Athletic Pubalgia

Sports Hernia is a term that has evolved with emerging knowledge regarding the anatomical causes of athletic hip, groin, and lower abdominal pain.  The most commonly injured athletes are soccer, hockey, gymnastics, & dance.  Athletes generally complain of pain that is not well localized to the groin and lower abdomen and often begins insidiously.  Some causes of athletic pubalgia are listed here:

  • Hip impingement (FAI) & labrum tear
  • Pubic symphysitis (osteitis pubis)
  • Stress fracture
  • Adductor strain
  • Hernia
  • Tranversalis fascia injury
  • Iliohypogastric nerve entrapment
  • Chronic tranversalis abdominis or rectus abdominis strain
  • Occult hernia

History of pain with athletic participation at the hip/groin prompts a careful evaluation looking for acute & chronic causes in history, a thorough & careful physical examination, & targeted imaging studies to elucidate any visible pathology.  Unfortunately with the diagnosis of athletic pubalgia imaging findings can yield nil or are sometimes misleading.  When patients fail to respond to physical therapy from a skilled rehabilitation specialist experienced athletic pubalgia, advanced treatment becomes necessary.

Reliance on diagnostic injections using lidocaine is an excellent tool. The anesthetic blocks pain temporarily and can aid in the diagnosis by taking away pain signals from specifically targeted anatomical areas. If the pain is absent while the injured athlete is engaging in their sports after injection, but then returns after the anesthetic agent wears off, we can safely argue that we have found the pain generator.

Once there is confidence that the body structure causing pain has been clarified the next step is selecting a treatment.  For inflammatory causes and in season athletes a simple corticosteroid injection can be utilized to expedite pain relief.  For more longer lasting results biologic injections including hyaluronic acid preparations, platelet rich plasma, & fat-derived stem cells can be utilized to optimize growth and repair of injured structures. Selective nerve blocks can also be utilized with techniques such as nerve hydrodissection.  When non-operative management fails surgery might be indicated, in which case careful planning and surgeon selection is coordinated by myself and my staff.

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