sports hernia/ athletic pubalgia

Thanks for the stretches, I also have VERY tight hip flexors. They also overpower the hip extensors so I need to work glutes and hamstrings a lot in the weight room. Whether I have a good run or not sometimes seems less dependent on aerobic fitness and more on whether or not my hips are loose and my stride is in balance.

garygrayfan wrote:

Start by putting 1 foot up on a chair seat, reach arms overhead and extend backwards slowly, do this for 25-30 seconds or so. Move into sidebending while maintaining some extension and finish with some rotation, work in this position for a minute or 2 and repeat with the opposite leg.

Just tried that out. I usually stretch my hip flexors on the ground with the classic half kneeling stretch but this new one seems to work the hip in a different way-and is probably more relevant to running because the leg of the hip being stretched is extended and weight bearing-just like during running. Thanks.

Good to hear, I think you should probably do both the half kneel as this gets the rectus femoris part of the quads which is also a hip flexor. The weight bearing aspect is what is good about it as it is more of a functional stretch. I am a PT but work in a rehab setting so not as involved with sports type of work (except friends and family). I have been advised to stretch frequently, every time you have been sitting for any length of time, at least for a short period. Of course before and after running.

In a healthy athlete, stretching all three planes is likely a good idea, however in one who has developed athletic pubalgia, it is probably a good idea to first work on range of motion in the sagittal plane first then work into frontal and transverse later on. Typically, there is a mobility and range of motion imbalance between frontal and sagittal plane in those presenting with sports hernia. You need to facilitate hip extension first (sagittal plane) before you make improvements in the frontal plane and transverse otherwise you'll maintain the same degree of imbalacne.

-CB

PS-Gary Gray Fan, I wrote a piece a few days back on spondylythesis and distance runner that you may be interested in reading. It's a few posts behind the one I linked, if you haven't seen it.

In deciding what stretches are necessary, we must first look at the functional anatomy of each muscle and the function in each individual. Typically with runners you'll see incredibly tight low range hip flexors and relatively inactive hip flexors that function above 90 degrees due to the typical high volumes of low amplitude running. As such, we spend a little more time opening up the low range flexors, especially rectus femoris. As it is a muscle that acts on two joints (hip flexion and knee extension), we need to exploit that to put it into stretch, so it is essential to put the hip into extension and the knee into flexion for proper stretching. With that in mind, we don't statically stretch pre-run as we don't want to increase joint laxity and risk of injury. It's generally reserved for gym work (to facilitate activation of the posterior chain) or post-run. Pre-run, we focus on more dynamic stretching types, depending on the condition of the athlete. If he can't do a basic routine pain free, he won't be running for very long if at all that day. Also of critical importance, static and dynamic mobility only play a small role in getting an athlete back and keeping them healthy. The best model is a multi-faceted approach that includes dynamic and static mobility work, strength training, running, and soft tissue work among other things.

Hope this helps.

-Carson Boddicker

CB457,

I had successful sports hernia repair surgery, followed by hip impingement/labral tear surgery approx. 1 year ago. While the hip is better, I still have a great deal of pain in my abdomen (doc thinks it is entrapped nerves), adductor, and knee, all on the affected side. I have done TONS of physical therapy, I've been to all the top docs in the St. Louis area, I've had ART, everything. I really don't know what I need to do to fix what is wrong with me. I haven't been able to run, bike, or even function very well since all this came about. you seem like you have a good understanding of this problem, can you offer me any advice?

Justintherunner,

Sounds like you've had a rough go at it. Before I can really answer that, I'd like to get a further detailed assessment of your history, which is a conversation that's probably not suited for this message board. As I know how frustrating this type of thing can be and that I feel like nobody should go through it, drop me an e-mail and we'll do some deep diving and fix you up. No cost, no bull shit, I just want to help you as best I can.

-Carson Boddicker

wenttogermany - how are you doing now any update?

Recovery going well.

Not taking any pain meds and hardly any pains now.

I hope it continues...

I'm really interested to hear how "wenttogermany" is doing since his/her surgery. I'm traveling to Germany three days from now for her surgery.

I obviously have a high interest in people who have seen her and been successful. I've heard a couple success stories, which is great, but "wenttogermany" seemed to go very indepth in their review of their Germany experience and I'd like to hear a follow up with the time that has gone by.

For those interested, I've got my own blog that you can find here:

www.thegroinpaincenter.blogspot.com

I put a lot of my own opinions on the "sports hernia" issue in my blogs, but I also try to follow it up with recognition of differing opinions and try to educate people as well as I can. There are so many opinions out there that its very difficult to find the truth, or at least the closest version of the truth that exists.

I've had a regular mesh repair that didn't alleviate my pain, and I've had surgery with Meyer's in Philadelphia and that surgery didn't do much of anything on my pain either. I'm hoping that Muschaweck turns out to be at least 70% true to how good she claims she is, that would be amazing compared to my last two sugery results.

Question -

Has anyone ever gone to see Dr. Muschaweck in Germany and she only did exploratory but found nothing to repair?

Has anyone ever gone to her and she said there was "nothing there" that she felt she could operate on and told you to go home and rehab it?

My 18 yo daughter just signed her National Letter of Intent to play DI soccer, and she is suffering from what looks like a sports hernia. We have been to PT, had MRI's, seen a colorectal surgeon all to no avail. We have contacted Dr. UM in Germany and are probably going to have an evaluation with her in NYC in April. My question for wenttogermany is, how much did the surgery itself cost? Did your insurance cover any of it? Are you better? She wants to be ready to play in August, but she has been doing nothing for four months and is in considerable pain. We are anxious for feedback.

Dr Muschweck operated on me on December 4th 2008. Before the surgery, I had aching above and to the right of my pubic bone that worsened with long walking, especially up hills. Jumping and running caused me so much pain that I had to avoid them all together. I also suffered from chronic tightness on the insides of my legs at and away from the pubic bone.

I had quite a bit of swelling and pain after the surgery. My right testicle was tender for about 3 weeks. The pain and soreness went away steadily, and about 3 weeks postop I was able to sprint. I've been skiing and playing dodgeball (all out effort in both) every week since early January with no problems. She is an incredible doctor. She was completely confident about the diagnosis and the post surgery prognosis - that I would be sprinting 2 to 3 weeks out.

I just read your post about the Lloyd release and sent him an email. I'm sure with your health care, it probably didn't cost you very much. We have friends in Warwick and we spent a summer in Oxford, so Leicester is a little less daunting to us than Munich. How are you doing now? Any idea of the cost for an American patient? Thank, you can email me at tstark@heidelberg.edu

I will add my problem to the mix.

For about a year now I have had pain in the left groin when running. It starts up near the top and seems to run down. I also had a tiny pain in pubic area and doctors believed I had synthesis pubis (I think that is the name). I had a cortisone shot in that area and have since had no problems with that. However this was a very minor thing compared to the groin. I dont get any pains when sneezing etc so dont believe it is a sports hernia. I have done the rounds... MRI, Xray, Physio, Core work etc and nothing seems to be working. Anyone in this thread got any ideas?

Thanks.

Bump

Hey all...Just got back from Munich, land of Dr. Muschaweck, and I'm less than 2 weeks post-op. Although I can now walk without the pain I had previously, walking is a slow endeavour and I am dealing with quite a bit of skin hypersensitivity and numbness below the incision line (no, she did not cut the nerve). I also have quite a hard mass beneath the incision scar from the suture job she did. Because I am still rather fresh out from surgery, I have a lot of tightness and sleeping at nights can be quite a chore. I will be posting a lengthier report of my experience once I get some more energy back.

For the person that asked...the cost was 4600 Euros. This did NOT include the hospital stay at the Residence or the pre and post-op meds. All follow-up visits to Dr. M and any imaging were part of the 4600 Euros.

My groin is now the same as it was before the surgery with David Lloyd.

So I can not recommend David Lloyds release procedure.

Aftercare is non existent!!!

How are you doing now? It's been three weeks since your last post. Just curious. We are seeing Dr. M in NJ on April 16.