Managing Sports Hernia Injury with Physical Therapy

A sports hernia involves weakening or tearing in the muscles, tendons, or ligaments of the lower abdominal and groin area that leads to chronic pain, often caused by repetitive and forceful twisting of your pelvis that places tremendous stress on the lower abdominal and groin areas. Men are more susceptible to sports hernia, accounting for 90% of sports hernia cases.

Sports hernias are most commonly seen in athletes whose sports require repetitive twisting, turning, or abrupt changes in direction. These sudden movements place a tremendous amount of stress on the lower abdominal and groin areas, which can weaken these soft tissues and muscles and lead to a sports hernia.

There are several factors that can increase the likelihood of an athlete suffering a sports hernia. One such factor is a muscular imbalance between the hip adductor muscles and the abdominal muscles; the stronger adductor muscles pull the pubic bone downward, causing the abdominal muscles to stretch and eventually tear. 

Engaging in a vigorous off-season conditioning program that emphasizes strengthening the lower limbs and ignores abdominal muscular strengthening, can lead to a pelvic balance disturbance and shortening of the hip flexors and adductors, which can increase the risk of a sports hernia developing. 

Other factors that can contribute to sports hernia development include abdominal weakness and lack of conditioning, lack of hip adductor flexibility, impairment of the hip’s range of motion, poor warm-up and stretching exercises before activity, and previous injuries to the area that may have damaged the overall stability of the affected muscles. 

A sports hernia often involves ongoing chronic pain in the lower abdomen and groin. Other common symptoms include:

• Sudden and intense pain at time of injury

• Chronic pain that feels dull or burning

• Difficulty pinpointing the exact area of the lower abdomen and groin from which pain is coming 

• Pain that radiates down the inner thigh or the scrotum

• Pain felt when sprinting, twisting, kicking, or sitting up

• Pain when cough or sneeze

• Pain that subsides with rest but return with sports activity

• Tenderness to touch or when pressure is applied to lower abdominal area

Sports hernias are most seen in soccer players due to the dynamic nature of the sport, rapid changes in direction, intense sprinting, and repetitive twisting and turning when kicking. 

Physical therapy can help athletes manage and recover from a sports hernia, addressing underlying muscular imbalances that contributed to injury through targeted exercise, core strengthening, and manual therapy.

The physical therapist provides a comprehensive evaluation of the athlete’s muscular imbalances, pelvic alignment, and movement patterns that may have contributed to the sports hernia injury.

Physical therapy treatment for a sports hernia can include:

• Pain management using ice and compression 

• Targeted core stabilization exercises

• Muscle re-training to activate the hip and abdominal muscles followed by progressing strengthening of these muscles. 

• Hip, pelvic, and thigh muscle strengthening to address muscular weaknesses and imbalances and improve coordination, balance, and endurance between hip and trunk muscles. 

• Manual therapy that involves hands-on stretching and soft tissue and joint mobilization to improve the athlete’s hip joint mobility and range of motion and to ease muscle pain. 

• Posture stability training to ensure proper posture during sports activity and improve the coordination of the trunk, hip, pelvic, and thigh muscles. 

• Aquatic therapy involves exercising in a warm water therapy pool to improve strength and balance before progressing to these exercises on land. Exercising in water allows athletes to build strength early in rehabilitation without placing undue stress on the injured area or joints.

• Sport-specific functional training is essential as the athlete progresses in the rehabilitative process, helping prepare them for an effective return to sport by practicing sport-specific tasks and exercises to simulate a return to competition without aggravating the injured area. 

Surgery is recommended only after an initial course of non-operative treatment with physical therapy for three months. A structured physical therapy program post-operation is critical to strengthen the lower abdominals and correct abdominal and thigh muscle imbalances for a safe return to sport.