Troubling groin or hip pain, unresolved by medical and surgical intervention, can be helped by evaluating the function of the pelvic girdle. Our Sports Pelvis service is specifically designed to consider the sporting population with the pelvic girdle in mind. With a background in elite football, we are all too familiar with niggling groin strains, unnecessary surgical procedures and post-surgical complications or pain that can ruin an athlete’s career.
Problems with cutting movements, sudden turning, sudden change in speed and stopping are common problems. A weak or over active pelvic floor and previous or poorly rehabilitated injury may prevent optimal recovery and continued over straining of the pelvis leading to complications.
Causes of pelvic pain in the sports person:
- Osteoarthritis of the hip
- Labral tears
- Femeroacetabular impingement
- Osteitis pubis
- Stress fractures of the pubic ramus and femoral neck
- Nerve entrapments - including genitofemoral, ilioinguinal, lateral femoral cutaneous, obturator nerves, pudendal.
- Iliopsoas strains
- Intrapelvic pathology
- Pudendal neurosensitive/neuopathic pain/neuralgia
Hernia is a common complaint in men and also in the sporting population. One of the most elusive causes of chronic groin and sporting pelvic pain to identify is that of Sportsman’s Hernia. A combination of signs and symptoms often without true herniation.
Common groin issue for men are Hernia’s. The inguinal is the most common type of hernia accounting for 3 in 4 of all hernias. They are related to sudden changes in direction or lifting activities. They affect 25% of the male population and occur with greater propensity in men than women.
Pain on coughing, or sneezing
Sudden changes in direction
The lower abdominal fascia opens wider at the inguinal canal and allows the intestine to poke through. This requires surgical intervention in many cases and should be checked by the GP.
This type of hernia was coined in the 1980’s and also goes by the name of Athletica Pubalgia. The condition of sportsman hernia remains a controversial diagnosis due the puacity in reliable clinial tests and diagnositc parameters. Wide spectrum MRI scans often reveals stress in the lower abdominal wall and surgical exploration may reult in the repair of any stress or strain found. It is not stricly speaking a hernia seeing as examination would often reveal no palpable mass. The sportsman’s hernia diagnosis is convenient but sometimes unhelpful because it looks for a surgical option for the resolution of pain rather than considering the wider pelvis and pelvic floor.
Pain is insiduous and no trauma can be recalled.
Pain is deep in the pelvis, bilateral and may refer to the perinium and testicles.
Turning, cutting and high hip flexion or knee raise may exaccerbate symptoms.
Pain will continue and worsen with activity and over time.
Manual therapy to the pelvis, spine and surrounding soft tissue
Stength and conditioning of pelvis, hips and lumbar spine.
Training and exercise management. Players will often need a highly specific and regimented program for rehabilitation
Where conservative therapy fails surgery for the repair of the posterior wall is a viable option.
It is important to consider the wider pelvis, nervous system, spine and lower limb function in these patients. It might also be useful to consider their sexual and urine function as such details may reveal contributing factors to continued pain and loss of sporting participation.
Pain can cause wide spread pelvic tonal increase and therefore disrupt the optimal function of basic function and loss in lumbo-pelvic-hip stability.
Sportsman’s hernia may also be called Gilmore’s groin. This is a diagnosis coined by Jerry Gilmore. Surgical approach is often the treatment of choice as it re-establishes stability in the abdominal wall. If therapy eases symptoms and there is no further pain or deterioration then it is likely not to be a true Gilmore’s groin. Where problems persist then surgery is often indicated.
While Gilmore’s groin is a clinical diagnosis, where no tests are available for differential diagnosis, the symptoms of groin/sportsman’s hernia/Gilmores Groin include:
- Pain is reproduced with coughing and sneezing (inferring an instability).
- Groin pain on squeezing the legs together (abduction of legs)
- Rotation in standing on one leg / cutting.
- Forced and sudden hip flexion (as such in sprinting from standing)
- Abdominal and groin pain following sport
- Progressively worse pain with activity
Should you wish to discuss your problems then please call the clinic and ask to speak to Adrian Wagstaff, Male Pelvic and sports physiotherapist.