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Thanks, I appreciate the reply and explanation! Figured I was somehow envisioning things in an oversimplified way.

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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.

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quote drkang:

Hi, SighFigh.

For a direct inguinal hernia, I fix the Hesselbach triangle after putting the cremaster muscle and the spermatic cord aside.
So the cremaster muscle is not injured during my direct inguinal hernia repair.

For an indirect inguinal hernia, I open the cremaster muscle by splitting the muscle fibers to find the hernia sac inside.
After treating the hernia sac, I close the deep inguinal ring by stitching.
So the cremaster muscle is not cut or removed but slightly injured during my indirect inguinal hernia repair procedure.

Thank you!

This may be a stupid question, but one that’s been on my mind:

For the type of indirect repair you do, would it be theoretically possible to make the incision right at the superficial ring, push the herniated tissue back up the canal, tie off the sack, close the internal ring and then sew up the incision, in order to do the repair without cutting through any muscle?

I’m sure there is something obvious that I’m not thinking about here, in terms of how anatomy works, and given that my understanding of it is based entirely on diagrams/descriptions online…

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quote Good intentions:

I think that the doctors that are part of bigger practices/clinics have too much paperwork to do to maintain a personal relationship with their patients. Plus, in today’s health care system, they probably have to account for all of their time, and each patient contact. It might also be part of today’s training, to maintain a certain distance from their patients. And, typical of large efforts, division of labor is more prevalent. Specialists that only do a few things, and have to leave other tasks to other specialists. So that the insurance company codes will fit.

I think I know who the sports hernia doctor is. He contacted me quickly also. It was odd and surprising, having been used to the day or more delays after every communication attempt, but after some conversation I realized that he was just being more true to his profession. He is very knowledgable.

I notice that you seem to have decided that you have a sports hernia. I read your story in your other posts and it doesn’t seem like it would be a typical sports hernia. You might be limiting your possibilities.

I am a big believer that you pick the doctor, not the hospital/health system. Hospitals/health systems probably want to discourage this.

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quote Good intentions:

I recall that post from Dr. Towfigh and as I recall it was referring to studies that others have done. More specifically, I think that she referred to “barbell lifting”, which, of course, is an odd way to refer to weight lifting. I think that it was recent and you could probably find it by browsing topic titles. It was similar to yours, I think.

My understanding of hernias is that once the “hole” is created, it’s abdominal pressure that will push material through it. So you want to avoid things similar to the valsava maneuver, a common weight-lifting technique to stabilize the pelvis, that pressurizes the abdomen. Personally, from my own experience, I would also avoid activities that might result in rapid reactions that create abdominal pressure. I played soccer after my hernia and think that reacting to the situation around me caused the hernia to increase in size. But, just before my repair surgery, I was able to run a couple of easy miles and do easy workouts at the gym. I had the surgery in an attempt to get back to my higher level of activity. It didn’t work.

I saw your other post. There is a lot of good information on this forum. Read carefully and consider well.

The reference to barbell lifting was in response to one of my posts, and I imagine she used the term because it’s the one I used, to differentiate between exercises using a heavy bar (squats, deadlifts, bench press, overhead press, olympic lifting) from lighter varieties of lifting such as dumbbells or cable machines.

Personally, I still squat 3x per week, press a couple times per week and do some deadlifting. Deadlifting is the only exercise that has felt like it might aggravate my hernia a bit, which is why I’m taking a break.

While mine may have progressed a little, it hasn’t been much and I noticed it first almost two years ago. I have, however, made some changes in how I lift, most notably I DO NOT wear a lifting belt, which I used to. A common misconception is that the belt is there to help provide support for the lifter’s back. It’s not; its purpose is to allow for a harder valsalva maneuver and maximization of intra-abdominal pressure. Good for lifting progress, bad for hernias.

I realize that this type of lifting is probably suboptimal for someone with a hernia, though I wonder how detrimental it really is, given its propensity to strengthen one’s core more than “core exercises” that involve far less weight. However, DO NOT listen to me on this, as I am hypothesizing with absolutely ZERO scientific basis for my thinking.

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quote drtowfigh:

Sounds like a pretty classic inguinal hernia.

Barbell lifting, etc., has not been shown to increase abdominal pressure, and so is considered safe for those with hernias.

Thanks! Prior to having some US imaging done, any way to know whether it’s direct or indirect (if that even matters) based on where it is/how it goes in/out?

The actual defect (where I can feel something there) feels to be just above the pubic bone, while the visible part (the outward protrusion with nothing underneath) seems to be just below.

Interesting about the findings re: barbell lifting. I certainly have modified my technique a bit since this happened (I used to wear a belt, for the explicit purpose of doing the hardest valsalva maneuver possible, but have since ditched that). Still take my breaths into my stomach (vs chest) but am not doing so with nearly the same force.

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Hope nobody minds my bumping this; would love any thoughts, particularly from our resident experts! Thanks.

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In my case, I have two thoughts:

1. I recall hurting my sacral region about a year ago from deadlifting with too rounded of a back so I have some residual pain in my back, unrelated to the hernia.

1b. The back injury impacted my lifting form, exacerbating some kind of preexisting weakness, causing the hernia to present itself.

2. Both the current chronic back pain and the hernia (if either a direct or “pre-hernia” condition) are stemming from one underlying issue such as lifting heavy weights with an undiagnosed leg length discrepancy.

I realize that, if this is an indirect hernia (statistically and demographically most likely), then everything is probably coincidental.

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Or, to put it another way, that little bit of “loose skin” feeling thing I’ve felt moving around down there sometimes feels as though it’s “inflating” upon Valsalva, almost like there’s some kind of weakness or slackening of something, rather than an outright hole. But what do I know; now need to find right doc for diagnosis.

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Thanks. The more I read the more I started to see reference to the idea of a “pre-hernia complex” which involves a weakness (so intermittent bulging) but no tear. When I get the “inflation/ballooning” sensation from a valsalva, it feels like the inguinal canal is inflating back-to-front, not top-to-bottom, and as though there’s no actual tissue. From some of what I read (mostly intended for imaging specialists using ultrasound) this sounds like a thing, albeit not necessarily that common.

I do get some hip pain, but can never tell if it’s originating in my hip, or radiating through from my back (frequent/chronic discomfort around my sacrum).

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I should perhaps add: While I could be wrong, that bit of “loose tissue” I’ve been feeling seems to be what “inflates” when I Valsalva and get that slight “ballooning.” Would that be indicative of some kind of weakness, or slackened internal tissue?

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Thanks for the encouragement! Did anyone ever explain to you why an inguinal hernia presented as lower back pain? And, if you don’t mind my asking, was it direct or indirect, was the pain in your back unilateral or bilateral and from where in your back did it feel like it was originating?

Since it’s a slightly different topic, I started another thread specifically asking some “sports hernia” questions. Started wondering if that “bit of squishy ‘something'” I’m feeling is actually some loose tissue, as it feels like it turns into a tiny balloon when I Valsalva. More reasons to go get some kind of ultrasonic imaging, I suppose.

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And one follow-up question: Other than the absence of pain in the region, does this description sound like it might be the non-hernia “sports hernia” instead of a “regular” hernia? I’d dismissed the idea initially, because the only chronic discomfort I have is in my lower back, which feels like it’s coming from the left side of the sacrum (approximately). Sometimes it radiates through to the upper part of my hip, but never down to my groin or leg…

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Thank you! The expand/contract behavior of a weakness sounds like a good descriptor of what I noticed, since the bulge comes and goes based on breathing in deep/clamping down and doesn’t seem to be filled with anything.

If the bulge does represent a weakness, are there any proactive, nonsurgical measures to take for the sake of strengthening it or preventing further deterioration?

Intuitively (based on my completely non-medical reasoning) the idea of a weakness makes sense; I felt like I may have overworked some of the other hip area muscles working out over the past few days, so I wonder if that makes other weaknesses more apparent?

Perhaps I should find out if my friend in radiology is running any research studies involving collection of abdominal CT/MR images of subjects and get a “free look” at what’s really in there…

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Fat in Inguinal Canal vs Hernia vs Cord Lipoma?

Thanks, will try and track it down. It was actually done in your neck of the woods at Westside Medical Imaging; before bothering to request the disk, do they generally produce good imaging? My only other experiences with medical imaging (aside from dental x-rays) have been at research universities, not private practice…

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Continued proliferation of Millikan tension-free plug and patch repair?

Agree 100%, and that goes well beyond hernias!! Besides asking other doctors and finding communities like this, how would you recommend laypeople go about looking for the most up-to-date specialists in any field? Where/how much they publish? Which institutions they are with?

I’ve been a bit lost looking for the right person to consult here in Chicago. Thought I was onto something when I first read the plug study, but have serious misgivings about a surgeon who named a procedure after himself, cited it as the “gold standard” only to have specialists abandon it within a decade (seemingly without replacing it with something significantly better).

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Something weird after workout: bulge seemed to recess

Guess that’s why they say only ask questions you want the answer to :(…

Thanks, though, appreciate the clarification. May indeed be what makes me a little more proactive about seeking a surgeon’s opinion on repair…

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Something weird after workout: bulge seemed to recess

quote :

Exercises that have been shown to increase abdominal include squats and jumping.

Sorry, Dr. Towfigh, but I reread your response and wanted to clarify something: Is there supposed to be a word in between “abdominal” and “include”, perhaps either “pressure” or “strength”? One would suggest that I proceed cautiously with squats and jumps, while the other implies their role in keeping symptoms at bay. Thanks.

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Continued proliferation of Millikan tension-free plug and patch repair?

[quote]Allow me to provide a different view]

And therein lies the greatest dilemma in picking a surgeon (any type of surgeon): By the time they are experienced enough for you to trust their skills and judgement, you risk the protocols and methods they were taught being outdated :ohmy: !

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Something weird after workout: bulge seemed to recess

Squats are the main exercise I do… Pre-hernia I did them with a belt (in order to maximize intra-abdominal pressure) but since finding this I’ve left the belt off and lowered the weight a bit.

They were great for building abdominal strength before, when I would really push it, but now I fear that doing so (maximizing pressure and weight lifted) might do more harm than good…

Should I not be squatting at all? There’s no pain, just a slight feeling of pressure in the area if I Valsalva too hard and crank up the pressure too much but I’m a huge fan of watchful waiting and don’t want something to accelerate the need for surgery.