Sports Hernia/Groin anyone? Recovery? "Minimal Repair" surgery?

Just got some bad news: The fullness/heaviness/tugging in the left groin, the burning in the inguinal area upon palpitation or sitting/resting on my back... appears to be a sports hernia (which is NOT a true hernia). 

I'm 29 y/o, fit, life-long active person. Was a competitive gymnast when younger, and played competitive soccer (this injury is most prevalent in professional soccer players) player partway into college. These days I cycle (road/cycle-cross style, but not racing), and have gotten back into skiing (expert, done this since 5/6 y/o, but just got back from a 5/6 year break). 

In any case, the dr I went to is something of a world-renown expert (she treats many pro athletes in Europe, and some flown in from the U.S.), and she very quickly diagnosed sports hernia via physical exam and high-res ultrasound. She said she could feel the spot (though not a bulge like a typical inguinal hernia) with her finger, and the image shows up in the US. Surgery is tentatively scheduled for Feb 1.

According to her (and I'm sure this is over-optimistic), restrictions are: 20kg (44 lb) day of surgery, return to jogging/cycling 2 days post-op, and dropping of all restrictions (specifically discussed off-piste/tree/powder skiing here in the alps) anytime after post-op days 10 to 14. That doesn't mean I won't have pain, tightness, and weakness... but that I can (and should) return to full activity quickly. This doctor invented her own surgery, based on the Shouldice technique, called the Minimal Repair technique-- non-mesh, and limited to a small area (open surgery, 2 to 4 inch incision). With pro athletes, the regimen for return to full training is post-op day 5. 

The main issues I have are that "sports hernia" is a disagreed upon injury, with inconsistencies on what causes it and how to best treat it. Surgery is never taken lightly (it comes with risks and recovery that can last up to a year). She says it'll only get worse, and could become a true inguinal hernia in a couple years (and it's pretty damn consistent that the medical field says true hernias ONLY progress, and ONLY get repaired through surgery). 

As is always the case: I find LOTS of praise for this doc and her technique (she only does hernia repair, and she's operated on 12,000 in the last two decades), but a couple of people who claim her procedure didn't work or she wasn't great about follow up problems. And, her repair technique, while it has roots in established procedures, is still relatively new (though near/medium term data suggests it works really, really well). 

Anyway, I'm wondering if anyone else has experience with sports hernia (Gilmore's Groin, Sportsman's Groin)? Have you had it repaired surgically (or not)? How quickly could you return to sport? How long did pain persist? 

What am I looking at? (In other simple surgies, on relatively non-complicated areas, I've had great recovery, little scarring, and no lasting pain/tenderness/numbness... but this would be a more complicated area to get worked on). 

Doc says Feb 1 surgery, back on the slopes (perhaps in pain, but as aggressive as I want) by end of Feb. I'm hoping I can at least take moderate runs by March (even if there's pain/tightness). 

This whole thing sucks. And I'm definitely worried about getting surgery at such a young age-- and potentially having life-long issues (or having this cut into my activeness). On the other hand, this surgery is specifically designed to prevent more serious life-long issues and loss of activity... 

I'll take moral support too (kinda joking). 

Oh, I should include that I have a planned trip to Lapland in Finland (above the arctic circle) Feb 25 to Mar 3. Won't be skiing-focused, notably because the mountains are fells-- gently slopped, above-the-trees. But I do plan on 2 to 3 days social downhill (lighter than normal), 2 or 3 days x-country, and some snow-showing, sauna-ing, and ice-pond swimming. 

Surgeon suggested I'd be BETTER getting the surgery before this trip, and that the surgery shouldn't cause me to miss any of these activities-- whereas given the nerve inflammation I have now, there's a good chance the trip would feel worse (but still be doable, pain aside) pre-surgery and so close post-surgery. 

This is dependent on the whole Minimal Repair surgery, as opposed to the mesh or traditional open repairs (that take much longer to heal.... reportedly). 

Many thanks to all who have answered so far. I'm continuing to follow this thread. 

And yes, I've been PM'ing with Pwdrhnd-- and may well owe him some beers down the line too! 

Quote:

Originally Posted by Finndog 

Anytime my friend! 

 

with the mesh, I can tell you, you won't feel like pushing it. It literally felt like something would tear out if you moved the wrong way or over did it. 

 So I've heard (from my father: bilateral, traditional inguinal hernia at ~60 y/o, fixed with mesh, slower than planned recovery, but great a few years on).

 Finndog: How does it feel now, a few years later re the mesh? Do you feel like you've lost range of movement or flexibility? Any strange feelings at the incision cite(s)? What I've heard about the mesh is that when done right, it holds super well (not likely to get another hernia)-- but that it irritates a lot of folks, ~30%, for some time (my dad had pain for about a year, though minor) before calming down, and can have negative consequences re flexibility (the mesh can't be stretched like a muscle). 

Quote:

Originally Posted by steveturner 

Me i am 64 yr old. I have had some right groin pain off and on for years. Most frequently after long drives in the car or long hours at the desk. Numerous docs administered the "turn your head and cough test" and found no traditional hernia. I Tweaked it this winter in a fall but never missed a day of downhill. I did try cross country for the first time and stopped after an hour because i could feel the groin and hamstring getting tight. It seemed that my right leg was uncomfortable extending behind my body. For a few nights I could not sit up in bed or lift my leg without some pain but that went away(90%)after a week.
Last week my urologist said it must be a sports hernia and referred me to a sports Otho doc. Ortho doc xrayed and examined and said it was likely a sports hernia but since I was not in significant pain he recommended no action, no therapy, no restrictions, no predictions about it getting better or worse. He said he did not recommend an MRI since he did not think I should consider surgery and besides the MRI was not always conclusive.
At first Ithought I got good advice by a doc who was conservative and cost concious. Now I am thinking Surely there is something I should do or not do that would reduce the likelihood of additional injury. Anyone with any thoughts?

There is a school of thought that physical therapy is possible to halt/support early sports hernias where not much damage has yet been done. There is also a believe that sports hernia might be an incipient, or early sign of, true inguinal hernia. As far as the literature I've reviewed-- neither case has been well supported by methodologically strong studies. Case studies are nice, but double-blind controlled studies are lacking. It's a bit of a crap shoot. What's not clear is that sports hernias go on to become true hernias-- though a weakness in the inguinal canal would, from a common sense perspective, suggest the area is more likely to take further damage-- and wether one can address the primary cause (poor alignment, poor flexibility, out of balance musculature, too tight hip flexors, etc) to prevent the issue from worsening (or even coming back AFTER surgery). 

See this: http://www.sportsherniasouth.com/Sports-Hernia-Surgery.html

I believe the physician also has a PT regimen he will share (I did email him months ago); he works with a few college/pro sports teams. 

I was scheduled to have surgery early Feb with one of the world's leaders on the condition-- who basically believes that surgery is the only viable option-- but I cancelled because I didn't want to lose my season of skiing.

I've since had a great skiing season, including XC, and now I'm starting my cycling season. When I was consistently stretching (common to find people with sports hernias play soccer and sit in chairs a long-- short, tight, too-strong hip flexors), I felt great. Once or twice I've had a twinge. 

I may well still get surgery, but I see no rush at this point. That said, I'm feeling no pain after that first acute episode-- but if the pain starts to rear its head, I'll be more inclined to do something as invasive as surgery (chronic pain is a strong predictor, according to some of what I've read, for trouble post-surgery, as is young age... so finding the balance seems important to me). And while hernia/sports hernia is a common procedure these days, it is still invasive like any surgery, and still has plenty of potential pitfalls.