sports hernia/ athletic pubalgia

Bill,

There is always a possibility that it could get better if you take time off from running and do rehab which focuses on your core strength (My surgeon said the same thing). I have already had a successful surgery though. I learned about ART after my surgery. But if I were to do anything differently, I would have combined the ART and the rehab before electing for surgery. Unfortunately, I didn't know about ART until later. I still have no regrets. My surgery with Dr. Jeff Hoadley was a wonderful success and I can do just about anything I want to do. I still have chronic hamstring tightness and some psoas tightness. But I have not had any serious problems. I had my surgery one year ago.

Bottomline is that you will not get better while continuing to run. That is hard to swallow for most of us athletes. Only very focused core rehab will improve your situation. If you ultimately plan to have surgery, many of these doctors would probably tell you that you could continue to run with consequences. If you completely tear something, you will be in great discomfort in addition to not being able to run anymore. I was lucky that I didn't completely tear my conjoint tendon... it was only stretched. This was most likely because I didn't continue strenuous activity.

I appealed my insurance's ruling at least twice and they apparently have agreed to overturn the ruling in my facor. However, my doctor has yet to see a check. Good luck.

Thanks for your responses. I'm seeing Meyers on the 22nd, but am pursuing a conservative approach so far - No running, ART, Stretching & need to start some strengthening. -Bill

My daughter was just diagnosed with athletic pubalgia after struggling with groin pain for over a year. We're seeing a Dr. Norris in Nebraska. She's scheduled for the bilateral pelvic floor repair in July. She's a sprinter. Are insurance companies begining to cover this procedure more often?

This doctor claims he's done over 200 repairs with a 95% success rate. Does this ring true with those of you who've had experience with this? We want her to have the best care, but after reading the posts, it looks like there's no clear cut magic surgeon out there. This guy says he traveled to Boston to observe and learn the procedure and has been doing on college athletes ever since. Any advice?

There are ways that truly patient-friendly doctors and their billing staffs are able to write-up and submit the report to insurance companies to increase your chances of having it paid. One was is to make sure that they avoid terms like 'experimental'. I have heard of insurance companies denying claims because the report listed the condition as AP - which many insurance providers view as highly subjective with no real standardized course of treatment; and on that basis they often deny coverage. If Dr. Norris is doing a repair that is very close to an inguinal hernia repair, you should request that he submit the claim as such.

As a parent I'm sure you asked plenty of questions to ensure she get the best possible treatment, but don't be afraid further questions as they occur to you. It has always been my measuring stick that if a surgeon ever become defensive or demeaning in regards to my questions, that put up a red flag for me. Surgeons who are confident in what they do should have no qualms answering even the most mundane questions. Let's face it - surgery is a traumatic shock to the bottom, and should not be taken lightly. Personally, I would ask who he observed in Boston and then research that doctor to learn more about the technique he will be employing on your daughter. Is he using mesh or not? Sutures, screws, staples or fibrin glue to affix such mesh? One important question that many people overlook because they just assume the doctor will do the 'right thing' should post-surgical problems arise, is to ask what he will do if the procedure fails during the subsequent months of healing or she does not improve enough to experience alleviation of the pain. What will his course of action be for her should she experience ongoing pain after the healing period. Will he re-operate to correct problems or does he just refer you to a pain clinic to be done with you. I know these may sound like questions that are looking for problems, but they cannot be dismissed as you need to be prepared for either a positive healing experience whereby she can quickly return to sports or an experience where things have not turned out as he has predicted and you need to know he will do everything possible to 'make it right'.

My best wishes to a speedy recovery for your daughter.

@Bill Haskins...any word on what was found at your appointments with Meyers and Boyarksy?? Where do you go from here? How do you think you will proceed?

Curious if anyone has been treated by Dr. Mark Zoland in NYC for a sports hernia? Anyone familiar with him?

Fuerza,Thanks for your detailed info on your history and your experiences with various doctors - very helpful. I am in the NY area and I've been diagnosed with a sports hernia and labral tear of the hip. I'm seeing a very good hip specialist, who's also trying to get me pointed in the right direction for figuring out a path to deal with the sports hernia.I've got appointments in late September scheduled with both Meyers and Boyarsky. The initial injury is rapidly leading to other problems, so I hope to speed things along. Re: Boyarksy:I'm wondering if you happen to know what imagining he uses, and if that's something that can be done prior to an appointment? Is it a dynamic ultrasound? And do you know if there's a reliable place to get that in NYC?His receptionist can't seem to tell me much and he's on vacation for several weeks.Day trips to New Brunswick are doable but it's not easy to miss multiple days from my job.Thanks.

fuerza wrote:

@Bill Haskins...any word on what was found at your appointments with Meyers and Boyarksy?? Where do you go from here? How do you think you will proceed?

@msnyc,

I got an opinion from Boyarsky while I was researching surgeons (I ended up having surgery by Meyers in July 09 and am happy to report all is well -- back to playing hockey and working out regularly). I live in central/northern NJ and my sports medicine doc recommended that I see Meyers and Boyarsky (my doc studied under him in med school). He uses ultrasound. Says he learned technique (and the repair technique as well) from Dr Muschaweck from Germany. He lays you down and has you breathe in and out, if I remember correctly. If he sees a "bulge" or something breaking through the tissue, then that's his signal that you're a surgical candidate. If not, he won't cut you. He recommended that I not pursue surgery. I ultimately decided to go with Meyers because I'd already tried multiple rounds of PT, rest, anti-inflammatories, the whole deal and still wasn't able to play hockey or work out without pain. Boyarsky essentially suggested that maybe my hockey playing days were over. I was only 36 at the time and that wasn't acceptable to me. I basically came to the conclusion after doing a lot of reading on these boards that the Meyers/Muschaweck schools look at the injury slightly differently. Some patients are better off with one, and others with the other, depending on how AP manifests in them. Boyarsky was very nice and professional, though. I think it will be worth your time to see him. His office is walkable from the New Brunswick train station, BTW.

Thanks for the response. Much appreciated.

For those of you who have BCBS insurance:

I am switching jobs -- and looked into signing up for an individual BCBS plan when my old insurance expires.

They tell me that since I have group health insurance (Oxford) available through my new employer, I'm not eligible for their individual plans. This goes for both NY and NJ.

Anyone know any way around this?

Cheers.

Yes, you can have a dynamic ultrasound with cine-loop and power doppler color shift performed before hand. Because the ultrasound is to help find a very specific injury/tissue disruption, you need to make sure it is done by an experienced radiologist (MD) and NOT by a technician. I learned this the hard way when I went to my local hospital initially and had a technician do it - nothing found. When I went to a larger university hospital and asked that only a radiologist do the exam, BINGO...he found the defect right away. So, lesson learned...it DOES matter who is performing the ultrasound. I never went to Boyarsky but have spoken to many that have. He mimics the exam that Muschaweck gives, primarily because she trained him on what to look for. He is not looking for a bulge but a weakness on the posterior inguinal wall. While bearing down, the pressure of that maneuver actually collapses the posterior wall of the inguinal canal and there is compression. If he says there is a 'bulge', then it is pretty cut and dry, you have a traditional hernia. With the sports hernia, a la Muschaweck sytle, there is no external or internal tissue bulge, just severe displacement and nerve compression. I will make this even more simpler, because I have been constantly researching my condition ever since my original injury in 2008. A sports hernia (posterior inguinal wall weakness) is an incipient hernia. An incipient hernia is the beginning of a true hernia - what Muschaweck likes to call a pre-hernia. I have learned that people who have a traditional actually go through the stage of having an incipient hernia first. Many people that go this route never experience any pain because the collapse of their posterior inguinal canal misses compressing specific nerves that also pass through the canal. In our cases, we have been unlucky to have the collapse of the canal directly occur at the point where a nerve is passing through.

On a more personal note (and these are just my observations) - overall, my view of Muschaweck and Meyers now is that they are both rather arrogant. They are both convinced that their way of treating the problem is the ONLY way to go about it. You will NEVER hear either say that they believe you have the "other" kind of sports hernia and that you should go see that specialist. They both will convince you, or at least try, that they will be able to correct the problem. (That's provided that they see something in their imaging test - which both use something different) From all of my interactions and communications with various people, both healed and not healed, both doctors tend to have a rather hands-off approach once they have operated on you. Oh sure, they will email with you and entertain calls for a short period after the surgery if you are having a rough go of the healing immediately following the operation, but if it goes beyond 4-6 months, you will quickly get the "heave-ho" from them. You will hear that they both treated you and that the operation went smoothly. All word games! Of course the operation went smoothly...you lived, right? you didn't bleed to death on the OR table, right? Am I being jaded? Possibly...but this is also what I heard from others that continued to have healing problems after the surgery. I'm not sharing this to scare anybody, but I do encourage people to ask A LOT of questions when visiting any doctor about this condition. The added irony to all of this is that if you ask Meyers about the possibility that you may have the other kind of sports hernia - the posterior inguinal wall deficiency, you will get a big fat "NO" from him. And if you ask Muschaweck about the possibility of having the other kind of sports hernia - torn muscles from the pelvic insertion point, you will get a big fat "NO" from her. This is why I say they are arrogant. They are so prideful of what they believe to be the only diagnosis that they will not even consider that you have the other kind of injury. And that, to me, is too much arrogance. I'm there to get healed, not to allow your swollen ego to get in the way of finding the appropriate treatment for my condition.

Just be mindful of what is being told to you and do trust your gut instinct. If you hear things that don't sit well with you or you feel that your questions are not being answered directly, listen to that inner voice and start asking even more questions or look for another doctor to evaluate your condition. I listed several other doctors that diagnose and do sports hernia repairs at the North Penn Hernia Institute forums. Just do a search for the 'sports hernia' thread. I hope this information helps as you search for a treatment that will bring some peace back into your life.

Sports Hernia Surgery Report

I feel like I owe my health to this thread, as many of you have experienced most MD's have no idea what a sports hernia is and the process of multiple doctors visits and loads of frustration was eliminated due to the incredible knowledge shared on this post. In saying that, I feel the least I can do is share my story of success from being diagnosed with bilateral sports hernia.

The embarrassing thing about my injuries was that I was running well and was in the best shape of my life. My mistake was signing up for a rec dodge ball league. After a few weeks of dodge ball I couldn't get out of bed and had constant sharp pains in my abdomen and sharp testicular pain. With the help from this site I was able to quickly figure out what was going on. After a long delay do to insurance issues and the tearing of my left side from cycling while injured I had to make the choice of where to go and who to choose to perform the surgery. I had spoken to a women who had surgery with the Philly doc, and I had heard really good things about the doc in Vegas, but decided to go with Doctor Pierce at the Midwest Hernia Center in Edina Minnesota.

My experience with Pierce was excellent. He has incredible bedside manner and was great at describing the procedure. I was originally really against the mesh, but once I added everything up I decided to go with the mesh because of Pierces non laproscopic approach and that he rarely does an aductor release, which I wanted to avoid if possible. Basically how he explained the approach was that the laproscopic technique is a blind surgery and with really opening the area up leads to better results from surgery. The one negative is that it takes longer to recover, but my mindset with this was that I just want to get this taken care of properly the first time and I don't care how long it takes to recover.

A day after our appointment I had surgery and he reported that I had two "text book" sports hernias and that he was very confident in a full recovery. The technique that he used was the double mesh technique, reinforcing the injured area on both sides of the injury further preventing re-injury.

The recovery from sports hernia surgery was not as optimistic as the doctor predicted. He predicted that I would be running after 3-4 weeks, but it was more like 3 months before I was really able to run. I tried to go back to work 1 week out and I really struggled, I had lots of shooting pains in the incision areas. In addition to this I had a lot of pelvic floor pain for about the first 2 months. I really couldn't sit down for more than 10 minutes or so. Finally after a lot of physical therapy and dry needling my aductors are loosening up and I'm feeling very close to 90 percent.

The only negative comments that I have about my experience was the post surgery communication was poor. It sounds like this is a common problem with all of the prominent docs, but it was frustrating at the time. It took Dr. Pierce about 3 weeks to answer my emails and eventually emails were never replied to. I feel like this is a small consolation for an incredibly talented surgeon and my extreme gratitude to be able to run pain free again.

If anyone has any questions please feel free to email me. I owe my health to this post and the least I can do is help others out.

I contacted Dr. William Brown in Fremont, CA about a suspected Sports Hernia. He suggested that I get an MRI. My MRI results showed that I had bilateral tearing in my rectus abdonimus-adductor longus aponeurosis. The day I emailed him the results he called me and suggested that I have surgery. It turns out that a Sports Hernia is exactly what I had all of this time just as I suspected. Being that I have had pain for over two years and a surgery that did not help me, I was excited to hear from someone who knew about the injury and said he could fix me up.

I made the 2300 mile journey to California on 10/23. Dr. Brown examined me on 10/24 and surgery was done on 10/25. I returned home on 10/27. I am very pleased with the way I was treated by Dr. Brown and his staff. Beginning with my initial contact email Dr. Brown has been outstanding. He called me personally the first time I emailed him and each follow up I made with him. In fact, he has called me every day since I arrived in California to check up on how I am doing. Today he called to make sure I made it home ok!

My surgery consisted of repairing the oblique muscles that were torn and a bilateral adductor tenotomy. When Dr. Brown opened me up he found that I had two tears on each side of my oblique muscles internally and externally. He said I really messed myself up in there but told me he was confident that he fixed everything up.

For anyone considering seeing a specialist for Sports Hernias/Athletic Pubalgia, be sure to put Dr. Brown on your list. He sees patients from all over the country for Sports Hernias and operates on athletes like us daily. He told me that approximately half of his patients are from other states. His procedure is an open procedure and he does not use mesh. He also recommends the adductor release if necessary. The procedure is billed as a hernia repair so insurance should not be an issue.

I will be happy to answer any questions that you may have about the trip to California, sports hernias, Dr. Brown, etc... If you would rather speak to me personally just PM me and I will respond.

2300 miles journey? You must be east of the Mississippi River. Where exactly?

So, you had a previous surgery before actually going to see Dr. Brown. Tell us more about that. Was it a regular hernia surgery by someone else? A sports hernia surgery?

Also, your MRI - do you know what protocols were used and where you had it done? I've learned in my experience that if you don't have an experienced radiologist that knows about this type of injury, it can easily be missed in reading the results of the imaging study.

My wishes for you are that you have a quick, speedy recovery with very few pains along the way. Please keep us updated on your progress with the healing process.

Fuerza-I flew out of the Nashville airport. I live in Kentucky. I had gone to see a surgeon in June 2010 suspecting that I had a sports hernia. At that time I had been dealing with pain for 1 yr. and 9 mos. The pain got a lot worse in June which is what prompted me to go see the doctor. Up until that point the pain was bearable but it hurt when I sneezed or coughed. I had been unable to pull myself up out of bed or do a sit up. I knew at some point since the pain had stuck with me for so long that I would eventually have to see someone about it. I had studied up on my symptoms and was certain I had a sports hernia.

I asked my local surgeon about sports hernias and he did not know much about them and basically told me that it is just another form of an inguinal hernia. I thought that since he was so experienced maybe I was wrong and he was the doctor so I trusted him. I learned the hard way. I asked about an MRI but he did not think it was necessary and ordered a CT scan. The CT scan showed no hernia but it did show that I had a small amount of fat in my inguinal canal. I had surgery on 06/24 laparoscopically with mesh. I never got better. My whole summer was wasted as far as racing and marathon training. I backed out of Chicago because I could not train for it.

I contacted Dr. Brown in September and told him my story and he recommended an MRI. I went to see a local orthopedic surgeon and requested the MRI. I had it done with and without contrast. The Radiologist was able to tell that I had Osteitis Pubis and tearing in the muslces. I immediately sent those results to Dr. Brown. He called the same day and recommended surgery.

Recovery is going well. I am very bruised but the pain is getting better day by day. The adductor pain is the most noticeable at this point. Dr. Brown told me to take it easy for 3 weeks and then I will start physical therapy. He has been calling me just about every day to check up on me.

msnyc,

I was diagnosed with a laberal tear in hip along with Athletic Pubalgia.

Just had the Hip repaired now waiting to rehab and then tackle the AP if not better.

Curious...about your situation.

Just got off the phone with Meyers office and Dr. Schuricht in PA....Dr. Schuricht takes BC/BS.

Jay

Hi Jay, I was curious do they believe the labral tear repair will also fix the pain from the hernia? I have been diagnosed with the same but not sure hot to go about it. was most of your pain in the groin? thanks

Hi - I've just put this on the other post but then saw that someone mentioned Jerry Gilmmore. I've just found some films by him on Youtube and he knows what he's talking about!

Just put his name in to youtube or in England they call the sports hernia a Gilmore's Groin.

Hi Jimmy,

Yes my pain was all in the groin. Using ladders, walking, pushing knees together. I had the pain for almost three years. first diagnosed with a cracked pelvis...2 shots in the groin later....still pain...ultra sound and pt...still pain.....two mri and 2 arthrograms later my 7th doctor explained that the labrel tear needed to get fixed and it (quite possibly) could remove the groin pain. One month later... off crutches rehabing hip ..."still have the groin pain" Waiting to see if the rehab will fix prob. Found a doctor in PA who accepts insurance for the pubalgia if I have to go that route. THey say I shoudl rehab till september.

Jay

Jimmy,

However I did keep playing soccer during the 3 years. Took some time off when diagnosed with the cracked pelvis. Then doc two said go ahed and play.. then doc 3 said no dont play...Its been back and forth for soooo long. The only thing I had to stop doing all together was playing raquetball...stopped that three years ago. Now....I cant play anything! We'll see what the future holds for me

Jay