Sports HerniasProbably the most important aspect to understand about sports hernias is that it is not truly a hernia. A hernia by definition is a hole in the muscle through which fat and/or intestines push through. However, in a sports hernia, there is a tear in the muscle, but no fat or intestine pushing through. The damaged muscle is what causes the pain and other symptoms.
Second, there are NO consensus statements about exactly what a sports hernia is, what causes it, and how to repair it! Any hernia surgeon that claims to know everything about sports hernias isn't being honest with him or herself, and likely their patients. Below is what we believe at California Hernia Specialists.
What is a Sports Hernia?
We believe that a sports hernia is a tear of the outer layer of muscle in the groin. This tear is often seen in athletes who have very strong thigh and abdominal muscles which pull against each other in the groin area. With this constant stress pulling down in the thigh, and up in the abdomen, a tear can occur in the outer layer of muscle in the groin area. This tear is what most describe as a 'sports hernia'.
Again, a sports hernia isn't a true hernia in the strictest sense, since there is no fat or intestine pushing through the torn muscle. The muscle tear causes pain with sitting and standing, or anytime the groin is used.
How do we fix Sports Hernia?
We believe that since a sports hernia is a tear of the outer layer of muscle in the groin, simply sewing this muscle closed could lead to recurrences. Therefore we perform a mesh repair similar to what would be done during an inguinal hernia repair. Sometimes nerves that run through the groin area are responsible for pain sensations will be purposefully cut to help prevent continued pain after the surgery.
Open Sports Hernia Repair on a 54yo Athlete
This patient had almost 6 years of left groin pain. He was an avid athlete and had felt a 'tear' in his left groin. Ultrasounds and CT scans failed to show an inguinal hernia however his pain continued. Over the years, the pain got worse and traveled further up and down his groin.
Ultimately he sought help at California Hernia Specialists where a tentitive diagnosis of a sports hernia was made based on his symptoms. No inguinal hernia could be felt on examination before surgery.
The intra-operative photo above shows an obvious tear in the external oblique, which is the outer layer of muscle in the groin. In the photo, the yellow fat from underneath the muscle is seen between two edges of the white muscle fascia which have torn. The tear was about 4 inches long, and about a 0.5 inch wide. This was repaired with a mesh under the tear, and by closing the tear with sutures.
The photo below is from a 50 year old patient showing the same tear in the external oblique. He was a multiple marathon runner and a competitive triathlete. During his cycling and running he would have disabling pain in the left groin. After resting for several months, the pain returned without improvement.
The photo below shows a normal external oblique which is white throughout with no yellow of fat from underneath and no tear.
Laparoscopic Sports Hernia Repairs?
Laparoscopic repair is NOT usually recommended in sports hernias since most doctors believe that the cause of a sports hernia is a tear in the OUTER layer of the muscle in the groin (see above). Laparoscopic surgery cannot reach those outer layers of muscle, and can only repair the inner layer of muscles. This approach is fine for inguinal hernias where there is a hole of the inner muscles of the groin. But for sports hernias, this is not the case.
About Sports Hernias Video
In the video below, Dr. Todd S. Harris describes what a sports hernia is, and how they form. He also discusses how they are treated and the expected recovery.
Causes of groin pain:
Sports hernias are more a diagnosis of exclusion, when all other causes of groin pain are ruled out. Since most tests are normal during work up for a sports hernia, they can be very difficult to diagnose. Hip pain, strained or pulled muscles, an actual inguinal hernia, are among things which are the most common causes of groin pain.
Occassionally an MRI can show areas of abnormality around the pubic bone in the groin. These abnormalities can help indicate a muscle injury, but again are sometime very vague and are not always helpful.
Important points to consider when choosing a hernia surgeon:
- The newest, advanced lightweight mesh can reduce not only recurrence rates for hernias, but also reduces the chance of postoperative mesh pain to almost zero.
- Being treated at a specialized hernia center with an in-house accredited ASC provides the highest quality care before, during, and after your hernia surgery.
- Patients should be seen by a surgeon who can offer all forms of hernia surgery, including open lightweight mesh techniques, as well as advanced laparoscopic techniques. This ensures the surgeon can offer the best technique tailored for each patient.
- Costs for uninsured patients are approximately $1500 for the surgeon fees, and $2000 for the surgery center fees (including OR time, materials, and recovery) for a total of approximately $3500.
- Some laparoscopic patients experience less pain post-operatively and may be able to return to normal activities sooner (when compared to traditional hernia repair). Laparoscopic hernia surgery can result in better patient experiences for some patients.
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Dr. Harris sees patients from all over Southern California, the greater US, and Canada. Our Newport Beach office is conveniently located in Central Orange county adjacent to John Wayne Airport between the 405, 73, and 55 highways.
Our office staff are experienced in verifying insurance coverage for each patient, as well as offering excellent pricing for patients without insurance (see costs above). We are happy to discuss all forms of payments with patients as needed.