As a sports physical therapist, I sometimes encounter patients suffering from pain in the groin, the testicle, the high adductors, or the lower abdominals. If you experience sharp pain in the lower abdominal region that prevents your participation in sports and seems to be gone at rest, you might have athletic pubalgia. If you play field sports, you are at risk, and in the event you have the sort of pain in the groin that makes you back off from your running , then you should seek medical help. As Dr Meyers points out “Pain can be minimal at rest and begin unilaterally or bilaterally. It may be fleeting, appearing and disappearing on one or the other side or involving both abdominal and adductor components. There may be pain with coughing, sneezing, turning over in bed at nighttime, sprinting, kicking, sidestepping, and performing certain maneuvers specific to your athletic activity.”
Athletic Pubalgia, sometimes (incorrectly) called Sports Hernia, is a complex injury involving the abdominal muscle insertions, the adductor muscle (of the legs) insertions and sometimes both of them at the pubic insertion. The injury can affect one or both sides of an athlete. The pain is thought to be caused by osteitis (inflammation) of the pubic bone that itself occurs when the muscles are torn off the bone.
The pain typically will subside with rest or conservative treatment, but it will reoccur almost immediately that activity is resumed. When an athlete continues to participate in their sport once the injury has occurred, the Adductor muscles begin to undergo compensatory changes that can result in torn groin muscles.
The key to understanding the athletic pubalgia is the anatomy. The pubic symphesis is sort of like a joint in that it has many complex insertions of muscles from above and below (the abdominals and the adductors) that insert into a cartilagenous plate near the pubic symphesis. When the tissues tear, the athlete can suffer what used to be thought of as a career ending injury. Now with advanced surgical techniques, this injury can be repaired, and the athlete back on the field in 3 short weeks!
This injury occurs as a result of the tension developed between the lower abdominals and the adductor muscles of the thigh. The typical athlete tends to have stronger legs than their stomach, and over time the lower and thin wall of the abdominal muscles tear creating the athletic pubalgia and the pain that follows. The surgery simply ties the torn structure back onto the cartilagenous plate, and once the surgical entry wounds are stable, the athlete can return to play. Occasionally, the surgeon will also perform an adductor release or fasciotomy to aide in the recovery.
There are just a few doctors I know who perform this sort of surgery.
This injury is common in soccer, hockey, football, and rugby players as well as lacrosse and other sprinting, cutting, stop/start sports such as gymnastics and ice hockey and ice skating.
Several “types” of Athletic Pubalgi have been identified, each requiring a slightly different surgical approach. The more common variants are listed on Dr. Meyers Athletic Pubalgia or Sports Hernia Site
Occasionally, conservative measures, like physical therapy are useful in treating early signs of AP, but once the structures are torn, surgery is the treatment of choice. Physical therapy that follows the surgery can often help a player return to unrestricted athletic participation in as few as three weeks.PT involves soft tissue work directed at the adductor muscles and direct treatment of the surgical scar, and progressive exercise designed to challenge the functional tolerances of the adductors to athletic loading.