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Inguinal Hernia, Sports Hernia, Lingering SI joint issues, or other?
Hi, and thank you for adding me. I have been dealing with “hip-area” pain for the last 2.5 years that started while I was tapering off from training for a 10 mile race and doing some strength training that involved squatting (mostly without weight or very light weight) and some yoga. Before the 10 mile race I had done a gradual training program only after I had worked hard to recover from a significant diastasis recti after childbirth (it is now down to 1 finger at most). I first noticed a discomfort in my hip area while I was doing my squats, followed by what felt was muscle guarding in my groin area – I couldn’t put my knee to the ground when sitting “criss-cross” on the floor. It would cause me pain intermittently, but eventually I felt pretty off-balance in my core and when walking, and sought out PT and chiropractic. I was diagnosed with SI joint dysfunction (though all my pain was in my hip/inguinal area). After 10 weeks of PT and chiropractic care didn’t help, I sought out imaging for a labral tear, which included a cortisone shot to the hip socket. That shot definitely reduced my pain for a very long time, and the MRI and X Ray showed no hip pathology except for some wear on my right SI joint and pubic symphysis (I have had 1 vaginal birth, but no back pain during or after pregnancy), so I continued treatment for my now unstable pelvis. It seemed my ligaments were stretched out.
Several months later I sought out treatment from a doctor who is a leader in regenerative medicine and received quite a few rounds of prolotherapy and PRP to my SI joint ligaments, pubic symphysis, and surrounding muscles. I gained quite a bit of stability through injections and quite a bit of PT, however, through the process, I would begin to feel “stable,” then feel my body wanting to guard that hip area (muscle and fascia, possibly, it seemed), so sought out more imaging for my hip, this time an MRI with contrast. The same results came back – no hip pathology at all, labral tear or FAI, and nothing else was noted as far as muscle or tendon damage. During this time I also had a lumbar MRI, which showed no real issues except for some mild facet joint wear (no disc issues).
Though the searing pain I had originally in that hip area had decreased, I continued (continue) to have what felt like inflammation, pulling, nerve pain that went down the front of my thigh and in my low back (above SI joint, not inside), and achiness in general in that groin area. I would also get a feeling of inflammation and “fullness” or “squeezing” in my torso (right side only), so we turned our attention in both PT and regenerative injections to my psoas. I had several treatments with prolotherapy and PRP and many months of manual work for that muscle and my QL, but the issue always came back (and the muscles involved seemed to be more muscles in my trunk than just those two).
After doing some reading, I decided to dig deeper and scheduled an appointment to see a hernia specialist, especially after learning my father has had a hernia. The doctor did not think I had a hernia, but saw that I had done lots of imaging for other issues, so ordered an ultrasound anyway. During the ultrasound, I was found to have “mild tendinosis of the adductor origin, which otherwise appears intact” and a “tiny, reducible inguinal hernia.” Armed with the imaging report, several weeks ago I saw Dr. Grishkan due to recommendations and reading that he has very good record with treating hernias without mesh (I am a 5 foot tall, 115 pound woman, and am not excited about the idea of mesh). Dr. Grishkan, however, did not think that my continued hip/inguinal area pain was coming from my hernia, because it was so small. I pushed back a little, because I have read on here that small hernias can still be painful, but based on my symptoms, he thought I had a sports hernia and that the inguinal hernia was just a coincidence, and that I had probably had it since birth. He thought maybe I had a femoral hernia that did not show up on ultrasound, but would not consider doing surgery for the inguinal hernia noted on the report. He hesitantly said he would schedule a sports hernia repair and do a somewhat “exploratory” surgery to see what needed fixed, since nothing was noted on my MRI except mild adductor issues.
I am scheduled to see another surgeon tomorrow for another opinion, but as far as I know, he only uses mesh, which I want to avoid if at all possible, and he didn’t think my symptoms were necessarily indicative of a hernia in the first place.
My third option would be to travel to see another surgeon who could give another opinion and does not use mesh, but that is a frustrating prospect for me as Dr. Grishkan is so skilled, takes my insurance, and is literally 7 minutes from my house.
So…I am somewhat at a loss. I am unsure if i should go into surgery with Dr. Grishkan not really knowing what I am agreeing to beforehand, and I am very scared to get a mesh repair of the noted hernia with another surgeon in case it were to cause further inflammation, pulling, and problems, if my inguinal hernia was not my pain generator in the first place. I just read that having a sports hernia and an inguinal hernia in tandem is quite uncommon that that a lot of my symptoms are common with hernias, however, I do apparently have adductor issues, a history of a weak abdominal wall with my diastasis recti, and have had pelvic instability, so a sports hernia may not be out of the question. My current symptoms are, as mentioned: inflammation, occasional burning, and some soreness in my groin area, sometimes a very tiny pinprick feeling in the groin, pulling (which makes me feel like muscles are guarding), nerve pain that goes down my thigh and sometimes to my back, one-sided torso tightness (including QL, obliques, psoas, rectus abdominus, and maybe more), a feeing of “fullness” (but not coming from bowels) in my torso, very, very low-grade nausea from that fullness feeling (more a loss of appetite). My back seems to want to twist to guard whatever this is, but attempts at fixing the twist seem to flare the groin. My symptoms do not seem to follow a pattern except that they are often worse at the beginning of my cycle and with prolonged sitting or standing (which is also common with SI joint issues and psoas issues). If my torso muscles are already angry, walking makes it worse.
Any advice would be appreciated. I know this is long, but really am at a loss of what to do and have tried everything to try to rectify this on my own and through exercises and therapies with many different PTs, even traveling 3 hours away for a specialist.
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7 Replies
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[USER=”3124″]HollyH[/USER] Thank you.
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[USER=”3118″]cshelter[/USER] Dr. Scarpone in Steubenville, OH. He is an amazing doctor who is very gifted with ultrasound (I would not get injections unguided) and has very reasonable prices compared to other leaders in the field. His staff is also very kind.
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[USER=”3124″]HollyH[/USER] Can I ask who you saw regarding regenerative medicine? I take it you are in OH if you are near Dr Grishkan as I am (Dublin area).
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Thank you so much. I will at least try to have my MRI re-read as a first step and go from there.
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We try not to operate on sports hernias. Most non-professionally athletic people do not get sports hernias. Their symptoms are related to an inguinal hernia. If you indeed have a hernia on Ultrasound, likely the MRI shows the same (and was misread). Thus, repair would likely address your symptoms. The best repair is based on a lot of factors.
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Thank you so much for your response, Dr. Towfigh. Are you saying that a sports hernia should have shown up on an MRI, or an inguinal hernia (which did show up on an ultrasound with Valsalva maneuver). Thank you for your advice about exploratory surgery, too. I have been very torn about that, especially with no major soft tissue damage showing up on any imaging.
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Your symptoms seem suggestive of an occult inguinal hernia as the cause of your symptoms. But, I do not agree with exploratory surgery. Dr. Grishkan does open surgery, and exploration is not without risks in an open approach. Your MRI should show a hernia. If it doesn’t, it can be because it was misread. I would have the MRI re-read and for you to see a hernia specialist who is a believer and knows how to treat occult hernias, especially in women. If you wish, you can initiate an Online Consultation with me to help re-review your symptoms, the MRI you had, and get some advice on surgical options, if any.
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