Understanding Sports Hernia (Athletic Pubalgia)

Athletes such as long-distance runners, soccer players, football players, lacrosse players, and wrestlers may hear the term "sports hernia" used to describe any type of groin pain, regardless of its cause. Some medical professionals disagree on what exactly a sports hernia is, and sometimes apply the term to several different types of common groin injuries.

It is important to clearly understand the true nature of this condition, however, because it is a frequent cause of groin pain in some types of athletes. Not only that, it is sometimes a difficult condition for physicians to diagnose, so athletes who understand sports hernia and whether their own patient history might indicate risk factors can sometimes help doctors arrive at an accurate diagnosis.

See Groin Strain and Injury

Sports hernia: an often misunderstood term for groin pain

Both the American Academy of Orthopedic Surgeons (AAOS) and the American Orthopedic Society for Sports Medicine (AOSSM) use of the term "sports hernia" to describe only one specific injury—athletic pubalgia.¹American Academy of Orthopedic Surgeons and the American Orthopedic Society for Sports Medicine. Sports hernia (athletic pubalgia). OrthoInfo, September 2010. http://orthoinfo.aaos.org/topic.cfm?topic=A00573 . Accessed December 12, 2014. Specifically, the definition is:

Straining or tearing of any soft tissue—muscle, tendon, or ligament—in the lower abdomen or groin area that connect to or are part of the adductors, or inner thigh muscles.¹American Academy of Orthopedic Surgeons and the American Orthopedic Society for Sports Medicine. Sports hernia (athletic pubalgia). OrthoInfo, September 2010. http://orthoinfo.aaos.org/topic.cfm?topic=A00573 . Accessed December 12, 2014.

While most medical professionals prefer to use the terms athletic pubalgia or core muscle injuries to describe this type of injury, the general public tends to be more familiar with the term sports hernia. Some medical professionals also apply "sports hernia" to other types of injuries, such as disruptions to the inguinal canal that present without clinically detectable herniated tissue,²Kemp S, Batt ME. The 'sports hernia': a common cause of groin pain. Phys Sportsmed. 1998 Jan; 25 (1): 36-44. doi: 10.3810/psm.1998.01.968.^,3Morelli M. Groin injuries in athletes. Am Fam Physician. 2001. Oct 15; 64 (8): 1405-1415. http://www.aafp.org/afp/2001/1015/p1405.html . Accessed December 5, 2014. osteitis pubis, or as an umbrella term for adductor strains.⁴Cohn M. Understanding sports hernias: University of Maryland doctor says condition can be tough to diagnose. Baltimore Sun. October 3, 2012. http://articles.baltimoresun.com/2012-10-03/health/bs-hs-ask-the-expert-hernia-20121003_1_sports-hernia-common-sports-groin-pain . Accessed December 15, 2014.

Sports-health.com uses the AAOS/AOSSM definition of sports hernia for this and any other articles that mention the term. Patients who receive a diagnosis of sports hernia from their medical professional are advised to ask what definition their practitioners are applying to their case.

In addition to athletic pubalgia and core muscle injury (the preferred medical terms), the condition is also known as Gilmore’s groin and slap shot gut.

Anatomy and physiology of sports hernia

There are many different types of tissue in the lower abdomen and upper thigh that can be involved in sports hernia, including muscles, tendons, nerves, and ligaments that are connected to either the lower abdominal muscles or the adductors, or both. Nerve pain may originate from multiple locations, including the ilioinguinal nerve and/or the iliohypogastric nerve, among others.

There are a number of different kinds of core muscle injuries, because they can involve any number of muscles in the pelvic area. The most common pattern of injury involves attritional tears at the point where the rectus abdominis muscle meets the pubis, and pain over the adductor tendon where it meets the adductor (upper thigh) muscle.