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Sports Hernia |
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Sports Hernia
Sports Medicine Conference
December 4, 2003
Kelly Helmle SPT
Des Moines University
Definition
• A broad term which refers to a spectrum of injuries to the structures
of the groin region, that results in the disruption of the inguinal
canal.
• Sportman’s hernia
• hockey hernia
• athletic pubalgia
• groin disruption
Epidemiology
• Football, soccer, tennis, rugby and hockey players
• 90% of occurrence are males
Debatable Etiology
• Unknown cause
• Distension of the peritoneum or stretching of the inguinal nerve
• Abnormalities of RA insertion
• structural abnormalities of EO aponeurosa
• deficiency of posterior inguinal wall
• Muscle overuse – 70%
• Muscle imbalance
– Gilmore groin
Evaluation: Subjective Exam
• Insidious or traumatic onset of pain
• Unilateral - often referral symptoms to the opposite LE adductor area,
sacrum and testicles
• Initially an “ache” that worsens with time
• Generally pain with jumping, pushing off, striding out, sprinting,
twisting, turning and possibly with sit-ups
Evans 1998
Objective Exam
• Typically no visible physical signs
– no apparent hernia or swelling
• Initially minimal symptoms
– pain over pubic tubercle
– tender external inguinal ring
– tender and dilated superficial inguinal ring
– positive direct stress exam (DSE)
• Females dx is based on history and tenderness in the inguinal region
with sit-ups
Differential Diagnosis
• Pelvic/thigh mm involvement
• Nerve entrapment
• Osteits pubis
• Fractures
• Legg-Calve’ Perthes
• UTI
• Hip OA
• Bursitis
• Referral pain
• Snapping hip
• Labral tear
Clinical findings vs. Imaging(CT,bone scan,MRI, X-ray,ultrasonography,herniography)
Sport Hernia Management
• Conservative measures
– Preferred initially to surgery
– Seldom effective
• Surgical Measures
– Second step
– Various procedures
– Seemingly beneficial
Conservative Management
• Rest
• NSAIDs
• Heat and/or ice
• Stretching and strengthening exercise
• Use of therapeutic modalities
Operation related to Sport
Sport
total surgery
%
– Football 2280
1593 70
– Rugby 400
241 60
– Racquet 136
40
29
– Athletes 106
41 39
– Hockey 53
21 51
Post-surgical Rehabilitation
• Typically 6-8 weeks for an athlete for full return to activity
• Initially begin with addressing mm imbalances and functional posture
• Pt allowed to straight jog at day 10 and straight-line sprinting after
day 21
• Controlled sport-specific activity at ~ 4 weeks.
Return to Sport Guidelines
• Equal ROM and strength of LEs
• No tenderness over pubic bone
• Able to jog straight ahead
• Able to sprint straight ahead
• Can do 45 degree cuts – half then full speed
• Can do 90 degree cuts
• Can do 10 yard figure - eight |
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