, it works by providing a neuromuscular and neurophysiological stimulus to the tight and inhibited muscles and other soft tissues. This allows you to experience short-term relief from tightness and pain, increasing your effective range of motion.
Why even do it then if it is only short-term?
Because myofascial release will allow you to then perform the stretching, mobility exercises, and strengthening exercises much more effectively and without pain.
To do so, you will need a foam roller as well as a lacrosse ball; both can be found for very cheap. There are a total of 10 movements:
- Foam Roll Quads
- Foam Roll IT Bands
- Foam Roll Glutes
- Foam Roll Hamstrings
- Foam Roll Calves
- Foam Roll Adductors (using caution)
- Lacrosse Ball Glutes
- Lacrosse Ball Hamstrings
- Lacrosse Ball Abductor Muscles and Hip Flexors
- Lacrosse Ball Feet
Stretching and Mobility Exercises
Stretching comes right after and helps to further relieve tightness. Furthermore, mobility exercises are more dynamic forms of stretching that focus on developing your balance, stability, and mobility through a full range of motion while performing different calisthenics.
It is important to be aware that stretching the adductors is not recommended as it will cause an increase in pain symptoms in most people. There are 8 movements for the stretching and mobility section:
- Seated Hip External Rotator Stretch
- Bench Hip External Rotator Stretch
- Calf Stretch
- Table Psoas and Hip Flexor Stretch
- Seated Groin Stretch
- Frog Stretch
- Lying Quad Stretch
- Standing Hamstring Reach
While the previous two layers of sports hernia physical therapy are absolutely crucial in preparing you for the final step—it is the final step itself that provides true, long-term recovery.
This is because structural changes are only possible through adaptive resistance—it is why bodybuilders and powerlifters are so muscular; they are constantly lifting weights (resistance that gets adaptively larger over time, a.k.a. lifting more and more) which causes them to put on large amounts of muscle (large, long-term structural changes to their muscles and surrounding soft tissues).
There are a total of 10 strengthening exercises in the first strengthening phase (the rest of the exercises are contained within the 2nd, 3rd, and 4th strengthening phases of the full plan):
- Light Abdominal Vacuums
- Bosu Crunches
- Exercise Ball Rollouts
- Hip Bridges with Dorsiflexion
- Bird Dogs and Dirty Dogs
- Supine Short-Levers
- Lying Psoas Holds
- Light Lying Adduction
- Bodyweight Squats
- Bodyweight Reaching One-Legged Deadlifts
Begin with only 2 sets of 10 repetitions on each exercise and gradually add more with each physical therapy session until you reach a total of 4 sets of 15 repetitions.
Additional Sports Hernia Physical Therapy Options
Along with the fundamental rehabilitation program described above, there are additional PT options that can help to improve and speed up your recovery.
While new methodologies are constantly being created and tested, only 4 currently have any form of scientific backing:
- Soft Tissue Mobilization
- Platelet Rich Plasma Therapy (PRP)
- Active Release Techniques
- Graston Technique (Instrument-Assisted Soft Tissue Mobilization, IASTM)
The first is one that you can and should be doing yourself, while the other three require the help of a trained specialist.
Soft Tissue Mobilization
During the healing process following surgery, the tendinous tissues of the groin are working to remodel themselves to stabilize the region. As this happens, it is important to break apart the collagen and other scar tissue as it develops to ensure your groins retains full elasticity and mobility.
Doing so is relatively simple: using your fingers apply light pressure and massage the scar site. This will help to promote blood flow to the area and make sure flexibility about the scar site does not become an issue.
Platelet-rich plasma is a part of human blood that is very high in protein. For this reason, it has a large concentration of growth factors that can help to promote healing in soft tissues. While ongoing research is still being conducted to further understand the full extent of PRP’s effectiveness, one 2014 study by the American Journal of Sports Medicine found that it led to significant improvements in alleviating pain in athletes.
Active Release Techniques
Active Release Techniques (ART) is a patented form of soft-tissue mobilization that works by breaking apart dense scar tissue. Using over 500 different movements, a trained PT will be able to provide precisely-targeted pain relief and mobility benefits.
A 2015 study published in the Journal of Physical Therapy Science found that ART was effective when used in conjunction with a complete rehab plan.
The Graston Technique is also a patented PT method that uses a set of special tools and devices (instead of therapy movements like ART). Also known as instrument-assisted soft tissue mobilization (IASTM), it works to alleviate mobility and flexibility issues as well as break down scar tissue. It is mostly performed by chiropractors, trained PTs, and sports team trainers.
A 2018 study conducted by Louisiana State University found that while IASTM is not effective by itself, it proves to be an effective multiplier when used as one part of a complete rehabilitation approach.
While the 4 additional options can provide further relief and a range of other benefits, the 3-part core rehab program is absolutely non-negotiable if you are truly ready to be free of pain.