Transcript Return to Play from Sports Hernia

By
Tad Leusch MS ATC
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Sports hernias are different from other hernias
in that they are not easily identified by an exam
or imaging technology. They may only show
up as groin pain that occurs during physical
activity and disappears during inactivity. A
tear in the Transversus abdominis is
responsible for this hernia.
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A sports hernia typically begins with a slow onset of aching
pain in the lower abdominal region. Symptoms may
include:
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Typically the symptoms are exacerbated with
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Pain in the lower abdomen
Pain in the groin
Pain in the testicle
Running
Cutting
Bending forward
Sports hernias are found in many types of athletes most
commonly
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Hockey players
Football players
Soccer players
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There are no diagnostic tests that can be used
to detect a sports hernia. The diagnosis is made
by the patient's history and physical
examination. Other tests may be performed to
rule out other causes of groin pain.
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Conservative Treatment
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Ice
Rest
Anti-inflammatory medications
Physical Therapy
Surgery
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Involves a patch of mesh-like material, held in place
with surgical tacks.
Rehabilitation from surgery for a sports hernia
usually takes about eight weeks.
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Male
21 year old
D1 College football player
Position: Cornerback
Demands of position: Linear running to
explosive change of direction movements,
backpedaling and opening of hips to change
direction
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Symptoms began approximately 1 year prior to
August 2008 surgery date
Reported to the athletic training room
following practice
Stated he felt a pop in his right groin during
practice
No bulge was noted
No bruising was noted
Strength was 4/5
ROM was equal compared bilaterally
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Athlete was allowed to return to play and continue normal
weight training schedule
During this time he was receiving treatment for his pain
which included:
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Heat
Modalities (estim and ultrasound)
Stretching of the groin, hip flexor, abdominals, piriformis
Soft tissue release techniques including:
 Foam rolling of leg and pelvic girdle
 Softball rolling over involved side hip flexor and groin and well as
piriformis
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Strengthening exercises such as:
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4 way hip movements(adduction, abduction, flexion and extension)
Seated internal and external hip rotation with theraband
Ball squeezes with leg lifts
Swiss ball core strengthening exercises
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With conservative management, athlete was
able to participate in all activities but felt
limited due to pain
During the 4 week winter break period, athlete
was instructed to go home and rest
If he felt his pain decrease, he was instructed to
begin straight ahead jogging in order to
maintain a level of fitness
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When athlete return to campus, he stated that he
was almost pain free
A slow return to play progression was initiated
which included:
Progression of linear running which went well
 Progression of explosive cutting drill during which pain
returned which halted progression
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Athlete was re-examined in March at which time
an MRI was obtained
No hip pathology noted
Received a cortical steroid injection at the pubis
symphysis which provide some relief
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With the relief of pain following injection,
running progression was initiated again
Athlete was able to achieve about 75-80 percent
of speed before pain returned
Even with a significant amount of rest, anytime
athlete would state his symptoms were
decreasing and activity was ramped up, pain
would return
This patterned continue on through the
summer until athlete was unable to participate
in any of the team workouts
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After approximately 1 year of conservative
treatment, athlete was not able to fully engage in
all activities
Pain became localized in the right groin area
Pain with squatting
Pain in lower abdominal area with core
strengthening
Pain with explosive change of direction
movements
Athlete was re-examined by the team physician
and it was determined that he needed to be
referred to Dr. Brad Pierce, a recognized surgeon
that deals with sports hernias
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Research in this area is sparse
Protocol is very open
Generally speaking return to full activity is
projected at 6 weeks
Typically we have been able to progress
athletes back to full activity by 10-12 weeks
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Straight line physical activity only for first 3
weeks
Start out with low impact exercises
By week 3 athlete should be back to jogging
and running
Re-introduction of sporting activities between
week 4 and 6
Continue core strengthening and flexibility
treatments
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Athlete was seen approximately 3 days
following surgery
Athlete was in noticeable pain upon entering
the athletic training room
Walked with a slightly forward hunch due to
pain
Initial treatment consisted of ice to control pain
After approximately 10 days following surgery,
athlete was able to walk with normal gait and
mild pain
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Week 2 athlete was able to walk on treadmill for 10 minutes
Exercises consisted of:
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Ice following rehabilitation session
Week 3
Pace was increased on treadmill but still at a walking pace
Progression of core strengthening
Body weight movement such as
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Isometric core strengthening
Gentle abdominal stretching
Lunges
Side lunges
At week 4 athlete began to notice an increase in pain
Activity level was decreased until pain subsided:
approximately 2 weeks
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After pain subsided, athlete resumed progression
of exercises
Core strengthening and machine upper body
exercises which did not create a valsalva maneuver
Body weight movements progressed into
movements with weight
Lunges
 Squats
 Side lunges
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After approximately 4 weeks, athlete was able to
transition to weight room activities
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At week 8 athlete began running progression
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Week 8 linear progression
 55 yard running (jogging to running)
 Cross Field’s
 Build ups
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Week 9 Add in slow tempo change of direction
 Box drill
 90 degree cutting drills
 X pattern drills
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Week 10
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Week 11
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Weeks 10 was a progression of tempo during linear
and change of direction exercises
Begin to incorporate position specific drills
Continue drills from week 10
Add reactionary change of direction movements
Week 12, athlete was given a recovery week
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At week 13, athlete was allowed to progress
into football practice activities
Individual drills for first 2 practices
 Individual drills and 7on7
 Individual drills, 7on7, and 1on1
 No limitations by the middle of the 16th week
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Increase in pain during week 4
Demands of the sport
Mentality of the athlete
As a Sports Medicine Staff we try to account for
Amount of whole body de-conditioning an athlete
may have
 Make sure that the athlete can tolerate activity level
 Make sure not to rush return which may lead to
other injuries
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