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Sports Hernia: A potential cause of groin pain

THE Zambian soccer season is coming to an end and footballers will rest.
The off-season also gives players time to recover from some of the overuse injuries which they might have sustained during the season.
It is during this time when injuries have to be attended to.
One important injury is the recurrent groin pain.
Pain in the groin can arise as a result of a tear in the muscle of the groin; it can also be a result of a ligament strain in the groin area.
The other causes of groin pain can be as a result of a nerve entrapment resulting in pain.
Despite so many factors linked with groin pain the other factor which should be considered is a long standing pain in the groin which resolves upon resting for a couple of weeks and later re-appear upon resumption of training.
A sports hernia is always important to consider in sports men and I will limit my discussion to this condition, which is not so easy to identify, and many people will view this as just a simple groin strain.
A sports hernia is an important condition to consider when there is recurrent groin pain, because it has potential of becoming a total nuisance and disturbs the athlete’s participation in sport.
By definition a hernia is a protrusion of an organ beyond its limiting boundaries. Most of the typical hernias involve the abdominal organs, which mainly are intestinal contents, which can be seen as a bulge in the inguinal or groin area or can actually be seen as a mass in the scrotum of a male patient.
The contents of the hernia is mainly loops of bowel and when this happens it necessitates quick action which in many cases will require surgery to be carried out as an emergency.
Hernias always occur as result of a weak point, which acts as a point through which abdominal contents can protrude.
As a reminder to the many readers, the front part of the abdomen is formed by the muscles, which always keeps the abdominal contents confined to the inner part of the abdomen, and also offers protection to the abdominal organs.
At times these muscles can be weakened especially in old people and act as points through which the abdominal contents can leave their confining boundaries.
In cases of the scrotal hernias the problem arises because of the potential weak points, which exist as a result of the descent of the testis into the scrotal sac as a male child grows.
It is important to get reminded that the testis in a male develops from inside the abdomen and only descend to settle in the scrotum of a male subject, and it is this same path of testicular descent, through which a hernia follows.
What I have tried to describe is typically what happens in a normal hernia, which is seen as a surgical condition in the general population.
Though hernias happen in the general population they can also affect sports men but today the type of hernia, which I want to describe, is what is known as a sports hernia.
What is so interesting about this hernia is that there is no typical bulging observed, unlike in the ordinary hernia.
A sports hernia is sometimes described as Gilmore’s Groin after the surgeon who first described this condition in 1980.
The medical term used for sports hernia is Athletic pubalgia and many doctors describe this condition like this. As mentioned earlier, in the sports hernia there is no typical bulging observed as a result of the intestinal organs going beyond the limiting boundaries.
The problem, which is in sports hernia, is the tear in the oblique muscle of the abdominal wall.
There is no bulge because there is no typical hole unlike the case in an ordinary hernia where there is a bulge and a hole within the abdominal wall.
Many sports men will ask the question as to why they should suffer from this kind of condition when they are physically fit. It has to be noted that, sports hernias happen in the thin part of the muscle and not in the thick part of the oblique muscle.
This happens when the muscle is over exerted and the tear occurs.
The tear occurs because of the losing battle between the muscles of the thigh and the oblique muscles, which are the muscle of the abdomen.
Most sports men will tend to concentrate in training and strengthening muscles of the lower limbs and not muscles of the trunk of which the oblique muscles are an important part.
When the muscles of the abdomen contract, there is a tug of war with the muscles of the thigh.
This results in the tear of the abdominal wall muscles resulting into the sports hernia.
A sports hernia typically begins with slow onset of pain in the lower part of the abdomen.
The other symptoms include pain in the lower part of the abdomen, pain in the groin area and also pain in the testicles.
The symptoms of a sports hernia are made worse by running, cutting movements, bending and this is the reason why this kind of problem is seen in football players, tennis players, rugby players, hockey players among many others.
The sports man will complain of pain made worse by exercise, and this is also likely to continue after finishing exercising.
The symptoms improve with a period of rest coupled with the use of the Non Steroidal Anti-Inflammatory drugs (Pain Killers) such as brufen.
The diagnosis of sports hernias lie in the taking of a good medical history and establish how the pain comes about and what makes it worse.
The main problem with sports hernia diagnosis is that there is no obvious bulge and this is a big challenge to the one investigating pain in the groin.
The other investigation, which is of great value, is the use of Magnetic Resonance Imaging (MRI) to check the integrity of the abdominal wall muscles.
However in our country with limited facilities the diagnosis of a sports hernia has to be through adequate history taking and physical examination.
Having taken care of soccer players for a long time, I must state that it is always a big challenge when you have a player presenting before you with recurrent pain which is not so obvious.
When it is established that an individual has a suspected sports hernia, it is always important to refer to other specialists like, general surgeons.
If it is established that the problem is a sports hernia then surgery is an option. This involves the use of synthetic mesh to help reinforce the tear in the muscle. After surgery the sports man can be back in full training after eight weeks.
In some cases conservative treatment has to be used. Conservative management involves rest, use of analgesics (Brufen, Diclofenac and other pain killers), and use of ice until the symptoms disappear.
The results are more beneficial if surgery is used unlike the use of the conservative approach.
A sports hernia is just as important as any other groin problem and it should always be treated with the seriousness it deserves.
In any given situation were there is recurrence of groin pain it is vital that a sport hernia is considered. I want to encourage sports men having recurrent groin pain to see a doctor and avoid self-prescription of the many painkillers, which are sold over the counter.
A sports hernia has to be fully treated if you are to enjoy your participation in sport.
For questions and comments write to Dr Kabungo Joseph
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