I am now recovering from a sports hernia (MRI clearly showed osteitis pubis and some seperation of the muscle from the bone on each side). Took 3 years of easy to moderate with many setbacks if try to over do it. Swimming was the worst--rotation comes from the core. 800 yards would aggrevate it enough to throb that night. So swimming was out for me. Running had to be backed off to about 45 minutes max at moderate pace. Offroad was out as the uneven terrain caused the need for more stability and thus core engagement. Cycling was fine for the most part. Lowered my seat to ease the stretching in groin and hip flexors. Had 2 cortisone shots, one right in the joint and one in some ganglia to the side. This really helped relieve swelling and start the healing. Also try foam rolling of the groin while going light on the stretching of the groin and flexors. I have a tendency to stretch too hard--go very gentle so not to tear new fibers anchoring the muscle to the bone.
After 3 years i am easing back into swimming. I'll go a few more months of 1500 to 2000 per workout to make sure everything is fine.
Good Luck

So my update is that I saw the surgeon and he wanted me to do rest and rehab for 6 weeks before assessing again. I'm now 4 weeks off running and 3.5 into PT. Overall the day-to-day pain is much better. Swimming and riding (non-TT) have been about 90% and I can go hard without any real trouble. PT had me try running again yesterday and there has been almost no improvement there, so looks like I'm probably going to be heading the surgery route based on that. The surgeon I saw in Chicago said likely mesh repair, but based on some reading about adductor longus tendon tears I'm not sure thats the best approach. I'm going to be in the bay area next month and thinking about trying to see Dr Brown for a consult.

I cannot recall where I read it but I believe sports hernias are quiet common among NFL players. Even Tom Brady may have had surgery to correct issues from a sports hernia. If I was you, and considering surgery for this, I would 100% seek out one of these docs who has a lot of experience with SPORTS HERNIA and not just the general topic of hernia (inguinal hernia, ventral hernia, umbilical hernia). As with any surgical procedure, the more of them you do, the better you are typically.

According to journal articles the mesh repair isn't really a repair. See Dr. Meyers. I am 100 percent happy with what he did.

Google Aspetar Institute. Go to their youtube channel. Find 1hr presentation on studies of sports hernia procedures if surgery is what you want. They cover all well known doctors around the world and their repair method, along with success rates.
Caution on mesh from watching their stuff, any other surgery in that area to deal with anything in abdomen, automatically means open surgery and much more complicated due to mesh removal. Think twice.
I have sports hernia and no surgery. I have been out since Nov 2016. I am in no hurry. PT and strength only. Running now 30mi per week. It was very very slow getting to here but I am staying off the table at all cost. Too many clowns in the field of medicine including that clown Meyers in Philly. He is the only physician that is not disclosing what he is actually doing during surgery but claims his results unverified are 98% success or something like that. The only known thing is that he does adductor teneotomy by default to everybody, which is opposed just about by everybody in the field........Good luck. I would be more patient if I were unless you have to make money with triathlon or running.
There are total of 4 different surgery methods, 2 involve mesh, 2 are suture type repairs, open surgeries, Muschwek from Germany does it with local only and minimally invasive.........Research your choices. Most insurance plans do not cover it. Experimental in nature.

Meyer's documents everything he does in his journal articles. Why would you go through years of PT when surgery can fix it in a day? There is a reason athletes come from all around the world for Meyers. My insurance covered it 100 percent.

I've made an appointment to see Dr Brown next month for a further consultation after speaking with him this morning. While I'm in no rush to get back to training and racing I dont see the point in letting something linger past a few months if it can be fixed and resolved once and for all. I've been dealing with it since October and possibly prior already.

I have to say, I agree with atasic's approach of staying off the table at all costs.

Just because Meyers documents everything he does in a journal article does not mean its all great. I'm not saying good or bad about him, in general, just what I know about the medical world. Waiting will cost you nothing but time. A bad surgery outcome can mean an end to athletics, more surgery, constant pain, and even worse.

I was at a medical conference years ago and this one professor was giving his results/outcomes for a particular type of surgery. I turned to the doctor beside me and said "I wish I could have outcomes that good". This other doctor was training under this professor and said "Those are only the results he shows you. I see the good and the bad". When you have a common surgery (i.e., gall bladder surgery), it is easy to compare results across surgeons/hospitals. When you have a rare procedure (i.e., sports hernia repair), it is not see easy to gather this information. Unfortunately, the number of athletes who need this surgery is rather small so it would probably be very difficult to ever do a (statistically significant) comparison study of physical therapy (physio) vs sports hernia surgery.

As far as recovery goes, it took me SIX months of no running and PT. I tried going for a run at 3 months and thought that had been long enough. After about 100 yards, I quickly realized I needed more time off from running. I continued to work on my core and to make myself more limber (gentle stretching and massage/rolling, especially of the inner thigh muscles and hamstrings).

I do understand that you don’t lose anything but time when waiting, but losing a whole year or more when you are young could be torture.
The day I went, he was operating on twelve others. He would operate every Thursday and they said this day was about average. That was about ten years ago. That would come out to hundreds a year and should be plenty for a statiscally significant study. I had bilateral tears and the pt wouldn’t have fixed it. I’m lucky and lived within driving distance but I can’t imagine what I would have done without surgery. I couldn’t even sleep or pick up my kids.

And as far as the journal articles-that was just a reply to the claim that no one knows exactly what he does. I wasn’t claiming he was great because of that.

Geez, you definitely had a very severe case and I think I would've gone the same route if my injury had been as bad. Some athletes have tears that can be visualized with MRI (as in your case) but others, nothing shows up on MRI and then it is harder to decide what is the best course of action. I'm glad you had a good result for what can be a depressing and chronic injury

Going in for surgery with Dr Brown on Friday. Its been 6 months since my problems started. Still having pain with running after taking a few months off and doing PT and unable to ride a TT position. While the adductor longus tendon tears appear to be healed with the time off, the rectus muscle tears are still there. I'm hopeful that I'll finally be able to get this fixed and get back to normal activity by this summer. At that point I'll have lost about 9 months due to this injury.

All the best. Keep us posted. I am over a year out for that, no intention yet of surgery. I can ride, run and do stuff with no restriction, just do not know how much. Rectus abdominis pain comes and goes. But like you, I feel that adductor longus is likely healed, rectus abdominis gives me pain, though low 1-2 on scale. Switched to ICF K1 paddling in the mean time.
I am terrified of any kind of surgery.

Wow, 9 months is a long time. I took off six months with ZERO running, but I could at least ride my bike, and it still seemed to be forever.

Best of luck with your surgery this Friday. I hope it gets you back at it ASAP.

Please keep us updated with how you progress

So I signed up just to reply to this thread.


I have what I believe is OP but just want some clarification. I believe it started last summer from cycling and drastically increasing my intensity from 0 KM to 2000km and 25kph average to 32kph average in 6 weeks on a bike with a saddle 2-3cm too high (confirmed after I completed a bike fit hoping to solve the issue. I also had my saddle pressure mapped and it came back nearly perfect, no soft tissue pressure)

On the bike I was fine, no pain, but after and especially at night I had an extremely dull ache coming from the center of my pubic bone area. Resting for a week or so would make the pain pretty much go away, but when I returned the same dull ache came back. By the time I stopped cycling, I had really did myself in and the dull ache lasted for weeks before it started to subside a little. I continued to play basketball through the fall, and while it doesn’t flair me up like the cycling, I think it is slowing the healing process.

In February I was feeling 80% better, not so much a pain anymore, but always sort of had a discomfort, especially when sitting at work for long periods. I went for a short 20 minute training ride and bam, the pain returned in full and I was back at square one.

So in late March I decided to buy a recumbent bike to try and keep up my fitness thinking it would solve the issue, but nope, same problem. I think the pedal motion flairs it up.

Does this sound at all like OP? I have an X-ray coming up. Initially I wasn’t sure where the pain was coming from exactly, I just knew deep in my perineum.I thought it was perhaps nerve related but a pelvic floor physio visit ruled that out. Then after this latest ride I pushed hard on my pubic syphisis area and it is very tender and produces a sharp pain when pressed.

I haven’t found any real results of people getting this from cycling. But based on the criteria I think rapidly increasing intensity on a bike with a saddle that was too high, with no stretching prior and pretty poor form may have been the contributing factors that caused it.

Best thing is just go to Dr. Brown's website and write him an email. He is very responsive and will probably call you within a day if you leave your phone number in the email.

Sorry to read about all of your trouble. As you mentioned, OP is usually associated with running or rugby, and not cycling. I was able to cycle with zero issues but NO running or swimming. To me, this definitely sounds like OP. But, the pain in the public symphysis can be referred from other area too, so get checked by your doc to make sure you do not have a hernia (not sports hernia but an inguinal hernia).

As far as an X-ray is concerned, it may not help very much with your diagnosis because the problem with OP is inflammation in the bone or damage to nearby muscles. My pelvic X-ray was normal so I had to get an MRI to demonstrate the edema in the pubic symphysis. Once other possible causes (i.e., hernia) are ruled out, you will most likely need an MRI for confirmatory diagnosis.

As far as your activity goes, I would avoid anything that exacerbates the problem. For now, no cycling, running, or basketball. Anything that requires jumping, leaping, or lateral movements is most likely going to irritate your condition.

Please make sure you have a thorough evaluation by a sports med doctor. Once you have confirmation of OP, then start work with physio. Best of luck!

So I had surgery at the beginning of April and was off everything completely for about 3 weeks. I started back to swimming first, then biking about a week after. PT began 10 days post-op and I was finally cleared to start running again by the middle of May. The repaired adductor tendon took a lot longer to heal than the rectus muscle (6 weeks versus 3), but by the beginning of June I was back to all 3 with no restrictions. Beginning to run again took some time and the adductor tendon and muscle were a little sore, but mostly it was just getting going again after a long layoff from running (close to 6 months). At this point I'm now finally back to biking and running with no pain at all and would consider the surgery with Dr. Brown a complete success. My only regret now is not having it done sooner. Its now been almost 11 months to get back to this place where I finally feel healthy and can train the way I'm used to. Time to get after it!

Wow, this is great news! I'm sorry it took so long but I'm betting you are grateful to be back training again. Thanks for the update