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Sports Hernia / Adductor / Hip Flexor / Lower Abdominal Strain...
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So-

Yes, I've searched, and I've read everything I could find here over the last few weeks.

Long story short: In my last race I pulled pretty much everything from my waist to my upper thigh on the run portion. I assume it was mostly a result of the "big damn hill" which was up and then back down a 1/4 mile stretch of 10% grade, 4 times. As far as I know this is literally the only section of road anywhere within 50 miles of here like this, so I didn't have much opportunity to "train" for that. Frankly it was a last minute decision to do that race, so by the time I scouted the course, it was only a week away. The entire front half of everything attached to my hips seems to be all fucked up.

I have pain in my lower abdomen (just above pubic hair) when I situp (or cough), I have pain in my hip flexors and upper quad where it meets the groin when I try to run, and pain in my inner thighs when trying to do any type of lateral movements.

I've been to the Sports Med doctor twice, diagnosed with a probable althetic pubalgia (aka sports hernia). I've been in PT since mid-November. I've made mild (or significant depending on the exercise)) progress with the various exercises. Eg, We've added resistance, reps or both to everything and/or added new more advanced exercises. However, there's been no measureable functional improvement in my ability to actually SBR after the 8ish weeks of 2x weekly PT. I've been pretty religious about doing the PT at home, to the point that my PT accused me of overdoing it and giving me "permission" to back off a bit.

[[I was doing all exercises every day, rather than some subset that consumes 45-60 minutes. She laughed...I guess that's not the typical problem with PT patients]].

As noted above, I've read all the related ST history I could find. Not much encouraging in what I found, and often it ends in "I went to see Dr. Meyers..." and Kiley says "charlatan...didn't work...wasted my money." etc...or responses are "there's been lots of discussions, do a search". But, frankly nothing much more useful than that even going back 8+ years.

Has anyone had a positive experience with recovering from similar symptoms? Was surgery required, or was PT sufficient (how long did it actually take)?

Anyway, I'll probably schedule a third follow up with the Sports doc. We last discussed getting an MRI and seeing the local Sports Hernia specialist (surgeon for the Dallas Stars), as the next step.

Just looking for something positive to keep my mental state out of the gutter.
Last edited by: Tom_hampton: Jan 11, 18 14:20
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Re: Sports Hernia / Adductor / Hip Flexor / Lower Abdominal Strain... [Tom_hampton] [ In reply to ]
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Hello Tom_hampton and All,

One of our sons had a hernia operation a year or two ago and it was quite successful.

He went out of his med insurance group to a specialist doctor that does NOT use mesh.

Evidently there are some side effects from mesh that he wanted to avoid.

If you want a reference to the doctor please PM me.

Cheers, Neal

+1 mph Faster
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Re: Sports Hernia / Adductor / Hip Flexor / Lower Abdominal Strain... [nealhe] [ In reply to ]
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Neal-

I don't mean to be insulting, but do you mean a hernia-hernia, eg inguinal or umbilical, where there is an actual tear in the abdominal wall and a piece of internal tissue (fatty or intestinal) poking through? I have had an umbilical hernia repair several years ago. Mesh was installed as part of that repair.

Or do you mean a sports hernia, which is more correctly called athletic pubalgia (or a few other related conditions) A Sports hernia is a very different thing from a inguinal or umbilical hernia, and the name is misleading. There is no opening into the organ cavity of the abdomen, and there may or may not be a tear in any tissue at all.

My understanding is that mesh is not involved in a surgical repair of athletic pubalgia. Hence my suspicion that we may be talking about two different things.

If, in fact, you DO mean Athletic Pubalgia (which is what I have a tentative diagnosis for), then I would be very interested in your Son's experience. If you live in the DFW area, I'd also be interested in the Dr. reference, but I already have a reference to Dr. Preskitt who treats these injuries for the Dallas Stars and the FC Dallas teams. I will gladly PM you for further info if we are talking about the same thing.

Thanks for taking the time to reply, in either case.
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Re: Sports Hernia / Adductor / Hip Flexor / Lower Abdominal Strain... [Tom_hampton] [ In reply to ]
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I had a sports hernia/athletic pubalgia repair performed in 11/16. In my case, I had continued pain pretty similar to what you describe (adductor/hip flexor area) following some pelvic fractures and a subsequent hip surgery in late 2014/early 2015, probably as a result of rushing back too quickly from those without adequate strength. I had a whole bunch of MRIs and such in there that didn't show anything, did rehab (I'm a PT, actually), got a ton of soft tissue work done, and had several rounds of injections that allowed me to train ~50% of normal and compete up to 70.3s in 2016. My symptoms had times of waxing and waning, but they never totally went away. Athletic pubalgia became my hip surgeon's diagnosis of exclusion, really, and we talked through a few options, which were either seeing a local general surgeon, or consulting with Dr. Meyers (who he did say can be a bit "my way is the only right one").

I ended up going with the local surgeon, who yes, did an open mesh repair. I thought about consulting with Meyers, but honestly couldn't justify the cost, especially given some other message boards and such I'd consulted. The surgery itself was pretty painful and recovery took longer than I had really been told to expect (in fairness, I also had to have a uterine fibroid removed in that time-I'm guessing that won't be a factor for you ;) ), but in time, the surgery did the trick. I had to work really diligently in the early stages to rebuild strength from the ground up, but within about 4-5 months I was better off than I had been in years when it came to that whole general area, and was able to get back to basically full training (limited by fitness/durability loss in my injured years) and racing last year. So, while I still have some soreness in the area from time to time if I slack on some of the prehab details, by and large, I'd consider the surgery I underwent a success.

Feel free to ask any other questions, it was a super frustrating time period and I was completely torn on what I should do based on the experiences of others, but happy to share my personal one!
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Re: Sports Hernia / Adductor / Hip Flexor / Lower Abdominal Strain... [Tom_hampton] [ In reply to ]
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Hello Tom_hampton and All,


Yes I meant ....... hernia hernia ...... Tom wrote: I don't mean to be insulting, but do you mean a hernia-hernia, eg inguinal or umbilical, where there is an actual tear in the abdominal wall and a piece of internal tissue (fatty or intestinal) poking through? I have had an umbilical hernia repair several years ago. Mesh was installed as part of that repair.


I was not aware of the other kind of hernia that you have ..... so no help here .....

Good luck .....





Cheers, Neal

+1 mph Faster
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Re: Sports Hernia / Adductor / Hip Flexor / Lower Abdominal Strain... [Tom_hampton] [ In reply to ]
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In very short:
1. No surgery here, takes long time, I have been out since Nov 2016
2. PT will work but with the right approach, search Mike Boyle, Understanding Sports Hernia I and II
3. Soft tissue hand work, miofacial release with balls and foam rollers, very specific and unique strength routines that target around and into the area, isometric holds first, loading with reps second, than introduction of velocity into the area.....loading adductor longus in eccentric state is critical
4. Multi planar work
5. Two PTs failed with me as they were one sided, has to be three step approach
6. Third round proved success, different PT dude, understood the issue like Mike Boyle discusses it
7. I decided myself on Crossfit, it just does magic to my broken up body, three months of that so far
8. My last week of 2017 was 30mi running, post runs, next day had some inguinal-abdominal pain, but nothing like before, running no longer than hour at a time, 6 short runs a week now
9. All last Summer I paddled olympic K1, kayaking with lots of trunk/core work, no pain
10, I do one day hip/adductor PT routine, the next day I do core heavy, I do not do PT every day
11. Improvements came very very slowly, questioned many times, doubted many times, put my head down and worked it

Had symptoms like you for very long time, pain in inguinal area of abdomen- rectus abdominis at the pelvic insertion, sharp pain, I could palpate it and get it, cough, sneeze, flip turns, resisted seat up.....adductor longus dull and sharp both at pelvic insertion same side......
It can be done but takes really a knowledgeable PT, arm yourself with enormous self belief and accept you will be out for long time.
I tore stuff up during 2016 IMAZ at mile 16 on the run. Still finished in 9:57 with a limping 3:42 run. I knew I would pay the price. I also have an impinged shoulder from all the riding and no strength training.....long long story.
Since I came out of olympic sprint kayak 30 years ago, decided to go after it in 2018 as a way to rehab my body back. So 2018 ICF kayak marathon and sprint racing for me at the National level. Hope to come back to triathlon and continue. Going to take time. I am 47.
Arm yourself with patience. In US, health insurance rarely covers surgery for sports hernia. If you go down that road it will be out of pocket. If you do opt for that, search Aspetar Institute on youtube and listen through their presentation on studies in surgical techniques. They cover Meyer, Muschawek and all others in the field. Meyer would be the last person I would go to.
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