Athletic Pubalgia (Sports Hernia or Gilmore’s groin)
Sports hernia involves injury to the posterior wall ofthe inguinal canal and can appear as a tear of the transverses abdominis muscle or as a disruption to the conjoined tendon (tendon of insertion of the internal oblique and transverses abdominis muscles). The internal oblique muscle and external oblique aponeurosis of the internal inguinal wall may also be involved. This injury is more common in men than women and typically occurs in fast-moving sports that involve twisting and turning, like soccer, football, rugby, and ice hockey. Because only the posterior abdominal wall is injured, the sports hernia differs from the more common inguinal hernia in that it does not involve a clinically detectable hernia.
This is a controversial injury. Some authors distinguish hockey player’s syndrome (slap shot gut), gilmore’s groin, sports hernia, and athletics pubalgia from each other. However, for the purpose of brevity, the author has chosen to label all of these as sports hernia.
Athletes may present with unilateral groin pain exacerbated by exercise. In chronic cases, the athlete may have pain with activities of daily living. It is usually insidious in onset and may radiate to the hip. Sudden movements, sit-ups, and increases in intra-abdominal pressure also exacerbate the pain.
Examination is usually performed by inverting the scrotal skin with a finger and palpating for pain over the conjoined tendon, pubic tubercle, and mid-inguinal region. Radiographs are important to rule out other injuries.
Treatment of this group of disorders is controversial. The simplest initial maneuver is rest followed by slow resumption of physical activity with supervised physical therapy consisting of core and pelvic stabilization, strengthening, and flexibility training. The athlete should avoid sudden, sharp, cutting movement. Those who insist on continuing activity will take considerably longer to heal. Supplemental administration of NSAIDs and application of ice packs 3–4 times a day for 20–30 min may also be beneficial. Athletes who fail conservative treatment should be referred to a surgeon for evaluation.
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