Many athletes, amateur or not, experience groin pain throughout their years of training, yet in some cases its true underlying reason may stay undiscovered for months.
Sports hernia, or athletic pubalgia, involves soft tissue injury in the abdominal and/or pelvic area outside of the hip joint that causes weakness of the posterior wall of the inguinal canal, giving rise to the mentioned ache [1,2].
Even though it occurs much more frequently in adult males who do football, hockey, or athletics, it may also happen to you.
Can this cumbersome condition heal on its own and, if not, what are the treatment options?
How Does Sports Hernia Heal On Its Own?
Since the groin area, in which a sports hernia can take place, includes numerous structures comprising various muscles and tendons, there is no single typical injury that leads to this ailment, yet one thing must occur for sure – soft tissue damage [1,2].
Accordingly, as every sort of soft tissue regenerates via the same process from the beginning to the very end, we can distinguish the following phases of sports hernia healing [6,7]:
The Injury/Bleeding Phase
Although by the book the first phase is called “the bleeding case”, in this instance it may sound excessive, as a lesion resulting in sports hernia might not necessarily entail any bleeding.
For this reason, in this particular case, this stage can be termed “the injury phase”, or simply the moment when the damage takes place.
Acute Inflammation Phase
Our immune system is programmed to instantly react to any kind of harm or injury, and
in a sports hernia, there is no exception to this rule.
In the inflammation phase, the affected area is marked by characteristic inflammatory indicators: swelling, bruising, increased temperature, pain, and loss of function.
Local blood vessels get dilated and more permeable so that any excess fluid, as well as immune cells and substances, can easily pass through. This generates edema and bruising.
Concurrently, the whole process is propelled by compounds called prostaglandins, which cause a rise in temperature and an increased feeling of pain – it is no coincidence that they are targeted by most of the pain-relieving agents.
At the same time, many immune cells including neutrophils and macrophages, neutralize any microbes that may have gotten into the site of injury, while secreting cytokines, which only enhance the inflammatory reaction.
The whole stage lasts from 2 to 5 days, unless the cause of it had not been disposed of.
Subacute Proliferation Phase
During the subsequent subacute proliferation phase, the main building protein of the connective tissue which gives its structure and elasticity, collagen, is being produced.
Consequently, this stage is responsible for reconstructing the tissue scaffolding of the affected area, hence is extremely important.
Simultaneously, it is also the time of angiogenesis, or new blood vessel formation, so that as many necessary nutrients as possible can be transported to the site of injury.
This one starts as soon as 2-3 days after the incident and peaks after 2-3 weeks.
Remodeling Phase
2-3 weeks post-injury (depending on its severity), the so-called “remodeling phase” begins.
During it, the so far produced, more malleable collagen matures and gets replaced by a firmer, more durable kind. This stage certainly lasts for months and can last for even years after the incident.
Looking at the above-listed stages, numerous habits come to mind that are both easy to implement into day-to-day life as well as will greatly accelerate the healing process of a sports hernia.
They go as follows:
Immobilizing The Affected Area
Athletic pubalgia is characterized by pain that improves with rest and almost instantly comes back with activity even after a prolonged break [1].
It is no accident – any further damage or stimulation of the area caused by movement rekindles the inflammatory cascade as well as extremely hinders both the proliferation and remodeling phases.
Consequently, abstain from working out for at least 6 weeks and revise your symptoms from there.
Sleeping Well
When we sleep, the restorative processes that take place in our body drastically intensify, thus it leaves no doubt behind that the better the quality and duration of your sleep, the faster your regeneration process.
A healthy adult should not sleep any less than 7 hours a night.
Eating Protein
As humans, we cannot synthesize all kinds of amino acids that constitute our building proteins. Even if we produce some, it may be in insufficient amounts for the time of healing.
Therefore, incorporate as many wholesome proteins into your diet as you can. If you are not a vegetarian nor vegan, here’s the tip:
An egg is considered a “perfect protein” among nutritionists since it has all the necessary amino acids that exist.
Sports Hernia Physical Therapies
Some types of sports hernia may benefit loads from physical therapy while in the other it might turn out to be too much or too little.
It is best to discuss your doubts with a medical professional so that you do not aggravate the injury and know the exercise plan most suitable for you and your needs.
In any event, the usual rehabilitation program for a sports hernia includes the following exercises [3,4,5]:
- Static Adduction Against A Ball
- Lie supine and place a ball, like a soccer one, between your feet.
- Perform an adduction, or moving your limb toward the midline of the body, against the ball for 30 seconds.
- Repeat 10 times.
- Bridge
- Lie down comfortably on the floor, with your arms along your trunk.
- Bend your legs at the knee, hip-distance apart, while keeping the feet at the ground.
- On an inhale, bring your body up, without moving your head, arms, nor feet from the floor.
- Try doing a few series, 10 repetitions each.
- Balancing On A Ball
- Sit on an exercise ball with your legs bent at 90 degrees angle at the knee joint.
- Place your hands on your thighs.
- Try to maintain stability for a longer while.
- Repeat a couple of times as you please.
- Abdominal Situps
- Lie down on your back.
- Bend your legs at the knee, hip-distance apart, feet on the floor.
- Place your hands behind your head.
- On an exhale, bring your upper body all the way up toward your knees.
- Slowly lower yourself down.
- Do a few series, 10 repetitions each.
- Quadricep Hip Extension
- Start on all fours.
- Activate your core and abs to stabilize your spine.
- Slowly lift one leg up while maintaining a 90 degree angle bend at the knee. Simultaneously, lift the left arm up so that it is parallel to the ground.
- Change sides.
- Do a couple of series, 15 repetitions each.
Try incorporating this exercise after already having exercised for some time.
How Much Time Does Sports Hernia Take To Heal Naturally?
It takes up to six weeks to recover from sports hernia naturally.
However, it is difficult to assess the exact time of recovery using one yard stick because, as mentioned before, a sports hernia may result from a quite wide array of injuries, some being milder and some being more severe.
Nonetheless, we can estimate the duration time of each healing phase in an average case of athletic pubalgia – that is:
- Acute inflammation phase 2-5 days
- Subacute proliferation phase 2-3 weeks
- Remodeling phase a month or two at the very best.
For this reasons, it is best to evaluate your symptoms after around 6 weeks post-incident.
How To Know That Sports Hernia Is Not Healing But Getting Serious?
In the most dramatic scenario, like an acute infection or so, the symptoms will be aggravating very rapidly to even vastly intense levels.
Nonetheless, other not that spectacular manifestations can be a sign of something going wrong.
For instance, monitor if there is still pain or tenderness on movement or palpation in the affected area, especially after a considerable amount of time has passed after the injury.
Similarly, check if the pain has gotten worse or a new type of it, or even a new symptom has arisen.
What Are The Other Medical Treatment Options If Hernia Does Not Heal By Itself?
Even having made your best efforts, sometimes a sports hernia will not heal on its own.
Luckily, there exist plenty of treatment options to choose from in such cases.
Moreover, if you would not like to wait and opt for professional care from the very beginning of the recovery process, these alternatives are also a way to go [1,2].
Anti-Inflammatory Therapy
Anti-inflammatory therapy can be really beneficial both in the long run as well as short-term, for instance when needing to achieve instant relief before a sports competition.
The first choice medications would be nonsteroidal anti-inflammatory drugs, like ibuprofen, which target prostaglandins and similar compounds that are primarily responsible for ongoing inflammation.
Acetaminophen could also be advantageous, nevertheless contrarily to nonsteroidal anti-inflammatory drugs, it does not present anti-inflammatory action, yet only antipyretic and analgesic ones.
In certain cases, like as mentioned when immediate improvement is imperative, corticosteroid injections might be implemented with great success.
Long-term steroid therapy is contraindicated mainly due to associated side effects.
Surgical Treatment
If anything else fails or from the start there is really no other way around it, surgical treatment is needed.
In all cases, it can be done either as an open surgery or laparoscopically which involves a much shorter recuperation period.
When it comes to the surgery itself, there exist many approaches to pick out from, for the most part depending on one’s particular sports hernia type.
Some of the frequently used techniques involve repair of the abdominal muscles like external oblique or transversus abdominus, the tranvescalis fascia, or even pelvic floor reconstruction.
“Minimal repair” methods, which consist of local nerves decompression, are also performed to relieve the symptoms. In the end, surgical treatment is one of the most effective options out there.
It is also important to remember that it is often followed by a physical rehabilitation period planned by a professional.
More On How Sports Hernia Generally Heal With Time, Also Know Different Other Treatment Options
References
- Ashley Brown, Solomon Abrahams, Denis Remedios, Stephen J Chadwick; Sports hernia: a clinical update
- Christopher M. Larson; Sports Hernia/Athletic Pubalgia
- J. Scott Woodward, PT, MSPT, SCS, ATC, Andrew Parker, MD, and Robert M. MacDonald, MD, F.A.C.S.; NON-SURGICAL TREATMENT OF A PROFESSIONAL HOCKEY PLAYER WITH THE SIGNS AND SYMPTOMS OF SPORTS HERNIA: A CASE REPORT
- Abigail A. Ellsworth, Mark P. Zoland, MD, and Timothy F. Tyler; ATHLETIC PUBALGIA AND ASSOCIATED REHABILITATION
- Walid Ahmed Abouelnaga, PhD, PT and Nancy Hassan Aboelnour; Effectiveness of Active Rehabilitation Program on Sports Hernia: Randomized Control Trial
- Ning Xu Landén, Dongqing Li, and Mona Ståhle; Transition from inflammation to proliferation: a critical step during wound healing
- HOSS SPORTS THERAPY; Phases of Soft Tissue Healing
