Classic vs. Sports Hernia: You should know the difference
Most males who played scholastic sports at some time in their life will recall their first Pre Participation Physical. How could you forget?! After a few boring tests of blood pressure, lung sounds, and oral temperature, the physician asks you to drop your shorts, turn your head, and cough as he places his cold latex glove under your testicles. Not the most pleasing of exams. Most likely, the amount of humiliation at that age far outweighs any potential finding of an inguinal hernia. Nevertheless, classic hernias (also called inguinal hernias) occur in males more than females, so the hernia check may be necessary to rule out any potential issue. Statistics suggests that the ratio of inguinal hernias is 8:1 male to female. Additionally, they can affect 1-3% of young children. Although the incidence may be high in adolescents, the risk increases in ages 75 and above, as well.
What is a Classic Hernia?
The word “hernia” in Latin, means protruded viscus or protruding organ. The meaning is directly related to what happens during a hernia. A small triangle in the low abdominal area called the inguinal ring houses many tube-like structures, such as the ilioinguinal and genitofemoral nerve, as well as the spermatic cord in men. When injury to this area occurs due to muscle strain, these structures, along with internal organ tissue, can protrude through the ring. During a routine physical exam, a physician may ask you to bear down or cough. What they are looking for is a protrusion of viscera through the ring. A noticeable bump accompanied with pain, sometimes, will be present if there is a hernia. Interestingly, not all hernias present this way. Many times, an athlete may have groin pain, although no protrusion is present upon bearing down.
Treatment of the Classic Hernia
If an inguinal hernia is present, treatment can be as easy as reducing the bulging tissue by pressing it back into the ring area. Although this may be a bit disturbing, having tissue extruded from the body over time, can create strangulation of viscera and cause a bowel obstruction. If the inguinal hernia is large enough and not stable, surgery may be recommended to repair the inguinal ring. The surgical procedure for a classic hernia involves placing a large mesh around the area. Surgeons may use a sterile, woven material made from a synthetic plastic-like material, such as polypropylene. The mesh can be in the form of a patch that goes over the weakness, or it can be in the form of a plug that goes inside the hole. Mesh is strong, yet flexible to allow for the body’s movement and position during activity.
To better familiarize yourself with different types of hernias, it is necessary to understand each of their clinical presentations. Unlike a classic hernia, the Sports Hernia presents differently. This type of hernia does not create any abdominal protrusions. Furthermore, there may be a gradual onset of pain in the lower abdominal area, which actually begins as groin pain.
The Sports Hernia does not have the same structural problems as the classic hernia. Sports Hernias typically occur in athletes that incorporate quick changes in direction. For example, a BJJ or MMA fighter who is attempting a throw or an MMA fighter who attempts a kick can be the victim of the sports hernia over time due to their rotation component of movement.
Sports Hernias are not acute injuries, such as the classic hernia. Classic hernias may follow one event that caused pain in the lower abdominal region, such as a heavy lifting session. Sport Hernias occur chronically: As certain groin muscles become under-active or weak, due to previous injury, an over-active lower abdominal region becomes over worked and under constant tension. If injury occurs to hip flexor or groin musculature, the lower abdominal wall will take up the slack for stability in the region and place undo stress, thus creating an abdominal tear.
Major muscles of the groin and hip flexors work in tandem with each other to create a strong hip flexion and adduction factor. This often occurs in guard positions. BJJ fighters use their groin and hip flexors a lot to overcome their opponent in various positions, especially the guard. Many times groin or hip flexor strains occur. As pain in this region sets in, the athlete will compensate to avoid the most painful position, thus resulting in a Sports Hernia.
Treatment of the Sports Hernia
Understanding that the Sports Hernia is truly an issue of weak hip flexors and groin musculature is the essence of a good treatment program. Although the lower abdominal wall may be injured, the treatment needs to occur at the source. Elongating the hip flexors, in addition to strengthening the adductors, will free up limited range of motion needed for the hip joint. Focusing on strength training the already injury abdominal wall will delay the healing process and potentially re-injure the area. If an athlete is suffering from pain in the lower abdominal region, it would be best not to attack the site of pain with exercises. Instead, direct all attention to muscles that surround the area, such as the glutes, hip flexors, abductors and internal rotators. Once the lower abdominal pain has subsided, then light core work can begin.
Below is a sequence of rehabilitation exercises to aid in treatment of both types of hernias. All exercises should begin with two or three sets of 10 repetitions.
- Cook Hip Lift – single leg bridge holds
- Quadruped Hip Ext
- Side Bridge – short lever
- Side Lying Adduction
- Ball Rollouts with Internal Rotation
- Lunge with forward foot lifts
- Lateral lunges
Key Point: Never work through pain in the lower abdominal region. If pain is present while performing corrective movements, discontinue that exercise until pain subsides.
Whether you have a classic hernia or a Sports Hernia, getting properly diagnosed is of paramount concern. Procrastination of diagnosis of both injuries can delay recovery time, in addition to fostering a cascade of events that will lead to further complications. Understanding the difference of each hernia type will be beneficial in the correct treatment course and rehabilitation regimen.
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