Sports Hernia Injury (Core Muscle)

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 is conservative management involving rest, icing, and anti-inflammatory medications, followed by focused physical therapy to strengthen the abdominal and thigh musculature.

If this nonsurgical regiment fails to resolve pain and allow return to sport, surgery may be recommended.  Professional athletes may elect surgery to return to play sooner at an elite level. 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.

Surgery may include repair of the muscles, reinforcement of the soft tissues, and repair of tendons. If concomitant hip injury such as a hip labral tear is coexisting, it can be treated with a same-day combination arthroscopic hip procedure with core muscle repair.