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ATHLETIC PUBALGIA (SPORTS HERNIA)
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What is it?
Athletic pubalgia is defined as pain in the groin area of an athlete. It has been given many names in the past, such as sportsman hernia and hockey groin. It often happens in sports that require running, twisting, or kicking including soccer, hockey, rugby, and football. Many conditions can cause athletic pubalgia, including tendon strains, nerve injuries, joint problems, and true hernias.

Symptoms
The pain is in the groin region, can occasionally radiate up into the stomach or down into the thigh, and is frequently increased with running, kicking, twisting, sit ups, coughing, or sneezing.

Sports Medicine Evaluation
There may be tenderness when the doctor pushes on the painful area, and it may hurt when the hip is twisted. X-rays may show abnormalities in the hip or pubic joint. An MRI or ultrasound may show soft tissue abnormalities such as a muscle or tendon injury. A dynamic ultrasound, which involves looking at the area while the athlete moves or "bears down" can help identify hernias or weaknesses in the muscles or tendons.

Treatment
Initial treatment usually includes avoiding painful activities and specific strength and flexibility exercises. Ice, heat, and occasionally anti-inflammatory medications may improve symptoms. Occasionally, tendon injuries require injections to help the area heal, and hernias and certain hip joint and nerve problems may require surgery.

Injury Prevention
Because there is no single specific known cause of athletic pubalgia, prevention can be difficult. However, strengthening the hip adductors and abductors is important. In addition, core strengthening and not playing through pain is important.

Return to Play
Athletes who require rehabilitation must have adequate hip range of motion, good strength, and be functional in their sport before returning to practice or competition. This may take up to 12 weeks. Athletes who undergo surgery are typically able to return to sports but this can take 4 weeks to 6 months.

References
Caudill P, et al. Sports hernias: a systematic literature review. Br J Sports Med. 2008; 42(12):954-64.
Litwin DE, et al. Athletic pubalgia (sports hernia). Clin Sports Med. 2011; 30(2):417-34.

AMSSM is a multi-disciplinary organization of sports medicine physicians dedicated to education, research, advocacy and the care of athletes of all ages. The majority of AMSSM members are primary care physicians with fellowship training and added qualification in sports medicine who then combine their practice of sports medicine with their primary specialty. AMSSM includes members who specialize solely in non-surgical sports medicine and serve as team physicians at the youth level, NCAA, NFL, MLB, NBA, WNBA, MLS and NHL, as well as with Olympic teams. By nature of their training and experience, sports medicine physicians are ideally suited to provide comprehensive medical care for athletes, sports teams or active individuals who are simply looking to maintain a healthy lifestyle. Find a sports medicine physician in your area at www.amssm.org.

Category: Hip and Groin,

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