Say it ain't so... sports hernia? (aka gilmore's groin)

Triathlon Forum
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i’m hoping to hear from those of you with personal experience with this as well as those with sports medicine background. as you’ll read below, i have been to see a doc about this but have not really been diagnosed (i’m a poor grad student with sh!tty insurance and a not-very-helpful student health care center). my worst fear is that i have a sports hernia (core muscles tearing away from the pelvic bone) and from what i’ve read online this is hard to diagnose and even harder to treat.

here’s my sob story:
about a week after my first 10K of the season (march) i developed a dull ache on the front of my right hip - specifically where my thigh meets my abdomen. it also wraps around the inner part of my leg (e.g. adductors). i stopped running but it hurt when i walked over 1/4 mile and even when i swam. i stopped doing anything for 10 days or so and it was getting better. so of course i tried running on it again - 2 miles at an easy pace resulted in severe pain and i could hardly walk the rest of the day. that was stupid!

i went to see someone at the student health care center. he literally took less than 5 minutes to talk with/examine me, diagnosed me with “a tight right hip”, and sent me off to a massage therapist/yogaist. the massage therapist said all my related hip muscles were tight (glutes, adductors, hip flexors, hamstrings, etc.) and working with her once a week and stretching 30 min a day has definitely helped (alongside a much reduced workout schedule), but it’s not gone completely…

i’ve been trying to run again. in the past month i’ve gradually worked up to running 1.5 miles at a time every other day. the “ache” is still there a few hours after the runs only on my right side and when it’s present i can also feel swelling/tightness over my pubic bone, in my inguinal area, and in my groin. it’s not painful per se but something is definitely not right.

i’m hoping this is just tendonitis stuff. from what i’ve read, most sports hernias are quite painful, no? other information that may/may not be relevant:

  • i’m a female in my mid-20s
  • i’ve had a history of knee pain (mostly left side) both IT band and PF related
  • i had my appendix out a few years ago (i think abdominal surgery is a risk factor for abdominal wall tearing)

any help/advice/opinions would be much appreciated!!

2

I had an inguinal hernia and never had any pain. If it IS a hernia it’s a simple proocedure and nothing to get worked up about. Get the mesh and you’ll be back to training in a few weeks. Do it now. The sooner the better. Don’t let it go.

AB

3

mmmm, a sports “hernia” is kind of a misnomer. it’s not the same as the usual inguinal hernia. it results from a muscle tear, intestines aren’t poking out or anything.

did you have a sports hernia or a “regular” hernia?

4

A buddy of mine got a sports hernia and it sounds pretty much like you described. He had the surgery to fix it and it didn’t work. He stumbled upon this blog and last I heard he was going to Munich to see a doc over there to get it fixed.

http://www.sportsherniablog.blogspot.com/

5

I have been diagnosed with the following (in chronological order): Psoas strain, Sports Hernia, no hernia at all, two Inguinal Hernias.

As mentioned, a Sports Hernia (Athletic Pubalgia) is a not a traditional hernia and “traditional” surgeons will scoff at the mere mention of the condition. Which is unfortunate that they’re so closed minded as to ignore the dozens of research papers on the topic. Finding a surgeon who believes in and will repair a sports hernia is extremely difficult as referenced in the excellent blog posted earlier.

I finally found a surgeon who at least agrees that sports hernias could possibly exis… but didn’t think I had one. I just 2 weeks ago today had surgery to repair the bilateral inguinal hernias with mesh. He did check out the area that a sports hernia would be concerned with and did not see a need to perform any additional work there (usually a tenotomy or additional reinforcement).

We will see when I get back to running what happens. I’m cautiously optimistic.

As you’ve no doubt read, hernias are much more rare in females. I would seriously see as many people as possible (chiropractors, physical therapy, sportsmed specialists) before getting surgery… but I would not hesitate for one second to get surgery once you’re satisfied with the full diagnosis. Hernias do not go away and they do not fix themselves. The mesh repair is good for life (give or take the few cases of botched surgery and mesh material repair you will read about online).

Feel free to PM me with any questions. I have read every medical journal on the subject and feel I am more qualified on the subject than many of the doctors I dealt with.

6

I’m not a medical doc, or sports therapist etc, but have had a similar problem - it could be many things, so don’t jump to conclusions without multiple opinions.

Back in October, had non-specific “ache” like you describe, thought for sure I had the dreaded “sports hernia”. My pain predominantly in front, right above the pelvis, though seemed to move around a bit, was sometimes on rhs, sometimes on lhs, where leg meets abs, where you describe your pain. Started as a tightness and somewhat painful at start of run, but would loosen up, and almost unnoticable by end of run, but couple hours later, hurt like hell, especially with sneezing/coughing. After a few weeks it got to the point where I couldn’t walk or run without constant pain, so went to the doc, way too late though - damage done!

I could go on and on about this, multiple doc visits, chiropractor, x-ray, MRI, PT, etc. but will cut to the chase (no problem giving more info if you want, just ask). PT diagnosed me with tendonosis of abs where they attach to pelvis. Have worked on “reconditioning” this tendon for 7 weeks (no run/swim) with what appears to be great success - slow but steady progress. For me, “the test” has been to do a double leg lift, lying on back, legs extended, heels on floor, then simply lift the legs till they’re vertical. At start, I couldn’t get my heels off the floor without a LOT of pain, for first time yesterday could lift legs without any pain and PT says to try a 1mi easy run next week! I started swimming again a week ago, no flip turns, no all-out sprints.

I’m impressed with Physical Therapists, multiple docs (one a sports doc), chiropractor (sports specific) unable to diagnose and/or treat correctly, the PT seems to have nailed it.

Be aware that fixing your problem could involve many weeks/months of therapy; if this is the case, be patient and don’t do any activity that causes you pain.

Good luck!

7

thanks to everyone for the replies. the suggested blog looks very helpful - i’ve been trying to get through the vast thread on letsrun.com but this is another excellent source of info.

whatever i have seems to be rather mild right now compared to some other horror stories out there. although the location/quality of my symptoms seem to point to a sports hernia, i’m still holding out hope that’s not it. 1) it doesn’t hurt at all when coughing/sneezing 2) the ab muscles i use for situps/leg raises don’t hurt when doing a few of these exercises 3) i can feel swelling/tightness in this area when it’s irritated from running, suggesting an inflammation or something.

looks like i should find myself a good PT… that could be a challenge!

i may take you guys up on your offer for further explanation in the future.

8

jbug,

I had a sports hernia last July from doing isolated leg squats and lunges. It hurt me to run and swim although I could manage the pain. I got a diagnosis from a surgeon and generalist and had a referral to see a specialist that deals with professional athletes. I never had time to follow up with the referral and the weeks turned into months and I started to notice it less and less. It would raise its head if I was doing sit-ups, pushups, or planks that put a lot of stress on the hips. I just avoided anything that made me notice it. Over the last four months I haven’t had any pain and can run, bike, and swim with no limitations.

My doctor told me to ask the specialist the return to activity rates after the surgery since surgery is not a fix all and could make thing worse.

Maybe this will give you a light at the end of the “my athletic career is over” doldrums. The body is amazing and can compensate (fix?) itself.

On top of a sports hernia I also had swimmer’s shoulder that cleared up after about 9 months too with therapy. Maybe a good sports PT can get you on the track with specific stretching and strengthening routine.

9

Yep, I got mine back last spring. There is lots of info about it if you do a ST search.

I could never get a doc to agree what issue I had. All never even heard the term “sports hernia”.

So, while I was going through the medical process, I was not able to do any run training. This is when I started
to really get into powercranks, since I could do those. For some weird reason, when I went to a race, then when I went
to run off the bike, I was able to do well. But, once the race was finished, if I tried to run again, impossible.
So, over a few months of no run training, it slowly got better, but it took a long time.

Good luck.

Dave

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Bump for anyone seeking more in-depth information regarding Athletic Pubalgia (sports hernia/gilmore groin, etc.)

  1. Dr Meyers’ published article about diagnosing and treating the condition (highly recommended to anyone dealing with this, as I am currently):

http://jdc.jefferson.edu/radiologyfp/5/

*click on “Download the document” hyperlink for a PDF copy

  1. Website created by an AP patient/medical student/athlete:

http://sports-hernia.net/home
.

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For people in MA, see Dr Litwin and Dr Busconi out of UMass Memorial. They have dealt with high level, high intensity triathletes
I agree with past posts that most docs are clueless on the subject. Can we start a list of who’s qualified in each state so people can stop wasting time before they receive a clear diagnosis?

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Can we start a list of who’s qualified in each state so people can stop wasting time before they receive a clear diagnosis?

Fantastic idea. From the research I’ve done over the last several months, Dr. Meyers (Drexel University Hospital, Philadelphia PA) should be top on your list. I recently switched insurance carriers (to BC/BS) just to have his work covered. United, Cigna, and a long list of others will not cover this procedure.

13

Do a search on Adductor Related Groin Pain (ARGP) and see what you think.

14

Like others have said, you are dealing with an area of the body that has lots of connecting muscles and nerves, so your best bet is to take the advice of others and see someone who specifically deals with running/triathlon injuries. Ask your athlete friends and their friends who they use.
When I read your post, I just kept nodding my head because I have symptoms very much like you describe. Luckily for me, I was already seeing a great chiropractor for my lower back when my “upper leg problems” occurred. I am fortunate that my chiropractor, Dr. Robert Meyers, treats many elite athletes in different fields. I am not elite, so I consider myself lucky.

Looking at my prior history, Dr. Bob did some more testing of motor control and determined that my femoral nerve was weakened. My pain did move around a bit, but it was primarily on the top of the quad/front of hip area. I could sometimes walk without any pain, but if I went to take two steps running, pain would flare up from that area and around it.

He helped me enough to get through my race, and now he is doing some intense ART stuff. The last session almost brought tears to my eyes, but I feel better whenever I leave. Since doing the ART, his diagnosis is that I had some damage where the psoas connects and that formed some scar tissue which also irritates the femoral nerve.

That’s my experience with a similar issue. I do hope this helps.

15

thanks to everyone for their replies. as it turns out, i was able to see a wonderful orthopedist/sports doc and a great PT who have put me back on the mend and assured me that i do not have a sports hernia. i have subsequently stopped bashing my student care center :slight_smile:

although i am not fully back to normal, i can now run 2.0 miles every other day without any pain and have been increasing my mileage very slowly. i am able to swim/bike/etc. without major constraints.

my very well-educated sports doc had heard of sports hernias (and actually had sent a patient out for repair surgery once with good results) but did not think it likely that i had one and initially diagnosed me with hip flexor/adductor strain. later down the line there was a period of time when we were worried about a hip labral tear, but when my symptoms abated with rest/stretching/strengthening, we dropped that idea.

i’m not sure what the smoking gun to my recovery was, but here are some things i did that might be of use to others:

  1. laid off running completely for 3 weeks
  2. on constant ibuprofen for 2 weeks while i started the running back up (i started back at 0.5 miles, 3x a week… that was hard)
  3. weekly appointment with a massage/stretch therapist who released some trigger points, broke up some scar tissue, taught me how to do the same to myself, and taught me specific stretches for my adductors/hip flexors/glutes/etc.
  4. diligent stretching: 15 min before running (after a warmup) and 15 min after running
  5. PT exercises to strengthen my hip muscles, specifically the gluteus medius.

my affected right leg is still weaker than my left. for example, doing 15 slow straight-leg raises on my back with my right leg (without any weight) is exhausting. this is not true with my left. i suspect there was some muscle/nerve damage. also, i can still feel a difference in the tissue around the affected area between my right and left leg. there does seem to be inflammation/scar tissue remaining. however, no pain!

i still have some work to do but am feeling optimistic about being able to run again. this totally ruined my triathlon season but that’s how it goes. i am also a little distressed that i can’t pinpoint the cause of this injury.

good luck to everyone else who has hip issues, what a complicated section of the body!