Athletic pubalgia, also called sports hernia, core injury, hockey hernia, hockey groin, Gilmore's groin, or groin disruption, is a medical condition of the pubic joint affecting athletes. It is a syndrome characterized by chronic groin pain in athletes and a dilated superficial ring of the

inguinal canal The inguinal canal is a passage in the anterior abdominal wall on each side of the body (one on each side of the midline), which in males, convey the spermatic cords and in females, the round ligament of the uterus. The inguinal canals are lar ...

Football Football is a family of team sports that involve, to varying degrees, kick (football), kicking a football (ball), ball to score a goal (sports), goal. Unqualified, football (word), the word ''football'' generally means the form of football t ...

and

ice hockey Ice hockey (or simply hockey in North America) is a team sport played on ice skates, usually on an Ice rink, ice skating rink with Ice hockey rink, lines and markings specific to the sport. It belongs to a family of sports called hockey. Tw ...

players are affected most frequently. Both recreational and professional athletes may be affected.

Presentation

Symptoms include pain during sports movements, particularly hip extension, and twisting and turning. This pain usually radiates to the adductor muscle region and even the testicles, although it is often difficult for the patient to pin-point the exact location. Following sporting activity the person with athletic pubalgia will be stiff and sore. The day after a match, getting out of bed or a car will be difficult. Any exertion that increases intra-abdominal pressure, such as coughing, sneezing, or sporting activity can cause pain. In the early stages, the person may be able to continue playing their sport, but the problem usually gets progressively worse. As pain in the groin and pelvis can be referred from a number of problems, including injuries to the lumbar spine, the hip joint, the sacro-iliac joint, the abdomen, and the genito-urinary system, diagnosis of athletic pubalgia requires skillful differentiation and pubic examination in certain cases where there is intense groin pain.

Diagnosis

The diagnosis is based on the patient's history, clinical signs, and, increasingly, an

MRI Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to generate pictures of the anatomy and the physiological processes inside the body. MRI scanners use strong magnetic fields, magnetic field gradients, and rad ...

exam. Symptoms can often be reproduced by maneuvers such as performing sit-ups or crunches. Pain can also be elicited with the patient in a "frog position", in which the patient is

supine In grammar, a supine is a form of verbal noun used in some languages. The term is most often used for Latin, where it is one of the four principal parts of a verb. The word refers to a position of lying on one's back (as opposed to ' prone', l ...

with knees bent and heels together. The exact lesion may differ, but common pathologic findings at operation are: * torn external oblique aponeurosis * tear in the

conjoint tendon also known as superior tendon of abdominal cavity. The conjoint tendon (previously known as the inguinal aponeurotic falx) is a sheath of connective tissue formed from the lower part of the common aponeurosis of the abdominal internal oblique musc ...

* conjoint tendon torn from

pubic tubercle The pubic tubercle is a prominent tubercle on the superior ramus of the pubis bone of the pelvis. Structure The pubic tubercle is a prominent forward-projecting tubercle on the upper border of the medial portion of the superior ramus of th ...

* dehiscence between conjoined tendon and

inguinal ligament The inguinal ligament (), also known as Poupart's ligament or groin ligament, is a band running from the pubic tubercle to the anterior superior iliac spine. It forms the base of the inguinal canal through which an indirect inguinal hernia may ...

* tear in the fascia transversalis * abnormal insertion of the

rectus abdominis muscle The rectus abdominis muscle, () also known as the "abdominal muscle" or simply better known as the "abs", is a pair of segmented skeletal muscle on the ventral aspect of a person's abdomen. The paired muscle is separated at the midline by a ba ...

* tear of the

abdominal internal oblique muscle The abdominal internal oblique muscle, also internal oblique muscle or interior oblique, is an abdominal muscle in the abdominal wall that lies below the external oblique muscle and just above the transverse abdominal muscle. Structure Its fib ...

from the pubic tubercle * entrapment of the

ilioinguinal nerve The ilioinguinal nerve is a branch of the first lumbar nerve (L1). It separates from the first lumbar nerve along with the larger iliohypogastric nerve. It emerges from the lateral border of the psoas major just inferior to the iliohypogastric, ...

genitofemoral nerve The genitofemoral nerve is a mixed branch of the lumbar plexus derived from anterior rami of lumbar nerves L1–L2. It splits into a genital branch and a femoral branch. It provides sensory innervation to the upper anterior thigh, as well as t ...

Several of these lesions may occur simultaneously. Also, many athletes have concomitant weakness or tearing of the adductor muscles or labral tears of the hip. When the adductor muscles are tight post injury, that can be enough to trigger symptoms.

Treatment

Conservative therapies (gentle

stretching Stretching is a form of physical exercise in which a specific muscle or tendon (or muscle group) is deliberately expanded and flexed in order to improve the muscle's felt elasticity and achieve comfortable muscle tone. The result is a feelin ...

and a short period of rest) may temporarily alleviate the pain, but definitive treatment consists of surgical repair followed by a structured rehabilitation.The Gilmore Groin & Hernia Clinic
". Retrieved November 24, 2006. The first conservative treatment option should be to restore normal motion after the adductor has begun to heal (usually 6–8 weeks post injury). Sleeping in a prone position with the hip on the affected side flexed and externally rotated can be a cure in some individuals. Early rehabilitation for sports hernias often emphasizes targeted strengthening around the symptomatic area. This approach typically involves exercises designed to engage and challenge the gluteal muscles and posterior chain.Reiman, M. P., & Mathers, J. B. (2013). Functional testing in the rehabilitation of the athlete with groin pain. Sports health, 5(2), 118–127. https://doi.org/10.1177/1941738112468305Hodges, P. W., & Richardson, C. A. (1997). Contraction of the abdominal muscles associated with movement of the lower limb. Physical therapy, 77(2), 1 132–144. The goal is to build supporting strength, which may contribute to improved stability and function during recovery.McGill, S. M. (2010). Low back disorders: evidence-based prevention and rehabilitation. Human Kinetics.

Incidence

The exact incidence of these entities is unknown: some believe it is the most common cause of chronic groin pain in athletes, while others argue that it is only rare.

References

External links

{{Dislocations, sprains and strains Sports medicine Injuries of abdomen, lower back, lumbar spine and pelvis