Sports Hernia

Well, it looks like I have a Sports Hernia. The physical pain lately has been almost unbearable. I have had to grind through my runs, haven't been able to run fast without significant pain, and have needed a few days off between runs. At times walking and even standing has been difficult.

I'm going to go to the doctor tomorrow, assuming he can fit me in, and am going to see a physical therapist, who also doubles as my training partner, on Thursday. She specializes in runners.

I'm assuming I'm done running for a while and that I won't be doing the Boston Marathon in two weeks and six days.

Here is the 411 on sports hernias:

DEAR MAYO CLINIC:

I keep hearing about "sports hernias." What are they, what symptoms do they cause, and can anyone get them? -- Minnesota

ANSWER:

A hernia, strictly speaking, is an abnormal protrusion from one part of the body into another. For example, one of the most common types -- an inguinal hernia -- occurs when soft tissue (usually, part of the intestine) bulges through a weak point or opening in the muscle of the lower abdomen.

In the misnamed "sports hernia," however, there is usually no bulge. Occurring in the same general area -- the groin -- as that of an inguinal hernia, a sports hernia is a tear, strain, or weakness in one of the three muscles or the fascia ("gristle" that attaches muscle to bone) of the abdominal wall.

Sports hernias are thought to result from extreme, forceful and repeated twisting-and-turning movements, as in serious levels of play in sports such as soccer, hockey and tennis. As such, it is an affliction of professional athletes and is very rare among, say, two-mile joggers. Actually, it is even rare among heavy-duty athletes. While professional football players number more than 1,500, there may be only a handful of cases per year.

The symptoms of a sports hernia are similar to those of an inguinal hernia: sharp pain or discomfort in the groin or lower abdomen, especially when patients exert themselves -- for example, by lifting, running or even coughing. Unlike an inguinal hernia, however, a sports hernia is difficult to diagnose, as it presents no obvious external signs. It is also hard to spot one through imaging technologies such as MRI, CT or ultrasound because a small, subtle and nearly invisible muscle injury is the usual culprit.

Sports hernias are identified by default through a diagnosis of exclusion -- when other possible causes of the symptoms, such as inguinal hernia, appendicitis, bladder problems or testicular problems, are ruled out.

The pain of a sports hernia can be relieved with analgesics or ice packs, though they may also have the perverse effect of ultimately worsening the condition. If an athlete continues to play through the problem, the tissue weakness, strain or tear will likely worsen.

The best treatment for sports hernias is nature's own -- to lay off the offending activity and rest for a period ranging from a few weeks to a few months. It is also useful to engage in exercises that strengthen the abdominal muscles and increase their flexibility. This course is especially effective for professional athletes; because they are young and strong, they tend to have tremendous recuperative powers. On the other hand, they also tend to be exceptionally eager to get back in the game and seek a quick fix.

But quick, reliable fixes are not to be had. While surgical procedures exist -- suturing the tear (if it can be isolated) or patching the area with a synthetic mesh -- they offer no guarantee of solving the problem or preventing its recurrence.

Fortunately, though, given enough time, patience and self-restraint, the problem will usually heal by itself without such interventions.

-- David R. Farley, M.D., General Surgery, Mayo Clinic, Rochester, Minn.