P -
Thanks for the links.
Here'S a link to articles by Michael Boyle on rehabilitation for sports hernia sufferers. He seems to really know what he's talking about.
PHYSICAL THERAPY FOR SPORTS HERNIA
http://www.sportsherniaforum.com/index.cgi?board=inactivity&action=display&thread=15
thanks for posting this site:
http://www.sportsherniasouth.com/Sports-Hernia-Surgery.html
One thing is says for treatment is:
"Physical therapy for sports hernia focuses on stretching the low abdominal and lower extremity muscles and tendons. In addition, strengthening of the core muscles is emphasized."
does someone have a list of stretching and strengthening that this might include? i would susepct you would want to avoid the adductor machine at the gym or doing v-ups or leg raises since they would put stress on the area. any suggestions for exercises would be much appreciated.
test...just tried this and it didn't bump
if there's anyone who's been through this kind of thing and can give me some info. please do...here's my hip story....
Last year i was diagnosed with a strained hip flexor/adductor muscle in my right hip. the pain started near my hip bone and slowly moved to my groin. i was in the middle of my track season so i kept running. i could run a speed workout on monday, take a day off, do a speed workout on wednesday, take two days off, then race on saturday. after 2-3 months of this and pt almost everyday, it finally started to feel better.
this same hip pain came back in cross country but only for about 2 weeks and then it was gone.
now the same pain is back but worse than it was the first time. the pain didn't even start near my hip bone it just started out deep in my pelvis area. so, my trainers told me to take as much time off as i needed to where it didn't hurt. so, i took 6-8 weeks off but after 2 weeks of training it's already back and worse than it was before i took the time off. I saw our school's doctor and he said since i have snapping hip syndrome, that's probably the problem. I had an MRI of my pevlis done but he said it came back negative (I don't think this guy is a great doctor, and i had just taken 6-8 weeks off so i dont know if that affected the results).
anyway, my hip hurts as my foot hits the ground and i start pulling my leg through. It used to only hurt in my pelvis but recently it's been a shooting pain starting from that area and going halfway down my knee.
can anyone help me with this? thanks in advance
treewagger wrote:
One thing is says for treatment is:
does someone have a list of stretching and strengthening that this might include? i would susepct you would want to avoid the adductor machine at the gym or doing v-ups or leg raises since they would put stress on the area. any suggestions for exercises would be much appreciated.
TreeWagger -
I've heard someone say they had poor experiences with lower abdominal stretches. But here are some groin stretches, in the link below. I've just started investigating these myself, but haven't tried them out of caution.
But I do notice that when I have pain in my left groin, or when my left testicle feels like its getting pulled, I can make those symptoms disappear for a while by simply stretching my right hamstring. But I've read that it's easy to irritate one's hamstring by stretching it too often, so I'm trying to do that only as needed, and very gently.
TreeWagger, I wish you a speedy recovery. It sounds like we're following the same general path.
http://www.strengthcoach.com/public/1606.cfm3 track -
Your symptoms don't sound like sports hernia to me.
I'm 58 yrs-old. From that perspective it seems to me that a young guy like you, who has his whole life in front of him, wouldn't want to risk permanently damaging your hip.
What if, by running so compulsively (we're all exercise addicts here), you were to ruin your hip, thereby preventing you from enjoying other good things in life such as skiing, hiking, boating, racquet sports, golf, surfing, basketball, etc. ?
Surf...thank you! this is exactly the kind of thing i was looking for. i've got some majorly tight hamstrings. i really don't think i have a case that is bad enough to think about surgery and i've figure out how to beat piriformis issues and other injuries through stregth and stretching.
so, i firmly believe that i can nix this issue in the gym. but, the trial and error of what works and what makes it worse is a long road. i'm going to give the exercises in this link a good try and report back in a few weeks.
one more question...do you know of a link to describe these or is there one on that page?
Phase 1 Core
Cook Hip Lift- single leg bridge holds
Quadruped Hip Ext (McGill Bird Dogs)
Side Bridge- short lever
Supine Psoas Holds
Supine or Side Lying Adduction- squeeze an Airex or Pilates Ring if pain free 75 cm.
Ball Rollouts (only direct ab work and only if pain free, larger dia, balls are lower stress)
Reaching 1 leg Straight leg deadlift
answering my own question:
Cook Hip Lift:
Quadruped Hip Ext (McGill Bird Dogs):
http://www.halfsquare.net/shetler_071505.php
Lying Hip Abduction
Conditions the hip abductors and hip external rotators, enhancing hip stability.
Lie on your side with your legs bent 90 degrees and your knees together. Now rotate your upper leg upwards and backwards, keeping the foot of this leg in contact with the other foot. Repeat 12-15 times or until you feel fatigue in your buttock, then switch sides. To make this exercise more challenging, perform it with a resistance band tied around your thighs.
Supine Psoas Holds - can't find
Ball Rollouts:
http://www.youtube.com/watch?v=qwFGedX9NQg
Reaching 1 leg Straight leg deadlift:
http://mboyle1959.wordpress.com/2009/01/24/video-of-the-week-reaching-one-leg-straight-leg-deadlift/
THE 33-HOUR TRAP
Reading all the posts on this board and others, I've noticed it common for sports hernia sufferers to lay off exercise until they feel better. Then they go try a little run, and feel great. The next day they wake up feeling great and assume they're all better, so they go for another run or another game, even harder. Then the next day, boom, back to square one.
So I did an experiment on myself. To set the stage, I took several days off of any exercise, until I my sports hernia quieted down.
Then, on Sunday at 5 pm, I did some rehab exercises, by dragging my foot across the carpet in my apartment:
- standing hip adduction
- standing hip abduction
- standing hip flexion (like putting ones pants on)
- standing hip extension (like a bull or dog rutting)
Then I resolved to abstain from any exercise for several days and just observe to state of my sports hernia symptoms.
Sunday night, after the exercise described above, I felt wonderful, better than ever. I slept well that night.
Monday I felt wonderful again, feeling like I've got this sports hernia licked. I felt so good I was tempted to go run or play basketball, but resolved to continue the experiment.
Monday afternoon at 5 pm, exactly 24-hrs after the exercise, I still felt terrific, ready to jump for joy, but again resolved to stick to the experiment.
Then, in the middle of the night I woke up having to take a piss. It was 2:30am Tuesday. But I could barely turn over in the bed, I was so utterly sore. I could barely get out of bed because of the intense pulling sensation on my left groin and testicle. After a few steps the pain subsided, but I back to square one with a case of full-blown groin pain for the next several days.
CONCLUSIONS FROM THE EXPERIMENT:
From the time of initial exercise, it takes 33 HOURS before the resulting pain strikes. Thus a 33-HOUR psychological TRAP exists for sports hernia sufferers. We all fall for it. We exercise, then feel wonderful because we think we've fixed it this time. The next day, still feeling wonderful, we exercise even harder. Then the day after that, a full 33-HOURS later we crash and burn, physically and psychologically.
It seems to me there is a PSYCHOLOGICAL factor in sports hernia, a complex mixture of elation and despair.
Any thoughts or further such observations will be appreciated.
Well guys. After a week of burning groin pain/soreness and testicle pain from my SH, I have taken a week off going thru rest and icing and NSAIDS. The pain has subsided but I can still feel the weakening or tear in the fascia wall of my lower abdomen. I am convinced that as the weakening in the fascia of my abdomen wall is irritated it swells. When it swells it further entraps or irritates the inguinal canal, which in turn affects my nerves. Once the nerves are affected the groin pain/soreness begins and your testicle pain begins again. I really believe that a long period of rest/icing to get the fascia wall repair to take place. As soon as you exercise, the repair that has begun and will be destroyed once you exercise. The following link has a great write up by Johnny on all the different factors in a SH.
http://thegroinpaincenter.blogspot.com/
He has a two part series that is excellent.
What is a sports hernia?
http://thegroinpaincenter.blogspot.com/2009/04/what-is-sports-hernia-part-i-so-what.html
How do you fix a sports hernia?
http://thegroinpaincenter.blogspot.com/2009/04/what-is-sports-hernia-part-ii-so-how-do.html
This guy has had surgery with both Meyers and Dr. Muschaweck. He has been threw it all.
I have my revisit with my Ortho today after my MRI and CT Hip Arthoscan. I follow this up with a visit to Dr. Muschaweck in New Jersey on April 16th. I have shut down any exercise or rehab, because the SH pain ALWAYS comes back.
Of the different potential types of SH, I believe mine is the weakening of the fascia wall. As long as the testicle pain subsides, the injury is bearable. I have started to come to grips with the fact that having Dr. M go in an repair this weakening and free up the entrapped nerves may be my only way to repair if I truly want to exercise hard again. If I decide to give up on exercise for a very long period of time, this injury could heal itself.
Of the Rehab programs I have seen posted on this board, most of them are made for people who have already had the injury to the fascia wall of the abdomen reinforced and repaired. Anyone who takes on these programs without this repair and reinforcement is only going to end up injured again. This is a harsh reality. I'll let you guys know how my Ortho and Dr. Muschaweck appointments play out.
Mike in Va with Ice on the Groin
Just a quick update. All my MRI and Arthroscan results came back clean. No Labrum Tears, No Ligament issues. I'm off to Jersey next week to see Dr. Muschaweck. My Orthopedic Doctor was somewhat knowledgeable on SH. He has seen 3 of them in his 10 years. No contacts on what to do locally or nationally, he clearly hasn't read this board :)
I'll let you know after my Dr. Muschaweck appointment whats next....
Mike in Va with Ice on the Groin
Mike -
Thanks for those links to
http://thegroinpaincenter.blogspot.com
That's a great resource. It puts a face on a problem we all share.
I can't help thinking that if all of us sports hernia sufferers really put our minds together, we could solve enough of the sports hernia puzzle to get, if not perfectly well, then generally well.
Perhaps a conference of sports hernia sufferers, or some other way for us to intensively collaborate based on combining our pragmatic observations.
How can we most effectively put our minds together?
Whatever way that is, we should all do it. We are all very motivated.
This LetsRun.com thread was step one.
Johnny Biacofsky's blog TheGroinPainCenter, is perhaps the next step for us. I'm going to join over there today:
http://thegroinpaincenter.blogspot.com
We really need to form an association.
Surf,
I highly recommend trying to get an appointment with Dr. Muschaweck in New Jersey next week if you can swing it. I am going to share all the information that I get out of my appointment with everyone. The biggest thing I am looking forward to is getting a specific diagnosis on my specific problem by an expert in this field. She could give me my life back. I have been to 7 doctors appointments in the US, and no one has an ability to firmly diagnose my problem. I know she can. Once she does, then I can make a more educated decision on how to treat it. I would love to solve this through rehab, which I have said before on this board. But, the more I learn about my specific problem, the less likely I think that is going to be. I have to reinforce the lower abdomen and release my nerve problem. I almost see this as very similar to having nerves entrapped or pinched by a slipped disk in the back. Its a snowball effect and why it takes "33 Hours" for it to take place.
1. The Lower Abdomen (which is weakened) gets irritated and swells.
2. Then the inguinal canal swells putting pressure on the nerves and creates soreness in the groin area.
3. The nerves are then entrapped and cause shooting pains into your lower abdomen, testicles, legs, and butt.
Will rest allow the fascia of the lower abdomen to repair itself over time? I really don't know. I am going to have to live a very stationary lifestyle for that to happen and avoid re-injury. As a Dad with a 3 year old daughter, somehow I believe this will never happen.
One thing you have mentioned and is a huge factor in this whole thing is that this problem is very mental. It beats you down. Doctors can't help you. You know more about it than they do. Insurance companies won't cover it. The pain comes and goes. Exercise will always have a high price so is it worth it when your still hurting. Sex life is definitely impacted. I am very grateful Dr. Muschaweck agreed to see me so I can begin to see a light at the end of the tunnel. I have only been dealing with this for 4 months. I commend people who have had this issue for years. It's a true testament to your will power, because this injury is life impacting and very real. I'll update everyone after my appointment next week.
Mike in Va with Ice on the Groin
Mike in Va -
Regarding your theory of swelling entrapping the inguinal canal, let me add my own observations.
I have two main symptoms,
(a) pain in the upper left groin and
(b) a sensation of something pulling on my left testicle cord.
I've noticed that both these symptoms can come and go, almost by the minute. If I walk up the steps of my apartment, I sometimes will get one or both symptoms a few minutes later. But something is very interesting:
If I sit on the floor of my apartment and stretch my hamstrings very gently for just 20 seconds, and then get back up, both symptoms will disappear, sometimes for an hour or two, sometimes for just a few minutes.
This leads me to believe that you're onto something about the inquinal canal, but I'm thinking its not necessarily a swelling, but maybe some kind of a tenseness maybe??
I don't know. But it seems to me very useful to share all our observations.
Thanks for your good post.
hi all,
i'm new to this forum, but have been experiencing chronic groin pain for the past year. i had a bilateral inguinal hernia operation in december at maryland, but it didn't help at all. i finally went and saw dr. meyers in philly last week and he said he recommended surgery.
of course my insurance doesn't cover it, so i'm looking at like 14k out of pocket. i'm only a student and this borders on prohibitively expensive. i'm considering flying to germany to see dr. m, as it would probably be half as expensive. however, a few posts back someone suggested that dr. meyers and dr. muschawek might not provide the same treatment. something about dr. mushaweck treating a SH like a normal hernia and dr. meyers doing something essentially unrelated, involving the abductors. this got me thoroughly confused, and i'd appreciate any clarification/ advice people might have.
my pain largely emanates from the spot where my right leg connects with my abdomen, right next to my right testicle. i haven't been able to run or anything for over a year, but cycling is fine. impact seems to hurt more, especially side to side motions. it doesnt not hurt any more when i cough, and some of the worst pain comes while i'm just sitting or sleeping.
thanks so much.
For anyone who is interested, here is how my appointment with Dr. Muschaweck went. Everyone's Groin Pain is different, this is my case so process this accordingly.
-------------------------------------
Back from Jersey.
Dr. Muschaweck was extremely thorough and I learned more today in 35 minutes than i have from everything I have read on the Internet. Here is what I found out.
1. Unless you have a digital Ultrasound done to determine how big the weakness or bulge is on the posterior Inguinal wall, then you are really shooting darts with rehab or any type of surgery. My bulge was 1.5 cm and was directly on top of the nerve, thus my pain. She was hesitant to push surgery on me at this point. She considers bulges that are over 2.3cm, more critical for surgery. Not once during this entire exam did she push any kind of surgery on me.
2. The ultrasound was very clear and I could easily see the bulge. She also checked my right side and the lining of the inguinal wall was completely intact with no damage or bulges. The bulge was visible on the left side when i pushed down with my muscles then relaxed. She recorded the pictures of the ultrasound for her records and took thorough notes during the meeting. She also did the standard physical exam to check for a true inguinal hernia. Ouch.
3. The bulge is not going to heal itself over time. It is there to stay, what may change is how much pain I feel from it. I can try to rehab the muscles around the bulge and she recommended that I do that since my bulge was not over the 2.3cm limit she goes by for recommending repair.
4. Our plan of action is that she will be back in Charlottesville, Va in early July to speak at UVA. I am going to see her again. She will do the ultrasound and we will measure the bulge again and discuss my pain. She wants me to try and get back to full activity before the meeting to see how I feel. If I do rehab and it works for me, then we will continue to monitor and check my "sportsman's groin".
5. Her biggest concern is that over time, if the bulge is growing and continues to press on the nerve, then the nerve will be damaged and becomes un-repairable as far as the pain. The nerve pain will then become chronic and is something the patient is going to have to face with some harsh reality. Early detection is key to a successful repair of the Sportsman's Groin. There is no doubt about this IMO.
6. There was 1 NHL and 2 MLS players in the waiting room. All of them have had the Sportsman's Groin problem for close to two years. She was very surprised I diagnosed this on my own and saw her in less than 4 months since this problem started. This is another reason why she is recommending to take some time and see how this plays out. We have time to fix it if that becomes necessary. I was by far the oldest person there.
7. Dr. Muschaweck is extremely thorough and punctual. Not one person went into the exam room with her after their appointment time. US Doctors should learn from her on this. She took copious notes.
8. The Digital Ultrasound was run off her laptop. I watched the whole thing and she explained all of it to me. I'm a techie at heart. Amazing that no Doctor in the US could do this for me, pretty sad if you ask me. The weakness in the posterior wall of my inguinal canal was clear on my left side ( a little round bubble right along the canal) and the inguinal wall was solid (no bubble) on my right side.
9. For people who have extreme pain with their Sportsman's Groin, she will see them in less than 8 weeks for repair. For people like me, who are not debilitated by the pain...then she takes 2 months to see them for the fix. She keeps her queue open, so that the patients who need the fix the fastest get it. She wouldn't do the fix on me in less than 8 weeks, even if I wanted it is my take.
In conclusion (and this only applies to my case). Sportsman Groin (hernia) is definitely a nerve related issue. The size of the bulge on the posterior wall of the inguinal canal matters. If you have this, you should have it checked. If you don't, then you are rehab'ing in the dark. I feel lucky that my bulge isn't any bigger and that I may have a chance to rehab this injury. It is never going to go away. The bulge is here to stay with me forever unless I get it fixed, but the pain could stay or go. Only time will tell. I'm going to execute on my core rehab program and start to walk a little harder until I get to the point of a slow jog. By my visit in July I want to be back to running my normal 3-6 miles with minimal or no pain. If this is not happening, then a Minimal Repair by Dr. Muschaweck may be necessary. Ask me any questions. I took a ton of notes.
Mike...I am so glad you had a positive experience with Dr. Muschaweck. She is a top-notch doctor who is unparalleled in the field of sport's hernias (sportsman's groin, as she likes to call it). And you pretty much echoed my opinion with your comment on how American doctors could learn ALOT from her. You should see how well they take care of you when you go to Germany for surgery. Have you ever known a hospital bed to be a queen sized bed or have a private bathroom with IKEA fixtures and glass? She is the best!
Just to further put your mind as rest - I, too, was told about her posterior inguinal wall defect limitations before hand. She told me the numbers before doing the sonogram; thus, no way for her to back pedal and claim I needed surgery when it didn't meet her own limitations. Mine was huge, and she categorized it as a "major defect" at 3.5 cm long and 2 cm wide, not to mention the 6 cm lipoma she found and excised during the surgery. She said that it had developed for me letting it go so long - almost a year.
If you are trying to rehab it to prevent it from developing further, I can recommend this website - the Hernia Bible:
http://www.groin-hernia.com/herniabible/exercises.html
Unfortunately, I found this website too late to make an effective difference to my injury before having her minimal repair surgery. The key is to strengthen the immediately surrounding muscles structures - internal obliques, external obliques and transverse abs - to add stability to the posterior inguinal wall. I have incorporated these exercises and a good dose of hip flexor exercises into my post-op rehab to leave nothing to chance. I hope you can find a way to keep the small bulge she found under control with these rehab exercises. If you find that you do need her expertise someday, please know that you will be in superb hands.
monchi -
Those exercises at HerniaBible.com are just what I need.
HerniaBible.com seems like a terrific resource.
My goal is to heal sports hernia without surgery.
Many thanks.
Surf