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Difference between a sports hernia and a true hernia

People often confuse the terms, and this is mostly due to the fact that a “Sports Hernia” is not a hernia at all. The definition of a hernia is simply a defect in the abdominal wall, and something (fat, intestine, organs) may “herniate” through the defect.

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CT scan showing a hernia defect. The defect is a large opening in the pelvic floor just lateral to the inferior epigastric artery and vein which are the blood vessels supplying the rectus muscles. Fat in this case protrudes through the defect.

The defect itself, the hernia, can be anywhere in the abdominal wall. Hernias are named based upon their location. For example, a hernia in the umbilicus (belly button) is an umbilical hernia. The most common hernias are umbilical and inguinal hernias. Inguinal hernias are a defect down by the groin, or inguinal canal.

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A photograph of an Inguinal Hernia defect from the laparoscopic hernia repair operation. The defect is large enough to allow fat, bowel, or other organs to enter. Pain occurs when the contents protruding through the defect compress nerves in the area.

The term Sports Hernia originated because the pain from this condition was similar to inguinal hernia pain, and located close to the inguinal canal. The term caught on, and has been used frequently and erroneously over the last two decades. The name, however, is a misnomer. There is no actual defect with a Sports Hernia. Rather, the term characterizes a series of injuries very close to the medial aspect of the inguinal canal. Under the heading of Sports Hernia, come the injuries of Athletic Pubalgia, Gilmore’s Groin, Adductor Tendonopathy, and Internal Ring Hernia.

A photograph of an Inguinal Hernia defect from the laparoscopic hernia repair operation. The defect is large enough to allow fat, bowel, or other organs to enter. Pain occurs when the contents protruding through the defect compress nerves in the area.
A diagram showing the difference between an actual hernia defect and a Gilmore’s Groin configuration. In the hernia, there is an actual defect, or opening in the muscle and fascial wall. In the Gilmore’s Groin, while there is a bowing forward of the wall, there is no actual defect. The protrusion of the wall however can cause a similar pain syndrome to the hernia, therefore often confusing the diagnosis.

There are multiple other terms described in the literature as well, with the commonality ultimately expressed as groin pain. The repair of these injuries requires a surgeon with an intimate understanding of the area, and an understanding of the multiple pathologies which can occur. Often, the repair of a presumed inguinal hernia, many times with a laparoscopic technique, DOES NOT repair the injury which is causing pain. Conversely, if the patient has a true inguinal hernia, and this is not addressed, a Sports Hernia procedure might not be as effective. Sports Hernia injuries are most commonly repaired by a different technique than Inguinal Hernias. Again, an intimate understanding of the injuries, anatomy, and repair techniques is required for patients to achieve an optimal result.

 

To add to the confusion, there is a growing understanding between Orthopedic Hip Surgeons and Sports Hernia Surgeons that there may very well be an overlap between Hip pathology, and Groin Pathology. Therefore, in many centers, a collaboration between these two groups has begun. To date, the literature suggests that there is an overlap of 1/3 of the patients who have both problems. As the knowledge base, research, and understanding of the multiple issues grow, we expect specific therapies and outcomes to continue to improve. Usually, the diagnosis of Athletic Pubalgia, a form of Sports Hernia, can be made with an extremely specialized MRI, looking very specifically at these structures. Only certain Radiology Centers perform tests with these specific parameters. Hip MRIs are usually not specific enough to diagnose the problem.

MRI using a specialized method known as a Pubalgia Protocol MRI. The method allows Sports Hernia Surgeons to understand the exact nature of the injury. In this image, fluid is sitting anterior to the pubic bone, indicating the area of separation. Specific findings on the MRI help direct the surgeon during repair.
MRI using a specialized method known as a Pubalgia Protocol MRI. The method allows Sports Hernia Surgeons to understand the exact nature of the injury. In this image, fluid is sitting anterior to the pubic bone, indicating the area of separation. Specific findings on the MRI help direct the surgeon during repair.

In the above MRI image, the arrow indicates the layer of fluid that forms when the Aponeurotic Plate detaches form the Pubis, indicating Athletic Pubalgia. Most of the time, this finding, and a long term pain process, will need a surgical repair to alleviate the pain. The term “Sports Hernia Surgery” has become a popular name for the repair.