General Surgery Conditions | Sportsmans Groin

Sportsman's groin is a widely used term for painful conditions affecting the groin region in athletes. The pain is usually chronic and affects the lower abdomen, groin or upper medial thigh.

 

There is no clear agreement on either the name or the exact underlying problems. Other commonly used names include: Sportsman's hernia, athletic hernia, Gilmore's groin, hockey groin syndrome, athletic pubalgia, inguinal ligament enthesopathy, incipient hernia and osteitis pubis.

 

Symptoms


Symptoms are pain in the groin, typically worse with running, sprinting, twisting and kicking. Stiffness and soreness after sport is common. Typically symptoms are aggravated by abdominal straining, and rapid rotational movements. There is rarely a history of a specific injury (<30%). The symptoms have usually failed to respond to conservative treatments by the time patients are referred. Physical examination usually fails to reveal a clear bulge or weakness associated with traditional hernias. However on examination a dilated superficial inguinal ring may be found with a cough impulse, and this examination will often reproduce the pain. Diagnosis may be aided by both soft tissue ultrasound, or MRI scanning.

 

Associated injuries


The commonest definition of a sportsman's hernia is a weakening of the posterior inguinal wall, but there a re a large number of other soft tissue injuries which can be associated, and a Sportsman's hernia alone is unusual. The associated defects include:

  • Posterior wall deficiency in the inguinal canal
  • Transversalis deficiency
  • Tear in the conjoined tendon
  • Dilatation of the internal inguinal ring
  • Thinned or torn rectus insertion
  • Thinning or tearing of the internal or external oblique aponeurosis
  • Iliopsoas strain
  • Adductor tendinopathy

The most common of these is the adductor injury with around 40% of patients with a Sportsman's groin injury having an associated adductor injury.

 

The sportsman's groin injuries are not seen in youth sports, and is increasingly common in professional and keen amateur athletes. The causes are most likely due to a combination of the increased stresses associated with higher levels of sport, and progressive degeneration injuries which manifest later in an athletes career. Preventing sportsman's groin injuries is key for many sports professionals and core stability and strength exercises are the most effective.

 

Treatment


Successful treatment of these complex injuries depends on accurate diagnosis, and restoration of normal anatomy, with appropriate physiotherapy for associated injuries.. Surgery is usually offered in sportsmen who are unable to play, or fail to respond to conservative treatment. The anatomy of the groin is repaired surgically in a number of layers. Most adductor injuries are treated conservatively, but in severe adductor strains tenotomy or release can be considered.

 

Surgery is performed as either a day case, or patients stay in hospital one night. Patients should follow a specific rehabilitation programme.

 

The outcome of surgery is generally good with over 90% of patients improving, most with resolution of symptoms.