In-Depth Sports Hernia Guide [Infographic]

Hernia Discussion Forums Hernia Discussion In-Depth Sports Hernia Guide [Infographic]

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    • #11233
      Physiqz
      Member

      Hi everyone!

      After having the privilege to speak with Dr. Towfigh and being invited to the forum we wanted to share a guide and infographic we created that draws from various scientific journals and provides a lot of very helpful information for anyone suffering with the vexing sports hernia injury.

      First acknowledged in literature in the 1980s, medical understanding of the issue has since grown tremendously. With this enhanced understanding and knowledge much progress has been made towards the development of effective rehabilitation and surgical techniques.

      You can read more from the actual guide here: https://physiqz.com/physical-therapy/sports-hernias-athletic-pubalgia/

      For questions regarding the article please feel free to leave them below and we will try to answer as quickly as we can!

    • #15841
      Chaunce1234
      Member

      Thanks for the added details about sports hernias / inguinal disruption.

      On a related note, here are a list of surgeons in the USA who are reported to be capable of diagnosing and performing surgery sports hernia / inguinal disruption / athletic pubalgia injuries. The sports hernia repair is typically a non-mesh tissue repair, or similar.

      EAST COAST SPORTS HERNIA SPECIALISTS:

      – Dr William Meyers – Philadelphia PA

      – Dr Alexander Poor – Philadelphia PA

      – Dr Litwin – UMass MA

      – Dr Brian Busconi – UMass

      – Dr Andrew Boyarsky – NJ

      WEST COAST SPORTS HERNIA SPECIALISTS

      – Dr William Brown – Fremont CA

      I believe Dr Shirin Towfigh may perform sports hernia surgery as well, but I am not certain of that.

      If anyone knows of any other sports hernia surgeons, feel free to add them to the list.

    • #15842
      Chaunce1234
      Member

      In addition to the US based surgeons I listed, for Europe a well-known sports hernia specialist is:

      – Dr Ulrike Muschaweck in Germany / UK

    • #15850
      UhOh!
      Member

      Question: Does the sports hernia ever present with a bulge? Much of what I am experiencing sounds very similar other than the fact that my muscle aches radiate upward and outward (from around “4b” to the outer, upper edge of “2” on the diagram) and there is a bit of a bulge that seems originate just above “4b.”

      Part of what has me coming back to the sports hernia is what causes them makes a lot of sense for me: my primary form of physical activity is power lifting (squatting, deadlifting, overhead pressing; particularly squatting). What the larger article says about creating a significant imbalance fits my working out to a T.

      All that being said, the fact that there’s visible bulging sounds like it may limit the diagnosis to a true inguinal hernia.

    • #15899
      Physiqz
      Member
      quote Chaunce1234:

      Thanks for the added details about sports hernias / inguinal disruption.

      On a related note, here are a list of surgeons in the USA who are reported to be capable of diagnosing and performing surgery sports hernia / inguinal disruption / athletic pubalgia injuries. The sports hernia repair is typically a non-mesh tissue repair, or similar.

      EAST COAST SPORTS HERNIA SPECIALISTS:

      – Dr William Meyers – Philadelphia PA

      – Dr Alexander Poor – Philadelphia PA

      – Dr Litwin – UMass MA

      – Dr Brian Busconi – UMass

      – Dr Andrew Boyarsky – NJ

      WEST COAST SPORTS HERNIA SPECIALISTS

      – Dr William Brown – Fremont CA

      I believe Dr Shirin Towfigh may perform sports hernia surgery as well, but I am not certain of that.

      If anyone knows of any other sports hernia surgeons, feel free to add them to the list.

      Thank-you for your excellent contribution to the thread!

    • #15900
      Physiqz
      Member
      quote UhOh!:

      Question: Does the sports hernia ever present with a bulge? Much of what I am experiencing sounds very similar other than the fact that my muscle aches radiate upward and outward (from around “4b” to the outer, upper edge of “2” on the diagram) and there is a bit of a bulge that seems originate just above “4b.”

      Part of what has me coming back to the sports hernia is what causes them makes a lot of sense for me: my primary form of physical activity is power lifting (squatting, deadlifting, overhead pressing; particularly squatting). What the larger article says about creating a significant imbalance fits my working out to a T.

      All that being said, the fact that there’s visible bulging sounds like it may limit the diagnosis to a true inguinal hernia.

      I actually just recently spoke with Dr. Goldstein of “The Hernia Institute” in New York and he told me that several of his patients that presented sports hernia symptoms in-fact has an indirect inguinal hernia–which is a “real” herniation. In this case, a small bugle will present itself–though not always palpable from the outside of the body like your case.

      It is great that you mentioned your powerlifting background. I am actually a competitive powerlifter and experienced the same imbalance issues that ultimately, I believe, led to my sports hernia. Muscular imbalances seem to play a very large, if not the largest, role in developing the injury.

    • #15918
      drtowfigh
      Keymaster

      Other surgeons for sports hernia:

      Michael Brunt: St Louis, MO

      Aali Sheen: Manchester, UK

      Giampiero Campanelli: Milan, Italy

      I also repair them.

      Note that most groin pain that is labeled as “sports hernia” is not a true muscle tear rather a run of the mill inguinal Hernia. Their treatment is different.

    • #15919
      katiebarns
      Member

      [USER=”935″]drtowfigh[/USER]

      How would you know the difference between a Inguinal Hernia (recurrence) and a sports hernia? I don’t have a bulge but I have achy pain in th same area as my repair.

    • #15920
      drtowfigh
      Keymaster

      Completely different examination findings and symptoms. A surgeon specialist can help differentiate.

      Most St people don’t have sports hernias. You have to a true athlete with huge muscles to get them, typically.

    • #15923
      katiebarns
      Member

      [USER=”935″]drtowfigh[/USER]

      Ok thank you! Would constant bloating go with one more than another?

    • #15925
      drtowfigh
      Keymaster

      In my experience bloating is more often seen with the typical Hernia. Sports hernias are tears that are painful but often don’t have content in them so bloating does not occur

    • #15926
      katiebarns
      Member

      [USER=”935″]drtowfigh[/USER]

      would a MRI show either of those diagnoses? I don’t have a bulge for a recurrent hernia but if it was “hidden,” would it still show? I’m trying to figure out what’s causing my issues. thank you!

    • #15933
      Chaunce1234
      Member

      Is it accurate to say that some “sports hernia / inguinal disruption” is basically the painful start of a direct inguinal hernia, but that has not broken through to full herniation completely yet? I recall reading that somewhere, but I do not understand the complex groin anatomy well enough to make sense of it.

      On a related note, this video presentation from Dr Ulrike Muschaweck on inguinal disruption / groin injuries may be of interest to some readers here, she describes the classic inguinal disruption injury, as well as her particular approach to repairing these injuries:

      https://www.youtube.com/watch?v=w-Rz4V-eGZI

      Note the video is intended for a medical audience and has some graphic imagery, so the squeamish may want to avoid.

    • #15950
      UhOh!
      Member
      quote Physiqz:

      I actually just recently spoke with Dr. Goldstein of “The Hernia Institute” in New York and he told me that several of his patients that presented sports hernia symptoms in-fact has an indirect inguinal hernia–which is a “real” herniation. In this case, a small bugle will present itself–though not always palpable from the outside of the body like your case.

      It is great that you mentioned your powerlifting background. I am actually a competitive powerlifter and experienced the same imbalance issues that ultimately, I believe, led to my sports hernia. Muscular imbalances seem to play a very large, if not the largest, role in developing the injury.

      At this point, if I had to guess (and it’s truly a guess), I would guess that what started as a sports hernia eventually progressed to a direct hernia, because I didn’t recognize the signs and kept lifting through it. However it sounds as though anything with a very visible bulge is a true hernia of some type.

      I am guessing direct because the bulge always, immediately, and automatically completely reduces upon laying down, with no manual reduction necessary. However I’m sure one of the docs can correct me if I am mistaken; I’m going by what a number of “difference between direct and indirect” charts show.

      I would also guess direct since the only discomfort I ever feel is muscular (vs. nerve/testicle) and if I manually reduce it while standing, then push all the air out of my abdomen/hold lower abdominals taut it stays in. However unlike an indirect (I think) it doesn’t stay in on its own for a time, then pop back out; it’s consistently visible unless I lay down or reduce with finger.

      Who knows… Will have proper surgical diagnosis at some point.

    • #15956
      UhOh!
      Member
      quote Physiqz:

      It is great that you mentioned your powerlifting background. I am actually a competitive powerlifter and experienced the same imbalance issues that ultimately, I believe, led to my sports hernia. Muscular imbalances seem to play a very large, if not the largest, role in developing the injury.

      I also have another hypothesis, which you may be in a great position to comment on: I think that, for any lifters with a weak area of the lower abdominal wall, the use of a lifting belt has the potential to actually increase the likelihood of developing a hernia. Using the belt properly, one creates more intraabdominal pressure than would naturally occur (even with a valsalva). However, the groin area doesn’t have the belt to brace against, so the tissue alone has to withstand that pressure increase.

      I used a belt up until about two years ago, when I first realized I probably had a hernia. Since then, that’s been a no-go.

      Also curious what exercises you’d recommend for someone wanting to even out that imbalance. I’ve taken a look through the guide on your site, but am a little lost, since I’m not injured to the point I can no longer lift without pain and need to essentially come back from zero. I still lift 3x/week and am squatting 1.5-1.75x bodyweight (which has always been on the heavier side for me, with or without belt or hernia), so my activities aren’t limited. I just want to avoid it getting any worse and keep everything as strong as possible.

    • #15987
      drtowfigh
      Keymaster

      It’s hard to different clinically between most direct and indirect hernias unless that are large.

      Sports hernias and direct hernias are different entitities. One does not evolve into another.

      Sports hernias are tears. If the tear is large enough, things can bulge through and hence the hernia. Luckily, most do not get that big.

    • #15994
      UhOh!
      Member
      quote drtowfigh:

      It’s hard to different clinically between most direct and indirect hernias unless that are large.

      Sports hernias and direct hernias are different entitities. One does not evolve into another.

      Sports hernias are tears. If the tear is large enough, things can bulge through and hence the hernia. Luckily, most do not get that big.

      So a stretching/thinning/slackening of some of the abdominal wall muscles, absent a tear, could lead to a true hernia, but would never constitute a sports hernia?

      Regarding the difference between direct and indirect, are you saying that in reality one cannot go by those “difference between” infographics found in various places online? The one that struck me was the supposed difference upon lying down (indirect must be manually reduced, direct self-reduces automatically) and standing up (indirect reappears higher than before, then drops, while direct reappears in exact same place). Sounds like it might not be quite that simple?

    • #16001
      Topochico
      Member

      [USER=”2486″]Physiqz[/USER] hey, I’ve seen your YouTube channel. Decent content. Was wondering what type of surgery you had done and which surgeon you had it with? You seem like a success story so sharing this information would definitely help myself and others! Keep up the great work.

    • #16046

      I have been diagnosed with a sports hernia, my inguinal canal feels tender nearly all the way to the testicle, have got pains in my pubic bone where no2 is on the diagram, but my ultrasound also showed a small inguinal hernia. My doc is reluctant to operate at this stage, told me to see if it settles, but am wondering if it is possible to have sports and inguinal hernia at the same time? Or are my pains due to inguinal hernia?

    • #16070
      Chaunce1234
      Member

      Here is a description of sports hernia of the “inguinal disruption” variety:

      quote :

      “Abnormal tension exists in the inguinal canal due to varying degrees of ID [Inguinal Disruption] and this is recognised as posterior wall weakness, external ring dilation, conjoint tendon damage and tears in the inguinal ligament. Not all of the features are present in any one individual and other pathologies involving the muscles, ligaments and joints may also be affected.”

      And potential diagnosis:

      quote :

      “The diagnosis of ID can be made if at least three out of the five clinical signs below are detectable

      1. Pinpoint tenderness over the pubic tubercle at the point of insertion of the conjoint tendon;
      2. Palpable tenderness over the deep inguinal ring;
      3. Pain and/or dilation of the external ring with no obvious hernia evident;
      4. Pain at the origin of the adductor longus tendon; and
      5. Dull, diffused pain in the groin, often radiating to the perineum and inner thigh or across the midline.”

      From the British Medical Journal:

      http://bjsm.bmj.com/content/early/2013/12/10/bjsports-2013-092872

    • #16252
      drtowfigh
      Keymaster

      [USER=”2491″]SomeGreyBIoke[/USER] yes it’s theoretically possible to have both inguinal and sports hernias. It’s very uncommon and unlikely.

    • #16447
      Chaunce1234
      Member

      Just wanted to offer an update on two other potential surgeons performing sports hernia surgery / athletic pupalgia in the USA. Both surgeons appear to be based out of GWU in Washinton DC

      – Dr Fredrick Brody at GWU in Washington DC

      – Dr Robert A Grossman (GWU in DC as well? Unable to confirm)

      This information is from the following video presented by Dr Grossman at a SAGES conference:

      https://www.youtube.com/watch?v=pL_8t-YXYFU

      Note that is a medical video of an actual surgery, so not everyone will want to watch it.

    • #16448
      Chaunce1234
      Member

      Just wanted to offer an update on two other potential surgeons performing sports hernia surgery / athletic pubalgia in the USA. Both surgeons appear to be based out of GWU in Washington DC

      – Dr Fredrick Brody at GWU in Washington DC

      – Dr Robert A Grossman (GWU in DC as well? Unable to confirm)

      This information is from the following video presented by Dr Grossman at a SAGES conference:

      https://www.youtube.com/watch?v=pL_8t-YXYFU

      Be aware that is a medical video showing a surgery, so not everyone may be comfortable watching it.

    • #19893
      columb.if
      Participant
      quote drtowfigh:

      [USER=”2491″]SomeGreyBIoke[/USER] yes it’s theoretically possible to have both inguinal and sports hernias. It’s very uncommon and unlikely.

      What if I have external oblique tear and small indirect hernia (sport hernia+indirect). What kind of no-mesh surgery is the best choice for this kind of hernia, Shouldice, Marcy, or Kang repair?

    • #19984
      drtowfigh
      Keymaster

      [USER=”2817″]columb.if[/USER] not sure i would repair both if wish a non-mesh repair. Determine which is the cause of pain and focus on that.

      foe example: Any tissue hernia repair will add tension to external oblique tear repair and make that fail.

    • #21180
      Good intentions
      Participant

      I was looking through some older posts and came across some information from Dr. Kang that is relevant to this Topic. I will just post an excerpt and link to the original Topic.

      From Reply #19071, in https://herniatalk.com/forums/topic/no-mesh/ Dr. Kang also repairs “sports hernias”::

      “You will find that many doctors have their own different definitions of sports hernia. Although the same name of ‘sports hernia’ is used, doctors have different opinions on which area is damaged. So, the area of surgery also differs frequently depending on the doctor. Thus, many of you who searched information of sports hernia might have been confused.

      I have so far performed about 500 sports hernia repairs mostly for professional soccer players. From my experience, I believe that the sports hernia is an event where the external oblique aponeurosis of inguinal canal is injured. So, I have administered a simple surgery, which repairs the external oblique aponeurosis only. They successfully recovered and made come-backs to their sports.”

    • #22074
      Alephy
      Participant

      The document at the start of the post mentions that another name for a sports hernia is indirect hernia…is this correct? ? I would think not…

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