Jan 29, 2015
Pre-Show Primer: Groin Injuries & Athletic Pubalgia

Sports hernias and other groin injuries aren’t fun to think about, but they’re a reality for many athletes in a wide range of sports. On Wednesday, June 23, an Ask the Experts event entitled “Is It the Hip or Athletic Pubalgia?” will feature William Meyers, MD, MBA, of the Drexel University College of Medicine, James McCrossin, ATC, CSCS, from the Philadelphia Flyers organization, and Marjorie King, PhD, ATC, PT, of Plymouth State University.

When T&C covered the prevention and treatment of groin injuries in a recent article, our authors–Dr. Paul Geisler of Ithaca College and Ed Kelly of Cornell University, who work with the Cornell University men’s hockey team–pointed out that these injuries can be difficult to define. Here’s how they explained the confusion:

Various researchers have complicated the subject of athletic pubalgia in published literature by defining it strictly in terms of the anatomical structures and precise pathology involved, often contradicting each other’s definitions and creating much confusion. For instance, one study describes a sports hernia as a “spectrum of pathology” involving the conjoined tendon, inguinal ligament, fascia transversalis, and internal and external oblique muscles, caused by a disruption of the inguinal canal without a clinically detectable hernia. Another describes it as a weakening of the posterior inguinal wall without an inguinal hernia detectable during a physical exam.

Numerous other authors have added to the disorder by introducing their own terms, such as “hockey hernia,” and listing specific body parts or symptoms that must be involved for the diagnosis to apply. For instance, varying definitions for a sports hernia may include or exclude the presence of a palpable hernia, and some incorporate the ilioinguinal nerve, while others ignore it.

So where is the common ground, and what do we really mean when we say an athlete has a sports hernia or athletic pubalgia? Despite the conflict over details, authors usually agree that a sports hernia involves a combination of injuries affecting both the groin area and the abdominal region. It’s actually more of a syndrome than a specific injury, encompassing several conditions that can be difficult to differentiate.

It has been theorized that athletic pubalgia is the result of chronic shearing forces across the pubic symphysis generated by repetitive adductor muscle activity. Over time, pubic symphysis forces indirectly cause progressive micro-stress to the posterior abdominal wall, causing a separation of the transversalis fascia and internal oblique aponeurosis from the inguinal ligament. This leads to the pain that we typically associate with pubalgia or a sports hernia.

Recently, a leading specialist who surgically treats this condition has attempted to create a more focused working definition for athletic pubalgia. According to William C. Meyers, MD, it consists of chronic inguinal or pubic area pain in athletes that is exertional only and not explainable by a palpable hernia or other medical diagnosis. Thus, since true athletic pubalgia (by this definition) does not include an occult internal-ring hernia, Meyers has called for the term “sports hernia” to be discontinued when dealing with conditions that don’t directly involve the inguinal rings.

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