Sports Hernia

[John Kissane]

I'm not sure but believe I might have a sports hernia.  I've had groin and lower abdominal pain combined with tightness in the hip/butt for several months.  Right now I've not run in a week and I've noticed some improvement but want to do some strengthening and therapy before resuming running and I don't know where to turn.  Seeing our family doctor is not likely to get me anywhere.  Does anyone have experience with this?  I've been reading various material on the internet -- seems a sports hernia can be very difficult to recover from and surgery is sometimes required.  I had similar lower abdominal pain eight years ago and was knocked out of action for 8-9 months, saw various specialists and never really knew what the problem was. But I didn't have the hip tightness and very little groin pain back then.

[Tom]

John - both Cal (cal.fastrunningblog.com) and I have had this exact problem for several months as well. Cal also suspects a sports hernia. My doctor said it wasn't a "regular" hernia but I've heard that sports hernias are a special kind of beast and sometimes hard to diagnose (also hard to recover from as you have noted) since there is typically no "bulge" like with normal hernia.

I've also had this in years past and usually it will go away after a few months but seems like this time around it's a bit more pesky. My current plan is to switch to less jarring crosstraining for a while and then ease into the running, only running mostly base miles through the winter with no speedwork and only minimal tempo type runs. I may also try to find a sports doc who is more savvy in dealing with these type issues as compared to my family doctor.

If you or anyone else has a magic bullet to kick this problem I'd be one happy camper to hear about it. I'm sure Cal would be tickled as well.

Good luck to you.

[Dave Holt]

Is hip/butt pain a sign of this type of hernia?  Because I have all of the same signs but just didn't want to admit it to anyone - low/low ab/groin pain and my hips and through to my lower glutes have been giving me fits all summer - especially after hard workouts. 

[John Kissane]

I don't know that the hip/butt pain (or in my case just tightness, not real pain) is typical but I'm not really sure. I believe the primary problem is abdominal/core weakness that results in overcompensation/extra strain on certain areas and eventually actual muscle tears at or near the pubic bone. I started getting some groin pain first, back in March or April, and the hip/butt tightness came on almost at the same time. This would fluxuate and in May and early June I seemed fine and trained well for a 3K track race. But perhaps the speedwork contributed to another flare-up and since July it's gotten progressively worse (altough a week or 10 days in early August I was doing better, then since mid-Aug. it's been consistently bad).  I also have had a bit of trouble with my hamstring in the same (right) leg -- this further leads me to believe it's all related and a sign of imbalance. I really have no good suggestions. It's probably caused by an imbalance and core weakness, but once one has the condition I don't know the best route to take.  Probably very conservative measures (mild stretching and strengthening work) would be okay. Crosstraining could be okay but I've done some cycling in recent weeks and that seemed to increase tightness (but I wasn't good about stretching afterwards so that was probably part of it). Surgery for me would be an absolute last option, I'd have to be in constant pain and a complete basketcase to go that route (partly due to not liking invasive measures, partly due to cost because I have a huge health insurance deductable so would be out major bucks).  I'll pass along any info. I get in coming weeks. Dave, hope your marathon didn't worsen anything!

[Tom]

Since I've been officially diagnosed with a Sports Hernia, or what is now more officially known as Athletes Pubalgia I thought I would revive this discussion. I'm in the process currently of trying to deal with the problem through rest, ice, steroidial anti-inflammatories, PT, and cross-training for at least 4 weeks with no running.

I've cut & paste some info from my blog related to this below. As I learn more about the subject through my experience trying to recover I'll post more stuff here. Based on the number of people I've heard from on the blog, both publicly and privately, it would appear this is a more common type of problem than I thought. If anyone else has additional information or questions, please feel free to post it here as well.

From my blog entry on Monday.....

So I went to the doc today to hear what the MRI said about my "condition". The official report had all kinds of medical mumbo-jumbo and jargon that was meaningless to me but the basic gist just confirms my suspicions. I do have Athletic Pubalgia or sports hernia. Pretty much my gut muscles are "frayed" toward the bottom of my abdomen with tears around the area where the ab muscles connect to the pubic bone. I also have minor tears in the groin area near the same area.

My options are pretty much 1) A dose of steroidal anti-inflammatories, rest (i.e no running or jarring activities for 4 weeks,  biking/elliptical is ok), ice, physical therapy focusing on core strengthening exercises, 2) More of 1 but also with steroid/cortisone shots in the gut, 3) surgery.

Doctor Rich suggested we try 1 first and I agreed. So pretty much no more running for me for at least 4 weeks. I would like to put in the same amount of time and effort into crosstraining but that will be tough. We'll try it the next week and see how it goes. Guess it will be time to try to build some mental toughness in the gym. At least for the time being Kim is in a similar situation so we can support each other and help each other keep from going bonkers. I plan on still blogging the crosstraining but probably not every day, maybe every week or so.

But I can say a part of me is thankful and looking forward to a rest from all the pounding of running and getting rid of (hopefully) these dang lingering aches and pains. November might just be the ideal time of year for both of us to get away from running for a bit.

[Dale]

Tom - Did you get a set of core exercises prescribed or are you winging it?

[Tom]

Dale - I went to the PT yesterday and he started me on some core exercises, some similar to what I've done before and some new ones as well. Monday he's going to have to do some stuff in the pool, not sure if he is going to have me just do pool running or some other type of water-based core workout.

[Jeff Linger]

Hope you heal soon enough Tom. I think sometimes injuries are blessings in disguise. They have this tendency to cause us to re-evaluate our training and improve it. Good luck with your recovery. Good time to read some training books!

[Tom]

I've had a couple of bloggers ask about the core exercises the PT is having me do to help deal with this injury. So I thought I'd make an attempt to describe them, although it's kind of tough to do with words alone. I tried googling to find some pictures but couldn't find anything that quite matched what I've been doing.

So the idea is that we're trying to strengthen the core muscles (abs, hips, back) but without aggravating the injury. So no ab crunches or anything else that tugs on those lower ab muscles which are thrashed with some of them tearing away at the tendon where they connect to the pubic bone.

So the exercises for now focus mostly on the lower back and hip flexors. However there is one key thing the PT says I should do while performing ALL of the exercises, that will help strengthen the ab muscles even though we aren't working them directly. And that is keeping those lower ab muscles engaged and tight at all times. Basically the suck-in-the-gut thing, pulling the navel in toward the spine.

He showed me an easy way to tell if I'm doing this correctly.....what you do is blow all the air out of your lungs and when you think have it all blown out, keep blowing some more until you are really emptied out and ready to gasp. At that point notice what the lower abs are doing and that is what we want to be doing (the ab part, not the non-breathing part) while we do the exercises. He pointed out that in general it's good to get used to sucking-in-the-gut a bit most all the time, while sitting, running, standing, whenever. Not just because you look more manly but because it's just good for those lower abs and core strengthing in general.

Now as far as the exercises....

1) Whatever the weight machine is called where you sit facing the machine, grab the handles in front of you and pull back like you are rowing a boat or whatever. Two sets of 20 reps each. This one works more the lats than lower back.

2) Another thing similar to 1) but in this case the machine is a two part unit, with one set of weights in front of you and one behind and you are standing. You grab one handle connected with a cord to a pulley and weights in front of you with the right hand and elbows bent. Then you grab the handle to the weights behind you with the left hand (elbows also bent but hand behind you). So you then pull against the tension of the weights, i.e. the right hand/arm pulls back toward the body from the front and the left hand/arm pulls from behind in the forward direction. Two sets of 20 reps each, alternating which hands are grasping the handles in the front and the rear.  Don't know if this makes any sense at all, kinda hard to explain. Basically while you are doing this your arms are doing the same motion as they do when you run.

3) Leg lifts. Lay on your back and lift one leg (just one at a time, not both at the same time as doing so makes the injured area very unhappy) up and down about 10 times. Keep your back and butt on the floor. Best if the leg you are lifting doesn't touch the floor during the exercise. 5 to 10 sets of 10 reps each alternating between right and left legs.  Don't forget to engage those lower ab muscles while doing this!

There are also variations of this you can do with the exercise ball. In one case you lay with your head and shoulders touching the floor, feet up on the ball with the rest of the body held rigid in a straight line from shoulders to feet, again keeping the lower abs engaged with the gut sucked in. Hands and arms on the floor to help keep balance while you do the single leg lifts raising the feet/legs up and down above the ball.

The other variation is similar but this time you have your head and shoulders laying on the ball, feet on the floor but rest of body still rigid in a straight line from shoulder to feet.

4) Not sure what this next one is called, might be called the Quadraped? Here you are down on all fours on the floor, hands and knees initially all touching the ground. You then extend one arm horizontally out in front, while at the same time extending the leg on the opposite side out behind you in a similar way. (i.e right-arm & left-leg or left-arm & right-leg). Hold this for about 10 seconds while keeping those lower ab muscles engaged as with all the other exercises. Back should also be level/horizontal so that a pool cue could be laid across your back from top to bottom without falling off. Then repeat with the opposite side, 10-20 times each.

A harder variation is to do this same thing while laying your belly across the exercise ball. In this case it's tough to keep from falling off the ball as the arm/leg not being extended are mostly off the floor and you're trying to balance on the ball while extending the arm and opposite-side leg. I look like a dork when I try to do this one.

5) Also don't know what this one is called. You need to have a springy, bungy-like rope to do this, with one end tied to a post (immovable) just a few inches above the ground. You then connect the other end of the rope to one ankle or the other and walk away from the post at a distance enough to give you some decent tension in the rope.  You are standing for this exercise.

Initially face the wall opposite to where the rope is tied to (i.e. the rope is behind you, stretched out from your ankle to the post). You then lift the rope leg off the ground a few inches while shifting your body weight to the non-rope leg and also bending slightly at the knee of the non-rope leg. Now tug on the rope in a controlled motion (again keeping the lower ab muscles engaged at all times), so you are swinging the rope leg forward pulling on the rope and then backward - not too fast - with the tension of the rope helping pull you back. 

You swing the leg 20 times and then repeat 3 more times but facing a different wall each time. So the rope leg will either be swinging forward and back, in the case when you are facing the wall where the rope is tied or the opposite wall (i.e the North/South walls). Or the leg will be swinging from side-to side laterally across the body in those cases when you are facing the East/West walls). You repeat the entire cycle twice per leg.

Hope this info makes some sense and is helpful. Good luck to anyone dealing with the same injury. Please feel free to share any other insight you may have learned along the way.

[Cheryl Keith]

That was helpful to have those exercises explained.  Several of them my PT told me to do for piriformis/hamstring issues, so I guess our PT's are on the same page.  I think core strengthening makes a big difference in being able to run injury free.  Thanks for spending the time to explain them all.

[Dale]

Thanks Tom.  I understood most of your explanations  .  Most of those exercises are somewhat familiar to me....I was secretly hoping for the magic bullet exercise!  Oh well, guess that means I'll just have to work at this core stuff like everyone else.  Hope they do the trick for you.

[adam]

Tom- I know you mentioned it a while back on this thread, but what were your sypmtoms/signs right before the MRI? I just want to check it with what I was feeling a few months ago to see if I was close to your condition.

[Tom]

Adam - The symptons/signs included pain in lower abdomen (usually it will be worse on one side) and extending down into the groin area. By the time I got the MRI, the pains had gotten bad enough that they bothered me quite a bit during running and especially fast running. The pain can be really bad right after stopping the run to where I didn't even want to try and stretch or work any muscle anywhere near the ab/groin area. Don't seem to notice any pains at all doing non-impact cross-training (bike/stair/elliptical). It's the pound-pound of running or any sport/exercise which involves any kind of jerky motion (basketball, football, soccer, etc) that will tend make my lower gut and groin just burn after an extended period of activity. There is also just a general sensation of the lower ab muscles being weak and "loose". Also sneezing is the worst, I think I've managed to not sneeze for about a month now.

In the early stages when I first noticed this in the spring it was only a slight pain in my lower left abdomen that wasn't really noticeable or bothersome during running, and for some people that get this (including me on 2 other occasions in the past 6-8 years), the pain will go away on it's own after a few weeks or months. But in other cases like my current situation, I first noticed a gradual decline in running performance over the summer, then more and more days where running just starts feeling unpleasant the further into the run, then eventually being unable to get out of 2nd gear while running which for me meant I couldn't hold a sub-7 pace for very long at all.

I really think if I would have taken a little break right after the Strider's 1/2 marathon and NOT have raced a hilly 10K one week after, and just run easy for a month or so and cut the mileage back a bit I would have been fine. We live and we learn.

[Dave Holt]

Tom thanks for the info - I hate to say it, but I think I've got this going on - at least a little bit.  During the summer sometimes it would be so painful it would bother me all through the night.  But after SGM it backed down (due to less running), but as I hit a speed workout the other day I could once again feel it, but not as bad. 

[Tom]

Dave - I hope you can continue to gradually improve and eventually get passed this annoying injury. Thing is from what I've read about it, what works for one runner may or may not work for another, and doctor's don't seem to have a real good handle on this type of injury compared to the more common ones we always hear about.

As a last resort, surgery seems to work in around 80-90 percent of cases, but there are only a handful of doctors in the country that know how to do it correctly, and from what my PT told me it can be a pretty hairy operation, the kind that may have you stuck in bed 24/7 for a couple weeks and then many more weeks before running again. Not much fun.

I think when running while having this you just need to ask yourself at the end of each week if the injury seems better, the same, or worse. If it's getting better that's great and you stick with the training regiment, if it's the same week after week you have to ask yourself if you can live/train indefinitely with the condition and be happy since it may never get better without doing something different. Of course if it keeps getting worse you'll want to make some changes and probably pay a visit to the sports doc or PT.