Anyone ever had a "Sports Hernia" aka: "Sportsman's hernia", "Gilmore's groin", or &quot

Post-surgery experienceThis sports hernia sufferer (soccer) had surgery in Germany 5 1/2 months ago (December 2008). Yesterday he was very kind to help me by sharing his experience to date. Here's what he said:

Mike in Va wrote:

One week to Munich. I'll be following Dr. UM's orders strictly when it comes to rehab and medicine.

How are you feeling Mello?

Mike in Va

Feeling good Mike. I've played in five or six indoor soccer games since Wed and other than sore muscles from exercising and being sore at the incision site (and slightly above it), I'm pretty much good to go. My fitness is beginning to improve and I can't believe how much sprinter speed I've lost.. Wow.. I can see I will need to spend some time at the track.

I contacted UM's office regarding a large bulge at the incision site. She stated this is normal and subsides after approximately a year. Feels like very thick, tough scar tissue. I massage it a few times a day hoping it will speed up the recovery time. Only time will tell.

All in all Mike, I'm very pleased with my results thus far. One positive I've taken away is the value of stretching. After not pushing myself aerobically for almost a year, the muscles in my back, buttocks and abs are very tight making running a wee bit uncomfortable at times. I've developed a daily stretching regiment that is paying some pretty good dividends.

The recovery continues... Good luck Mike and keep us posted on how your surgery goes next week.

Mike in Va.

Thanks for your input. I believe you are right on the money on the points you make.

I definitely notice the radiating pain at different positions.

When Dr. Um checked you, did she apply pressure directly to the groin? One GP did this to me, pressing pretty hard and this did cause quite a bit of discomfort. The other GP was more thourogh, doing the turn your head and cough numerous times. Enough that it felt like I do when I haven't ridden a bike for a long time. I was sore for two days, but she could not locate an inguinal hernia.

I know what you mean about taking it easy. I have cut back on my physical exertion and the pain has been less intense.

I can't wait to hear back from you after your surgery.

Thanks again.

Mike in Denver,

Your exam with Dr. UM will be very detailed in gathering information and explaining her protocol to you. She will then check you for an inguinal hernia, followed by a ultrasound on your groin canal. You will be able to watch the Ultrasound on her laptop. She will have you push down with your lower abdomen and if you have a SH, you will see a little bubble on the Ultrasound. She will then do this several times, taking different measurements on the height and width of the bulge. After that she will explain to you the options for treating it based on its size and your level of pain. Bring a lot of questions with you and she will answer them all very thoroughly. She understands the pain this injury causes and will be very aware of your discomfort during the exam. After the exam, you will feel a great mental relief if you have been stressing over this anything like I was before the diagnosis. I hope to feel even better in about 10 days.

Mike in Va

Further correspondence of post-surgery soccer playerThis soccer player had surgery in Germany 5.5 months ago (December 2008). He writes this today:

i suspect you will need surgery either way, because i have never read about anyone curing their sportshernia without surgery. however it might be worth a try. also it is good for other reasons, and also good to prevent sportshernia on your other side to fix your posture and stuff... i recommend you contact eric cressey and pay him the $400 for him to give you a training program. roughly it is "anti extension" training of the core and butt muscles... though i dont understand it well. also outward rotation of your feet and hips.

btw, i think a large number of people test positive forthe ultrasound exam cause if i remember right, like 50% of the population has the same condition, only they are asymptomatic. so IMO it is not that interesting or helpful.

Thanks Mike. I know she will be very thorough. I do have a lot of questions for her, mainly the ones I asked here on this board.

I asked in my email to Dr. UM if she had any questions about my condition and she said that she would get back to me with the exact date and time in Denver along with any questions she might have. I am very excited to meet with her and get this thing figured out.

I never thought I would learn so much from a thread though. This post board has been a Godsend. I never would have contacted Dr. UM or any sports hernia specialist. I would have just relied on the other GP's suggestions and continued to try to work my way through it. I'm so glad you all recommended to rest it and do the exercises.

How far out was your surgery set after your exam. from Dr. UM? I'm concerned about getting my passport in time and also raising the amount of money I need.

I am considering going by myself to save the cost of two tickets, hotel, etc. Do you recommend this or do you think it is wiser to go with another person?

I saw the video from ESPN that showed the soccer player walking 7 hours after the surgery. What kind of recoup. time did she say your surgery would require?

Maybe if I pick your brain I can save her some time. I know every situation is different, but it sure is good going to battle with you all. I feel like I have some co-patriots alongside during this stressfull time.

Thanks for all your help.

Mike in Denver

Mello,

It is good to hear you are doing well... be careful with the indoor though... it's hard on your body. It wasn't long after I started playing indoor that I developed this problem.

I still have a bulge at the incision site in day 11... my inflammation is starting to subside a bit. Of course, I also had mesh applied so I'm sure it is going to take time.

den

Mike in Denver,

Unless you are a pro-athlete who pays a premium, you are going to have to wait at least 8 weeks from exam to get the repair from Dr. UM, unless you make arrangements to fly over for the exam and get repaired the next day.

I am taking my wife with me. I never really considered going over by myself to have this done, but others have done it.

If you follow Mello on this board, recoup time is 8-14 days for return to full activity. I'm sure this depends on if you just have one side repaired and how big the tear was. I won't know this until I go through it myself.

Despite my attempts to answer all your questions, I would make sure you bring them up with Dr. UM and get answers directly from the expert.

Mike in Va

Mike in Va.

Thanks for the info. I definitely will bring up those questions and more. I appreciate all the info I can get before I go to my appointment with her.

It's funny, the guys I play pickup basketball with don't understand why I don't get more local doctors to look at me. I explain to them that I've seen 2 doctors already and just want to have someone who specializes in this field look at me.

I know it's worth the wait. But another 6 weeks seems like forever.

Thanks again,

Mike in Denver

A tiny bit of progress

To all. Yesterday I paddled my surfboard in a very calm ocean, and was able even to straddle it, i.e., sit on it, in the water, without pain. To me, this is a meaningful step of progress. I never thought my groin would permit me to do that again.

Angle of lower back, or pelvic tilt

It all started with the exercise that Mike in Va had turned me onto, that showed a "Curl Up":

http://www.halfsquare.net/shetler_071505.php

Up until then, I had ruled out any and all abdominals work because some earlier abdominals work had caused severe aggravation. But I tried the "Curl Up" from Mike in Va in two ways: (a) With hands under back, as shown, and (b) without hands under back. I could feel a distinct difference between the two. Without my hands under my back, I could feel some light pain and tugging on my testicles with each rep. But with my hands under my back, no pain.

The hands under the back both curves the lower back and/or tilts the pelvis anteriorly. So I tried walking with curved back (anterior pelvic tilt) vs. posterior pelvic tilt (butt tucked in). What was the result? With butt tucked in (posterior pelvic tilt) there was definitely more groin pain with each step. With butt stuck out, there was much less groin pain, or none.

Strengthening my muscular back

In Florida there are many old people. I recently happened to notice a guy, about 85 or 90 yrs-old I think, putting groceries in his car at the supermarket. He was kind of a handsome old guy with a good full head of hair, but his back was curved outword very, very much from age. His pelvis, like many old people, was extreme posterior tilt. In other words his pelvis was thrust forward very much. This is very common in old people who are not fat.

One thing about paddling a surfboard is that it forces you to keep your back curves backward, like doing the "rocker" calesthentics drill from elementary school, where your lay on your stomach with head up and feet up and start rocking.

I was pretty leary of trying to paddle a surfboard but I went to the beach on a flat day and tried it only for about 5 minutes, then went home to await any inflammation for a day or two. There was none.

So now I've paddled my board about 7 times over the past 2 weeks and my abs are getting some significant strength back, and all my back muscles are getting some strength back. My muscles had really gone to hell with 3 months of inactivity.

Water walking

Anoter thing. The first time I took my board to the beach, my adductors were surprised by the feel of the sand, and especially surprised by the feel of water. I almost fell over wading in only 6 inches of water. But now, each time I go, I get in water about up to my neck, then move in slow motion in long strides, in all directions, like I'm running, or sort of like ballet. My adductors seem to relax and become pretty darn flexible in this weightless world.

Hoping

I'm now convinced that, just like in the "Curl Up" from Mike in VA, the curve in the lower back (anterior pelvic tilt) is perhaps the central issue of sports hernia. I feel there is a real possibility that if I can get all my back muscles strong again, and get my abdominals good and strong again, then I put myself in a situation where I can slowly heal over several months.

I've been wrong before, and could be wrong here, but now I've got some hope to hang on to.

In other words, it's just the opposite of what some people might expect. Keeping the butt tucked forward actually causes/worsens sports hernia.

But that stands to reason when you consider dead-lifting. A dead-lifter that tucks the butt forward will break his back. The pros keep the back arched inward a little bit, being careful avoid tucking the butt in.

Surf,

I agree with everything you say here. The only caveat is that this will reduce the pain, but it will not heal you. As soon as you introduce any running, lateral work or jumping for any kind of sports, the SH pain will come right back. I was feeling good and attempted light running again 4 weeks into my rehab thinking I was going to have success and to follow Dr. UM's advice. The next day was very bad. This plan of attack I believe will work, as long as you are willing to avoid the activities that will cause significant pulling and imbalance on the pelvic bone. You also have to be willing to accept the risk of the problem spreading to other areas or to the other side with a bilateral SH if you stress the pelvic area where balance is now structurally deficient. The fascia tissue where the tear is located, will not heal itself ever. This Dr. UM and Dr. Meyers are very clear about. Rehab has strengthened my core considerably, now Dr. UM will finish this off for me so hopefully I never have to worry about it again. I just wasn't willing to give up any kind of sports or additional injury at 38, so off to Munich I go.

Good luck with the Rehab. I'm glad your taking it on. It does have great benefit for reducing pain.

Mike in Va

Mike in Va,

Here's another theoretical question.

If the sports hernia tear in the lower abdomen were caused by an accidental cut by a piece of glass in the diet, or maybe a knife fight, then I would be much more inclined toward the surgical solution. Suture up the glass cut. Because then one would feel that the root cause of sports hernia were being fixed, once and for all.

But in our cases, yours and mine, the tear in the lower abdomen is not the root cause, but rather the result of some mechanical activity in sports competition that could very well occur again.

The only way I can see to get around this theoretically is to say, "The original sports hernia occurred when I was not sufficiently in shape, my core was weak. Therefore after surgery, during the remainder of my life, I will always remember to keep my core super strong, or I won't compete."

How many people undergoing surgery can live up to that? (And notwithstanding the fact that I was in excellent shape when I got sports hernia.)

Even after someone has had surgery, they still need knowledge to avoid getting it again. For example, the concept of keeping a small curve in the lower back while walking or running. How many places is that mentioned in all the rehab programs we've come across? None. Yet, it could be crucial for avoiding a second surgery it seems to me.

This is how it seems to me. But I just turned 59 yrs-old, so I'm viewing from another angle, of course. How best to help a friend? Me whistling past the graveyard doesn't help anybody in the long term.

7 Weeks post op (bilateral mesh repair)

Most everything is better signficantly, but not to pre-injury levels. I expect that it may take many more months, or maybe never, to be the way I was before the injury. (Actually feel the same way about my achilles injury, which has been very slow to heal totally - may never really be the same)

Yesterday I ran about 3 miles and played 3 sets of tennis. It takes me a while to "warm up" the groin/lower ab area when running, but after 10 minutes, it was pretty smooth sailing. Played tennis with no pain. Able to accelerate again. Still, later that night, there was some fatigue and even some aching. I am being very conservative with my running and do most of my aerobic work on the elliptical or bike.

I have had a bad cough for a while now and can tell when there is more inflammation because sometimes it hurts (just a bit, not like before!) to cough/sneeze and sometimes it does not.

Played golf last weekend and was able to climb out of deep bunker pain-free. That (uphill walking) used to really hurt. This was my first round since surgery. Felt a few "pings" when swinging hard, but not too bad.

Strength training is where I may have tried to do too much too soon. Initial work with core rehab and strength machines went very well and still is good. Got excited and started doing pull-ups again. May have bitten off too much as I really got sore in the lower abs after my second session. I am going to hold off doing pullups and pushups for at least a few more weeks. Same with lunges.

Everyday activities such as walking, riding my bike mowing the lawn - very, very close to pain-free. For that, I am very grateful. I just have to remind myself to take it easy from time-to-time and not push too hard. Most of us on this board are very much A-types when it comes to fitness and sports but we have to remember that the body needs to deal with inflammation after activity. That is best done by rest and simply walking, which has been shown to reduce inflammation in general.

Surf-

I agree that an excessive anterior tilted pelvis contributes to this. That generally means tight quads, hip flexors, QL's and weak lower abs, weak hamstrings etc.

It makes perfect sense to get in balance.

However, that being said if the tear is too large then it will not repair itself.

I am doing exactly what you are speaking of because I have to lose 50 pounds and get my core bullet proof. I tend to overdo things and that includes my rehab. I am actually taking my cardio down a notch to 30-40 minutes a day and increasing my stretches and strengthening. I will also do my pool work. i am finding out the more cardio I do the tighter i am getting. I think what I am saying is this. Until the dysfunctions are sorted out then hard cardio is just going to perpetuate them.

My problem is that i equate alot of cardio with weight loss and the true fact is that diet is 80% of the equation anyways. I am running a pattern of 3 good days followed by 1 day bad inflamed and then 2nd day not bad and then start all over again.

I feel my scar and it feels like a tight cable under the skin. I am moving much freer but when i inflame my legs get tight and i get that pressure i referred to earlier. But i think that is an overtight TFL now more than anything.

SH in SC,

Thanks for your practical report, which is very useful and helpful to me and probably everybody. Seems to me you're progress is excellent for only 7 weeks.

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Albert,

I didn't make myself clear. It's the posterior pelvic tilt, like The Hulk, that is associated with sports hernia.

Of the three postures in this image, it's the one on the left who is most likely to get sports hernia.

http://g.imagehost.org/download/0460/Postures3

Surf,

In my case I know exactly the event that caused the tear of my lower abdomen and resulting SH. Dr. UM reviewed and agreed on this when doing my exam. I do agree that if the root causes are not fixed in some people, due to a structural issue, the SH will return if core worked is not committed do. In my case, it is different. I will however be dedicated to a core workout from this point forward, more so than anything else.

I'll chime in next time from Munich. Good luck to all of you.

Mike in Va

Guys, thanks for all the progress updates. It's very helpful.

Albert, are you following Dr. Meyers' rehab program on your own or are you using a physical therapist? I am about a month away from surgery with him and after reading the rehab program he gave me I'm not sure I fully understand what each of the exercises demands. I'm thinking of sending the rehab program to the PT I was working with before deciding to go under the knife to see if he can help, but thought I'd ask you to see if you think it's something that can be done easily on one's own.

Thanks in advance for any thoughts you can provide.

Im guessing that people she does surgery on do not have tendon tears???.......she seems to be looking for bulges where the muscle or tendon is poking thru. OR does she actually look for and repair torn tendons like Meyers........I know any type of hernia is a quick recovery compared to having to repair a tendon and rebuild the strength of that tendon thru rehab