Repetitive twisting and turning done by hockey, soccer and tennis players, as well as those who ski, run, or hurdle, may cause a sports hernia according to a study in the August 2007 issue of the Journal of the American Academy of Orthopaedic Surgeons. Researchers from Johns Hopkins Bayview Medical Center, in Baltimore recently reviewed the diagnosis and treatment for sports hernias, which are often initially dismissed by athletes who think they may just have chronic pain.

According to the study's co-author John H. Wilckens, MD, chairman of the department of orthopaedics and associate professor at the Center, sports hernias can occur after overuse of the thigh and lower abdominal muscles resulting in a weakness or tear of the posterior muscle wall of the groin.

"Initial examination or imaging (MRIs, X-rays, computer tomography, ultrasound and other nuclear medical studies) are not specific enough to provide information about sports hernias, because of complex anatomy and biomechanical considerations that accompany this injury," said Dr. Wilckens. He added that surgical exploration is the only sure method to confirm diagnosis. Other tests, however, can be done to eliminate other diagnoses and determine if other orthopaedic conditions exist. Diagnosis tools include:

-- Thorough Review Of Imaging Results
-- Complete Training History
-- Observe Specific Movements While Athlete Participates In Sports
-- Conduct A Physical Examination (including palpation, range of motion and motor strength testing)
-- Check For Muscle Tears And Strains, Bone Inflammation, Stress Fractures, Bursitis, Osteonecrosis (dead cells on the top of the femur)
-- Check For Pain Levels (sports hernia pain is created by quick movements, twisting, turning, running and bending forward, kicking, sprinting, sit-ups, or when the patient is coughing or sneezing pain can radiate to the scrotum (in males), hip and back).

Nonoperative treatments of sports hernias include:

-- Rest
-- Ice Packs
-- Physical Therapy (massage, stretching, core strengthening and stabilizing the hip and pelvic areas)
-- Anti-Inflammatory Medication Or Anesthetic And Cortisone Injections
-- Gradual Return To Activity

Another co-author of this study, Adam L. Farber, MD, an orthopaedic resident at the Center noted that if nonoperative approaches do not work within three months, laparoscopic or open surgery is recommended. "After laparoscopy, athletes can return to sport within two to six weeks, while open surgery requires one to six months of recovery," he said.

Dr. Farber added that with both conventional and laparoscopic techniques, success rates are typically 80 to 97 percent. He added, "due to the potential underlying pelvic imbalance that can occur from sports, treatment of a contracted or overdeveloped adductor muscle should not be neglected. This can sometimes be corrected preoperatively; if not, some clinicians recommend that the muscle be cut to allow it to lengthen and stretch in conjunction with the sports hernia repair," said Dr. Farber.

"The exact incidence of sports hernias is unknown," said Dr. Wilckens, "however a number of previous studies have indicated that 39 to 85 percent of chronic groin pain is due to a sports hernia."

"Additional research is needed to more clearly identify the role of imaging studies in the evaluation of a sports hernia, and to evaluate training regimens and conditioning exercises that may prevent this type of injury," added Dr. Wilckens.

American Academy of Orthopaedic Surgeons