Sports Hernia Symptoms and Treatment

A sports hernia happens when the lower abdominal muscles, ligaments, and tendons get weak, which can lead to painful strains or tears. This can happen when people engage in repetitive physical movements, like twisting or bending, that are common when playing sports.

Making a proper diagnosis of groin pain in an athlete has become a challenge for healthcare providers and athletes. Not long ago, most groin pain in an athlete was diagnosed as a muscle strain. Over the past few decades, significant research has investigated the source of groin pain and found a variety of conditions from muscle injury, cartilage damage, nerve problems, and urologic conditions can all cause similar symptoms. One particularly difficult problem to diagnose is called a sports hernia.

Playing soccer
Aleksandr Osipov / Flickr / CC BY 2.0

A sports hernia occurs when there is a weakening of the muscles or tendons of the lower abdominal wall. This part of the abdomen is the same region where an inguinal hernia occurs, called the inguinal canal. When an inguinal hernia occurs there is sufficient weakening of the abdominal wall to allow a pouch, the hernia, to be felt. In the case of a sports hernia, the problem is due to a weakening of the same abdominal wall muscles, but there is no visible hernia.

The inguinal canal is a region in the lower abdomen, just above the groin. The canal is formed by the insertions of abdominal muscles and tendons, as well as several ligaments. Within the inguinal canal travels the spermatic cord (in males) or the round ligament (in females). This area of the abdomen is prone to weakening of the abdominal wall, allowing an outpouching, or hernia, to form.

The problem with the abdominal wall in people with a sports hernia is not a muscle strength issue. Having a weak part of the abdominal wall doesn't mean you haven't done enough sit-ups or other core strengthening exercises.

The sports hernia does not occur in the area of the large, thick part of the muscle. Rather, the abdominal wall in a particular region is too thin, allowing the hernia to form.

Symptoms of a Sports Hernia

A sports hernia typically begins with a slow onset of aching pain in the lower abdominal region. Symptoms may include:

Typically the symptoms are exacerbated by activities such as running, cutting, and bending forward. Patients may also have increased symptoms when coughing or sneezing.

Sports hernias are most common in athletes that have to maintain a bent forward position, such as hockey players. However, sports hernias are also found in many other types of athletes such as football and soccer players.

The diagnosis of a sports hernia is determined based on the combination of the patient's history, physical examination, and diagnostic tests. Recently, the use of MRI tests has become more common in looking for signs of a sports hernia. Previously, the MRI was primarily used to look for other causes of groin pain, but recent research has found some characteristic findings on an MRI in patients with a sports hernia. Therefore, MRIs are being used more commonly to help confirm the diagnosis of a sports hernia.

There are a number of other causes of groin pain in athletes, and in fact, a sports hernia is a relatively uncommon cause of groin pain. Unfortunately, many patients are given this diagnosis without an adequate evaluation of all of the possible causes of groin pain. Athletes who have a difficult to diagnose symptoms of groin pain who are told they have a sports hernia. While this may be the case it is important not to jump to this diagnosis without a thorough evaluation by an examiner familiar with all of the possible sources of groin pain in athletes. 

Some of the other possible sources of groin pain include:

Sports Hernia Treatment

There are few treatments that have been shown to be effective for sports hernia other than surgery. That said, the initial treatment of a sports hernia is always conservative in hopes that the symptoms will resolve. Resting from activity, anti-inflammatory medications, ice treatments, and physical therapy can all be tried in an effort to alleviate the patient's symptoms. Strengthening of the pelvic and abdominal musculature is sometimes effective in relieving symptoms.

If these measures do not relieve the symptoms of a sports hernia, surgery may be recommended to repair the weakened area of the abdominal wall. A number of studies have shown between 65% and 90% of athletes are able to return to their activity after surgery for a sports hernia. Rehabilitation from surgery for a sports hernia usually takes about eight weeks.

A Word From Verywell

Sports hernias are a difficult problem to treat; some healthcare providers don't believe they even exist. However, most sports medicine surgeons see these injuries and see the recovery athletes can make when the condition is properly identified and treated. If you are having lower abdominal or groin pain symptoms, and your healthcare provider is having difficulty making a diagnosis, ask if you can be evaluated by a healthcare provider who regularly manages athletes who have sports hernias. 

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Jonathan Cluett, MD
Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams.