What is Athletic Pubalgia or Sports Hernia

Are you athletic, and now suffering from groin pain? Have you been told you have a sports hernia? Before you undergo a hernia repair surgery, make sure you have an accurate diagnosis because many times a sport hernia is NOT actually a true hernia, and a routine hernia repair may not always alleviate your symptoms.



In fact, the true diagnosis is called athletic pubalgia. The “sports hernia” has been a subject of debate and confusion for years, even among doctors and physical therapists. Athletic pubalgia is a general term for many of the pubic bone based muscle or tendon injuries.

The underlying problem in athletic pubalgia is a sprain, tear, or avulsion of a muscle or tendon that originates or terminates on the pubic bone. These muscles and tendons may be part of your abdominal wall or your leg. This is often a result of repetitive kicking, twisting, or turning, but it may also be caused by a single, abrupt movement. Overall, the etiology is likely a combination of overuse and imbalance of forces acting across the pelvis. Sometimes the swelling of these muscles can compress the nerves running within them causing referred pain from the groin elsewhere. Sometimes there is no obvious injury, and just a dilated internal ring, and this is one subtype of athletic pubalgia labeled as a sport hernia. Since this injury is commonly caused by repetitive activity, patients typically present with gradual onset of groin pain that worsens with activity. The pain can be aggravated by certain movements, or even coughing or sneezing. Inflammation of the pubic bone can result, and is called osteitis pubalgia.


The difficulty in diagnosis of a sports hernia lies in the fact that no “hernia” is evident on physical exam or imaging. Occasionally, a dilate internal ring is appreciated. Unlike the common inguinal hernia, the sports hernia does not have an associated bulge or protrusion, even with different clinical maneuvers. A specific physical exam for groin pain can usually isolate the muscle group involved MRI (magnetic resonance imaging) can be very useful in identifying different types of athletic pubalgia; it may also help identify other causes of groin pain.

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