The symptoms of sports hernia can mimic those of many other types of common groin injuries, and there is no definitive diagnostic test—making it a difficult condition to diagnose. Symptoms can also be vague, with athletes unsure why they have suddenly or gradually seen a drop in their athletic performance.

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Symptoms of sports hernia

Symptoms of sports hernia may include one or more of the following:

  • Sudden and severe groin pain at the time of the injury
  • Groin pain that goes away with rest, but returns during sports activity
  • Groin pain that is more commonly felt on one side of the groin area only (unilateral), rather than on both sides2
  • Pain that only appears during twisting movements
  • Pain associated with other movements that involve the deep abdominal muscles, such as half sit-ups (stomach crunches) or coughing
  • Tenderness or bruising in the upper thigh and/or lower abdomen
  • Groin pain that gradually increases from intermittent to constant, and/or pain that develops to the point playing sports becomes impossible

Even if none of the above symptoms are present, the often-vague nature of the injury means some athletes may still have sports hernia if the only symptom is chronic groin pain or lower athletic performance.

Diagnosis

Because sports hernia's symptoms can mimic those of several other types of groin injuries, diagnosing the condition requires meticulous medical evaluation that may take more than one doctor's office visit or test to complete.

Doctors typically use a three-step process for diagnosing sports hernia, as follows:

    Patient history. Determining the exact mechanism of injury, whether it was a specific event or the result of many weeks, months, or years of overuse during sports, is important for arriving at a sports hernia diagnosis. Therefore, the doctor will likely spend considerable time interviewing the athlete about recent athletic performance, when the onset of pain and/or tenderness first occurred, whether the pain grew worse suddenly or gradually, and so on. For example, a hockey player may have undergone sudden, debilitating pain immediately after making a slap shot during a match.

    Physical exam. The doctor will conduct a thorough exam of the lower abdomen, pubic area, and the legs. First, the doctor will palpate (touch) these areas and inspect them visually with the patient sitting and/or lying down, searching for tenderness and other signs of tissue injury.

    The second component of the physical exam may involve the patient attempting one or more exercises, such as standard and oblique sit-ups. The patient may also be asked to do one or more thigh-contraction exercises as well. These exercises can help the doctor determine the source of the pain during exertion, evaluate range of motion, and other factors that can help identify which tissue(s) is injured and where.

    Diagnostic imaging. One or more diagnostic imaging scans may be performed to help the doctor confirm the clinical diagnosis, and/or to determine the exact location(s) of tissue injury. Magnetic resonance imaging (MRI) is the most common test used to identify sports hernia.

    It is strongly advised that the MRI be ordered by a groin-injury specialist and read by a radiologist who routinely reviews groin-injury images and uses specific protocols to detect injuries in the groin/abdominal wall. X-ray, ultrasound, or CT (computerized tomography) may also be used to confirm the diagnosis or rule out other possible injuries.

Once the correct diagnosis has been made, an appropriate treatment plan for sports hernia can be administered.

References:

  1. Kemp S, Batt ME. The 'sports hernia': a common cause of groin pain. Phys Sportsmed. 1998 Jan; 25 (1): 36-44. doi: 10.3810/psm.1998.01.968.
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