Management and Therapy for Sports Hernia

Abstract

D G n d h p i u d d p d q he etiology and management of groin pain in athletes ave evolved gradually over the last 40 years. Initially, in 966, Cabot reported 202 cases (0.5%) of groin pain in 2,000 Spanish soccer players over a 30-year period. Since hen, recent studies have reflected an increased prevalence f groin pain in athletes, ranging from 5% to 28%. The ajority of these athletes participate in soccer and ice ockey. For both the patient and physician, groin pain is diagnostic and management challenge. This dilemma is econdary to the extensive differential diagnosis associated ith groin pain, including osteitis pubis, stress fractures, vulsion fractures, hernias, entrapment neuropathy, and eferred pain from the spine and sacroiliac joints. The ost common cause of groin pain in athletes is chronic nflammation associated with the adductor muscles and endons. But many of the previously mentioned diagnoses ave overlapping signs and symptoms that prohibit a deinitive diagnosis and complicate the management of groin ain. A variety of diagnostic radiologic studies are usually perormed. Although they may fail to provide a definitive iagnosis, these studies do exclude many pathologic conitions. Depending on the injury, extended periods of rest nd rehabilitation may permit patients to return to their espective sports. Yet many patients fail to respond to long eriods of rest that range from weeks to months. Along ith rest, some patients require lengthy sessions of physical herapy, corticosteroid injections, or longterm nonsteroidal ntiinflammatory drugs. Regardless of these treatments, ome patients develop recurrent symptoms when rigorous ctivity is resumed. Some investigators believe that when onoperative medical therapies are exhausted, surgical exloration of the groin is warranted. In 1980, Gilmore attributed unexplained chronic roin pain in a large series of patients to a dilated superficial nguinal ring. Although a definitive diagnosis of a hernia as rarely present, Gilmore documented a number of antomic pathologies in more than 1,000 symptomatic soccer layers. These distinct pathologies included a torn external