Adductor Strain / Athletic Pubalgia
Athletic Pubalgia (Sport’s Hernia) is a condition characterized by anterior pelvic or groin pain. As different tissues may be affected, the medical community uses the term “athletic pubalgia” to refer to this type of injury, however, the lay public may be more familiar with the term “sports hernia.” Sports hernia occurs more commonly in males, particularly in hockey, lacrosse and soccer players. Symptoms present as pain in the area of the adductor origin and/or the abdominal wall. The injury may occur with an acute trauma or microtrauma which occurs overtime.
The obliques are most frequently affected with sports hernia, particularly vulnerable is the attachment point of the oblique muscles to the pubic bone. Often, the tendons that attach the adductors to the pubic bone are also involved.
Causes & Symptoms
Sports that involve planting the feet and twisting with maximum exertion, such as ice hockey, lacrosse and soccer, can results in injury to the lower abdomen or groin. Pain occurs in the groin area, tends to improve with rest, but return with provocative sport motions.
Physical Examination and Work-up
On exam, patients often have tenderness along or at the origin of the adductor longus at the pubic bone. Symptoms are provoked with abdominal concentric exercises, such as sit-ups, or by performing a Valsalva maneuver. A common sign of athletic pubalgia is pain during a resisted sit-up.
Pelvis x-rays are utilized to rule out avulsion fractures at the adductor origin and hip x-rays are performed to assess for concurrent hip dysplasia/FAI. MRI assess the integrity of the soft tissues of the pelvis/adductor complex, and additionally the hip labrum. Occasionally, bone scans or CT scans are ordered to rule out alternative causes of the pain.
Management of Athletic Pubalgia
Physical therapy, activity modification, and NSAIDs are the first-line treatments. Early stage rehab avoids concentric activation of the abdominal wall and focuses on building deep core/foundational abdominal and pelvic musculature. A stepwise, supervised program with a skilled therapist is essential. In many cases, 4 to 6 weeks of physical therapy will resolve any pain and allow an athlete to return to sports.
If non-operative treatment fails, surgery may be recommended. Surgery may include muscular repair with or without adductor tenotomy. If present, concurrent hip pathology must also be addressed to achieve optimal outcomes. Some cases of sports hernia necessitate cutting of the inguinal nerve (inguinal neurectomy) during the surgery to relieve pain. In some cases, an adductor tenotomy may be recommended to address this pain. Post-operative rehabilitation is closely monitored and guided with criterion-based advancement based on regular exercise testing intervals at the COSMO Fit Lab.