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Sports Hernia Injury (Core Muscle)

Core Muscle injury (aka sports hernia) is a soft tissue injury to the groin or pubic region. It is also called athletic pubalgia and is a common cause of pain in athletes. It is a tear in the abdominal muscles that can occur during strenuous physical activity. The most common cause of a core muscle injury (sports hernia) is overuse, but it can also be caused by sudden trauma or impact.

It has several names because it encompasses multiple sites of muscle, tendon and ligament damage in the pubic area including the rectus abdominus and oblique muscles and tendons in the lower abdomen, the inguinal wall, the adductor longus tendon that attaches the thigh muscles to the pubic bone and the pubic symphysis (the joint between the left and right pubic bones).

Treatment may include a variety of procedures such as muscle repair, tendon repair, abdominal wall repair, and even concomitant hip arthroscopy for the treatment of Femoroacetabular Impingement (FAI) where extra bone grows on the hip bones causing friction that damages the hip joint. Bone impingement due to FAI can lead to excessive strain on the pelvic core causing injury and pain.

Core muscle injuries can occur during any type of strenuous physical activity but are most common in sports that involve twisting or rotating movements of the trunk, such as golf, tennis, and baseball. They can also occur due to a direct blow to the abdomen or pelvis.

Sports that involve rapid cutting, sprinting, and sudden acceleration and deceleration create a high risk of core muscle injury. Basketball is among the top 5 sports that cause core muscle injury. Sports like ice hockey, soccer, football, and rugby also involve the potential for core muscle injury. A core muscle injury can cause an inguinal hernia.

Other potential causes of a sports hernia include:

  • Poor flexibility or tightness in the abdominal muscles
  • Weakness in the abdominal muscles
  • Poor conditioning
  • Improper warm-up or cool-down
  • Wearing improper footwear
  • Excessive weight gain

Core muscle injuries are characterized by severe pain in the lower abdominal & groin region made worse with flexion and strain of the pelvic core during activities involving abdominal contraction such as kicking, cutting, and sprinting. This sharp pain typically resolves somewhat with rest and activity modification but usually returns with recurrent athletic activity. Intermittent numbness and swelling can occur in the groin and pubic region as well. Left untreated, the pain becomes chronic lower abdominal and groin pain that interferes with sports participation.

The expert clinicians at LALL Orthopedics + will take a detailed history to determine the exact leg and core position during the injury event, which is important to understand the location of muscle/tendon tear. They will perform a comprehensive physical exam of the pelvic core, abdomen, lower back, and hip to identify the location of your pain.  A specific physical test that helps to identify core muscle injury is the sit-up resistance test where the patient will perform a sit-up against resistance.

Your clinician will likely order a specialized core muscle MRI that can help identify tears and strains of the abdominal muscles and hip adductor tendons. Lidocaine injections can be used to localize and confirm the source of pain.

First line treatment in acute injury involves evaluation by a surgical specialist to address if urgent surgical repair is warranted. Pelvic MRI is required to visualize symptomatic insertional pubic plate injuries and retracted tendon tears. Surgical intervention involves direct repair of injured tissue via all-suture techniques, which has been shown to be more favorable compared to the use of bone anchors or mesh. Following surgical repair, post-operative recovery begins immediately following the procedure with focused physical therapy, rest, icing, and anti-inflammatory medications. Patients can expect to be back to sport within 6 weeks of surgical repair. Studies report that return to play, and return to preinjury baseline, after surgery for core muscle injury are high ranging from 80% – 100% across multiple sports.

Often, concomitant hip injury such as a hip labral tear is coexisting. If this is found to be the case, both injuries can be treated with a same-day combination hip arthroscopy procedure + core muscle repair, even in cases of bilateral injuries. In other words, if indicated, patients can undergo up to four possible surgical procedures (bilateral core muscle repair + bilateral hip arthroscopy) all in a same-day procedure, which is extremely unique and only offered in few elite surgical centers worldwide. Patients initiate physical therapy the following day and can expect a full return of function, even at the level of professional athletics.

If you have symptoms consistent with a sports hernia, schedule a hip consultation with LALL Orthopedics +. LALL Orthopedics + is led by renowned hip surgeon Dr. Ajay C. Lall. Dr. Lall is a former dual sport NCAA collegiate athlete (football and track & field), American board certified, triple fellowship-trained expert orthopedic surgeon. LALL Orthopedics + specializes in the treatment of sports hernia.

LALL Orthopedics + has offices in Paramus, NJ, Philadelphia, PA and Belvidere, IL. Our team regularly sees patients from Bergen County, Hackensack, and Morristown, NJ.

At a Glance

Ajay C. Lall, MD, MS, FAAOS

  • Board Certified – Orthopedic Surgery
  • Triple Fellowship Trained
  • Performs over 750 Surgeries Per Year
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