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Sports Hernia opinion

post #1 of 10
Thread Starter 

Here's my story.


On November 23rd (2015) I was at my son's basketball practice and I decided to run a killer with the kids at the end of practice.  A killer is where you start at the baseline, sprint to the free throw line and touch the line, sprint back to the baseline(touch the line), sprint to mid court, etc.  There's a lot of starting, stopping and twisting involved and my 41 year old wasn't warmed up sufficiently.  As I touched the baseline and turned to sprint to mid court I felt a "large" rip in my left groin/lower abdomen and I went down in a heap.  I immediately had the sensation that my guts were falling out.  I spent the next 5 days pretty much completely immobile.  I was able to hobble around, but that was about it.


The day after the injury I went into urgent care and they took an x-ray which revealed nothing (as expected).  They gave me some pain killers and told me to follow up with a physician in a few weeks if I wasn't feeling better.  After 3 weeks of inactivity with little improvement I visited a Sports Medicine doctor.  By poking around she was able to pinpoint the primary injury location being where the adductors connect to the pubic bone. She diagnosed me with a sports hernia.  On that day I could barely my lift left leg off the table and any movement requiring my adductors was very painful.  The doctor gave me the option of getting an MRI right away or doing physical therapy for 3 weeks and then re-evaluating.  I opted for the PT route.  


Today is January 20th and I've been doing physical therapy for ~4 weeks.  I have improved quite a bit since the initial injury 8+ weeks ago, but I would estimate my recovery at about 40%. I had a followup on Monday and the doctor was a bit disappointed that I wasn't further along.  She gave the option again of getting an MRI or continuing with PT since I am showing improvement all be it slowly.


I'm able to walk, climb stairs and do daily activities with minimal pain. I still have pain at night when I roll over in bed and I am unable to run.  I can jog slowly on the treadmill (4.3 MPH), but if I push it any more then I feel an uncomfortable pulling sensation in my left lower abdomen.  I tried using the hip adductor machine today and I was only able to do 3 reps at 10lbs.


At this point I suspect that I may have two injuries.  The first being an adductor tear which I believe is improving. The 2nd is a possible tear in my lower left abdomen area.  I don't see any bulging, but I certainly felt a rip at the time of injury and the pain is pronounced when I try to run. The doctor wasn't sure if the pain I'm feeling is related to the adductors or if it is a separate injury.


If you were me would you get the MRI immediately or continue with physical therapy?  

post #2 of 10

The answer depends on what you are going to do with the information.  The term "sports hernia" is a misnomer as there is not a true hernia or defect.  MRI is the gold standard for diagnosing it although usually, as your doctor has done, it can be highly suspected.  They can heal with plenty of time unlike a true inguinal hernia.  Surgery will also fix them but it is still surgery you may not need.  Unless you are an aggressive or professional athlete I would try the non-operative approach for at least 2-3 months before doing surgery, which will require a month to recover from.  If you are going to opt for PT even if you have a sports hernia on MRI then there is no hurry to get an MRI.  If you think you would opt for surgery then get the MRI sooner.


Remember, YMMV and only you and your physician, who has seen and examined you, can decide what is best for you:).

post #3 of 10
Thread Starter 
Originally Posted by Pwdrhnd View Post

Unless you are an aggressive or professional athlete I would try the non-operative approach for at least 2-3 months before doing surgery, which will require a month to recover from. 

I'm not a professional athlete, but I do lead an active life style.  I coach basketball and baseball and I typically run 15-20 miles per week.  From what my doctor has said this injury "should" heal on it's own.  I'm trying to figure out if the surgery route (if needed) would actually speed up my recovery.  Ideally I would like to be back to 90% normal by the end of March (start of baseball season).  That doesn't seem likely based on my current trajectory.  If surgery will cut 2 months off of my recovery time then I would likely opt for that route.  If it would only save me a month then I don't think it's worth it.  


When you say it will take a month to recover from surgery what does that mean?  After a month will I be able to return to my normal activities? I've never had any type of surgery in my life, so I'm not sure what to expect.

post #4 of 10

Healing from that kind of injury takes months, not weeks. Look at what happens when professional athletes have a hamstring injury--same sort of injury--they will not be right for the rest of the season. I can't tell you if surgery will help heal it any faster--I don't do that kind of surgery--but I can tell you that if you opt for a nonsurgical approach you will have to be very patient.

post #5 of 10
What @oldgoat said...weeks not months and then there is no guarantee you will totally heal. As far as recovery from hernia surgery, you should be able to return to unrestricted activity in 4 weeks, but recommendations differ by surgeon. Your best course of action is probably to ask for a referral to a general surgeon and let him/her decide if you need an MRI or surgery.
post #6 of 10

These two things, MRI and PT, are not mutually exclusive.  You should get the MRI to find out what's going on.  You should do PT to fix it, if it is possible to fix it without surgery.

Some good info here http://www.shouldice.com/

post #7 of 10
Thread Starter 

Thanks everyone.  I've decided to get the MRI right away.  It may turn out to have been unnecessary, but at least I will know what I'm dealing with.

post #8 of 10
Thread Starter 

I received the results of the MRI last week.  I have a 9mm tear in the Rectus Abdominis where it attaches to the public bone.  Apparently it pulled away from the bone leaving a small gap.  The tissue is very irritated right now.  I also have an adductor strain, but that appears to be improving each week.  


I had a consultation with a general surgeon on Friday at the Mayo clinic.  The surgeon told me that it will eventually heal without surgery, but since the abs muscles are used constantly it could take a long time.  If I was to opt for surgery then she would use mesh to hold it in place.  That would be out-patient (laparoscopic) procedure.  She estimated that in 6 weeks it would be as strong as it's going to get, but that there could be residual pain well after that.


I'm inclined to get this fixed right away.  Does anyone have experience with the recovery for this type of surgery?  

post #9 of 10

I can't comment on the surgery itself--I have had inguinal hernias repaired (and repaired hundreds) but no sports hernia surgery. What I can tell you is that from your description of what your surgeon said she seems to be an appropriately conservative surgeon, giving you the options fairly, and not trying to sell you on surgery. I can tell you that while healing in that area is generally said to take about 6 weeks from a mechanical standpoint, from a pain standpoint there is a lot of variability, even between the two sides when patients have had the same operation by the same surgeon on both sides (as was the case with my hernias.) good luck whichever way you decide.

post #10 of 10
Thread Starter 

After doing next to nothing physically for 6 weeks my core muscles had atrophied significantly and my adductors were super tender with limited mobility.  Physical therapy has helped a lot with the flexibility, core strength, and my adductors are feeling much better.  I had virtually zero lateral movement when I started PT and now I'm able to shuffle my feet and I can move around normally with limited discomfort. Unfortunately this has been a double edged sword.  Since my adductors have been feeling better I've started doing more at basketball practice (demonstrating drills, walking up and down the court, shooting with the kids). This has definitely put more stress on my abdominal tear.  I'm getting really tired of the constant aching while sitting at my desk at work.


I am at the point emotionally where I want to get this fixed, so I've decided to have the surgery.  History tells me that I'm not a fast healer.  7 or 8 years ago I ruptured my calf playing basketball. I opted for the non-surgical route and that took me 10 months to get back to 100%.  .

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