some signs and symptoms of a sports hernia

many people have groin pain that is chronic. sufferers of athletic pubalgia have symptoms that also exist in numerous other pathologies.
obviously, the worse the injury, combined with chronicity of the condition, can have a exacerbating effects of the symptoms. it can also be noted that a chronic sports hernia causes muscle imbalances in the pelvis, back, and legs which in themselves can be painful but repairable conditions. here are some syptoms reported by some sufferers...

• dull ache, often accompanied by sharp pains, especially after activity involving hip flexion and/or twisting. such an activity can be as simple as raking leaves or someting more demanding such as playing soccer or moving furniture.
• pain is often felt off of the corner of the pubic bone, and can radiate to the testicle(s) in males.
• there is almost always accompanied adductor muslce tightness and often pain in the adductors. it can be difficult to adduct (squeeze them together) the leg(s) because of this.
• pain can also be felt while twisting, from the pubic bone up to the inguinal ligament. this pain can also wrap around to the hip and lower back.
• there can be irritation of the nerves that travel to the perineum and genitals.
• it can be painful to externally rotate your bent leg, but it can also hurt to internally rotate your femur. this can be interpereted as a pathology involving the hip. attempting to kick a soccer ball with the inside of your foot is such a movement that can induce sharp pain, as can sitting cross-legged, or "Indian style."
• there can be intense pain while trying to get up out of bed, causing the sufferer to need to roll off of the bed as opposed to sitting up first.
• in general, bearing down, as in coughing, can be painful, just as in an inguinal hernia.

a couple of misdiagnoses

some conditions are "diagnosed" when a sports hernia might actually be the culprit:

1) pulled groin/groin strain: so while one may in fact pull/strain the groin or adductor muscles during sports or the overload that a sports hernia is caused by, a patient who see such a chronic groin strain that will not go away should seek out more advice from a more experienced doctor of physical/sports medicine. sure the injury can be chronic, but if you are in doubt of the diagnosis, and the mri doesn't show any tears....

2) inguinal hernia: as we know, ap/sports hernia is NOT an inguinal hernia. if a doctor tells you it is, and he has never heard of AP, then he or she is in left field. if an inguinal hernia was also called AP, you would think that any doctor would have heard of it by now, considering thousands of inguinal hernias are diagnosed every day. i had to tell this to several orthopedic surgeons, even after the surgeries i had for AP. one of them would not budge, so i printed out info on sports hernias and mailed it to him (needless to say, i have no interest in going back to see him)! when i left his office, he told me i have something totally unrelated, which was proven wrong by the next 2 practitioners i saw afterwards.

3) non-bacterial prostatitis (chronic): obviously applies to only males. since the phantom pains are in the groin, your doctor might send you to see a urologist. the ur will natrually assume that the problem is under his speciality range and will do his/her best to diagnose you. when the nerves around the groin are irritated (such as when you get kicked in the groin), the body reacts by tightening up the muscles in that area. with severe, chronic nerve irritation, the tissues will also be chronically tightened. such a scenario can cause the prostate gland to be swollen as well, seeing how the gland is attached to the pelvic floor via connective tissues. the ur won't think of this, and if you suggest a muscular issue (like i did), he might tell you that you are wrong and you have this mysterious swelling in your prostate that might be caused by a bacteria, which they cannot find. hmmm, makes you wonder. this is what happened to me, and i was put on levaquin for 35 days! after 7 months, i had given up on my ur and went my own route. chronic prostatitis has no cure as far as the ur's are concerned, basically because all eitologies are theoretcial. that is another reason why all doctors should have basic knowledge of sports hernias and their prevelence; chronic prostatitis is a much worse diagnosis than a sports hernia.

there are more to come...

to stretch or not to stretch?

i did a bunch of stretching before my surgeries (as instructed by a pt) as well as afterwards.

for the last 2 months i have not been stretching, and it has made a difference. an irritated nerve can be more irritated by stretching it. it would make sense to me, that a deep lunge/psoas stretch would more than likely irritate those nerves that are located in the fascia of the psoas. note the nerves that are often irritated in the sports hernia: ilionguinal, iliohypogastric, and genitofemoral nerves.

i wish a doctor would post here and provide insight on the irritation of these nerves. from what i understand, in many cases of ap there is a tearing of the obliques. the ilioinguinal and iliohypogastric nerves pass bewteen the layers of obliques. i can only assume that is why reaching overhead and twisting is painful to so many that suffer from this injury.

so, i think that stretching was bad for me. that is, until the nerves really began to calm down through a period of NOT STRETCHING. by the time i had my surgeries, i was no longer in shape, in fact, i had lost about 27 pounds due to lack of mobility and desire to eat due to pain, and sickness from the antibiotics i was carelessly put on.
as my nerves are slowly becoming less irritated, my mobility has begun to really come back. i can bend over without pain most of the time.

recoup time different for everyone

this is the lesson i need to learn myself. an example of one who took a long time to recouperate: nba star grant hill had actually retired due to this injury and, i think, post-op pains that lingered on for a long time. now he is back in action and playing.

another example: hockey goaltender dominick hasek went through the 90's with a chronic groin injury and had to eventually retire after being in and out of the game. since then he has found the right doctor and thus had surgery. now he is playing again. what i find interesting is that he definitely was pushing himself despite the injury, which i would think could make the nerve irritation (the pain of the injury) worse. at least that would make sense. goalie spilts (butterflies) and whatnot could be very taxing on abdominal and groin tissues that are already damaged.

there are more examples.
the bottom line is, the doctors who do this surgery really don't know how long it takes to recover. if you are a paid athlete, chances are you are monitored better than non-pros, thus you can get surgery in prompt time: thus better the chances you can recover properly. but as you can see that is not necessarily true just from looking a the two above examples.
if you have no helpful doctors near you, then it is really up to you to find the right doctor/physio/pt/etc that is willing to listen to your story and maybe a good physical therapy or similar protocol can be developed to your individual case.

i too am guilty of worry that i will not recoup enough to function without pain. but i am slowly seeing the light at the end of the tunnel, thanks in part to others that have suffered and shared their stories. mine has been a long recovery but then again my case is different than many in the fact that i also had developed postural issues in my back, hip, knee, and ankle. these things oocured from years of wear n tear and unattended injuries. the sports hernia was probably just the icing on the cake. it is common that people develop compensatory patterns and thus painful muscle imbalances when they are chronically injured. in the case of ap, the longer you go with it, the worse imbalances become. i was out of balance before my injury became full blown. add 18 months of misdiagnosis, and *whammo*...

link to a loooong thread on sports hernias

most of you have probably found this already, but a good discussion on sports hernias can be found on a thread here:
http://www.letsrun.com/forum/search.php?board=1

type in "sports hernia" in the search bar and go from there. people discuss their personal stories in dealing with the injury.