Sports Hernia - Nonsurgical Approach

good luck comaboy - I like the alien analogy - I did that. Mine felt more like my abdominal muscles weren't tied down anymore - like they were just moving around on their own.

But I must have a minor case - I can run 90% pain free - only hills and springs and sneezing hurt badly. But I am curious to see what you come up with. I'll put it in my calendar to check back in April or so.

It's a really terrible condition, I feel for you. I had it, or something like it last Spring. I could still run, well jog, it was like I had governor on me, any thing that required real movement and heavier breathing hurt badly.

I rested for 10 days, that did no good. So I started doing some stretches and strengthening of the lower abs and hip flexors.

If you google search you can find the common recommendations. I did NOT have surgery and I was able to get back to running but it was months later.

Oh yes, the sneeze.

The sneeze is still painful, but the feeling is a little less severe.

Thankfully, I don't have that sneeze condition that some have where they sneeze multiple times in a row.

I worked with a guy who always sneezed 7-8x one right after the other.

I am optimistic about the eventual outcome but for now I keep the pepper grinder at arm's length!

I tried the PT approach but after a few months, it wasnt any different and ended up having surgery. I still have discomfort running sometimes, but for the most part it feels better. Took me a good 6 months to really feel like i could run like i was before the surgery.

could you please give an update? and could you please disclose the name or practice you're seeing? i have what i fear to be a similar condition, and like you, i am surgery-averse and very open to the therapies mentioned.

thank you very much!

To Fracture where did you have the surgery? I am going to my ortho today for what I believe is sports hernia. Been 2 months and still can't run to mailbox without pain in lower abs right on pubic bone. Hurts when i roll over at nite and cant do sit ups.

this discussion should move to the main thread so it doesn't get lost -

http://www.letsrun.com/forum/flat_read.php?thread=559820

Update #1

Progress continues. I am surprised (and pleased).

I had a 2nd PT session. PT needled a few more muscles (sartorius was a bi%$#) but said my adductors were holding the needle release from the initial session. PT mostly focused on The lower and lateral abdomen with some deeper mobilization. Still not running or doing any single leg exercises in the gym (step-ups, lunges, etc). But I am swimming, walking, limited cycling (see comments on this below), and gym workouts (which include a mixture of bootcamp and free weight exercises). One thing I noticed immediately was jumping rope. Prior to the 1st PT session and before taking 10 days away from the gym, I noticed that I was clamping my legs together while jumping. That is no longer happening. My feet are now a comfortable 5 inches apart, not pressed next to one another.

The lower abdomen is still sensitive and some days are better than others. Sneezing remains painful, but I try to bend over a little prior to the sneeze and this seems to minimize the pain. But overall the severity of the pain is diminished.

I have come up with some exercises that I think are helping, but want to show them to the PT before I post them here.

Spinning/cycling note: I had ramped up my spin workout durations in the weeks just prior to the Alien run mentioned in OP. I am becoming convinced that sitting (which I do on my job) is a contributing factor to this condition. I am limiting myself to 2 one hour spin sessions per week. Riding on the bicycle on the road does not seem as "confining" or restrictive as the spin bike.

I am also making an effort to stand up and take a few steps around every 15-20 mins at work.

The PT remains optimistic. Next session is week of Mar 5.

I am convinced that sitting (work, classroom, studying, driving) is the root of much of this. Muscles get shortened, tight from long periods of sitting.

Need to be constantly stretched and strengthened. Attention to standing posture very important.

Update#3

It has been almost 3 weeks since last PT appointment.

I have been out of town for work and have been doing plenty of sitting. (Nasty, nasty sitting!)

I developed some additional issues that also involve muscles and joints in the pelvic region (including an SI joint that went out) and some spasm issues with the quadratus lumborum in the lower back. These issues have happened before, but they kept me from doing my usual "rehab" workouts.

Instead, I had to do some stretches and other rehab exercises to get the SI joint to cooperate ('cause it hurt like hell).

Also, I was popping Alleve up to 3 per day. The Alleve likely helped relieve some of the SH pain. Final Alleve was taken this morning.

Next PT appointment is Mon Mar 5. PT remains confident that this can be fixed with therapy.

Awesome man - good luck and please keep the updates coming

I had a sports heria last year (confirmeddby MRI.....it was pretty clear, too). It knocked me out of running for a few months. I probably had a month of no running at all, road an exercise bike a few times per week, and biked next to runners on my team a couple days per week.

I tried changing anything that I thought contributed to it- sleeping position, the way I crossed my legs when seated, driving position. I started wearing compression shorts a lot....and not just when running. I saw a chiropractor. I started sretching. I started a lot of hip flexor, quad, and hamstring exercises.

Slowly, I added in running a couple days per week, and slowly built up over a couple months to where I was running 6 days per week and about 45 miles.

I honestly don't think the hernia has gone away because I still feel a tingle down there occassionally(no pain, just a sensation), but I'm back to running full strength now. It's been a full year at this point.

To give you some hope, I actually PRed in the 5000 (14:58- my first sub 15) last April, about 5 months after bein diagnosed, and nearly PRed in the marathon this winter.

It was a lot of patience and paying attention to every little detail that may have been addin strain to my lower abdomin and groin.

A lot of my motivation was that I desperately wanted to avoid surgery.

I had one last year. I was out for 3 months, nothing helped. I had the surgery (Dr. Brown, Fremont, CA), Oblique tear repair and adductor release. 3 weeks after, half a mile in 12 minutes. 10 Weeks after surgery, 25-30 miles a week. I'm like 15 weeks post surgery now. I almost feel fully back to normal.

Update #4

(Seems that update #2 didn't get posted).

Things are improving, but still no running.

PT has done more of the IM release work and has, I think, needled every muscle in the pelvic region. TFL, adductors, quads, quadratus, you name it.

I am trying to walk 2x per day or mix in some swimming and easy workouts in the gym.

I would guess it has improved about 50%. There is still some abdominal pain on the right side. Sneezing is no longer an issue - at all. I consider this a strongly positive indicator.

The PT said that too many folks out there think that surgery is the only solution.

Some of my rehab exercises:

Ab contractions: while laying on back exhale fully using the diaphragm and pull the stomach towards the spine - hold for 5 seconds, relax and inhale. I am up to 3x10 sets. It took some concentration, but has become 2nd nature now. I do this before getting out of bed.

Frog stretch: Lay on back with knees bent and allow knees to fall laterally such that the soles of your feet are facing each other. Relax in this position for 5 min.

Ab massage: As I mentioned in the OP, my ab muscles were a mess. Some were tight while others were weak. I can feel the tightness when probing around with my fingers. When I find a tight spot, I use all four fingers to press into the body until the pain sensation goes away - a time interval that has been steadily declining.

Next update in early April. PT thinks I should be back to some limited running in late April!

hey - did you have needling done on your abs / is that possible at all? what other areas in the pelvic region did you have needled?

going in to see someone in a few days so would love to know. thanks!

Yes, abs were needled.External obliques for sure. Not sure if it would work for the internal obliques-might require some real maneuvering by the patient and the PT. Rectus was not, but there is still some soreness in the umbilical area.

Good luck.

Hi Dez,

Would you say the surgery was worth it? I'm seeing Dr. Brown next week. Similar to you, it's been just over a year now- I've had some improvement with physio & pool-walking but definitely not 100%....

Thanks & wish you the best with your recovery.

Update #5

Improvement continues. At this point I would say that improvement is in the range of 60-70%.

My attitude has improved along the way. I was previously hesitant to make quick moves (such as chasing our 2 cats around the house). In fact, I didn't do those quick moves at all. (Yes, label me an abuser of animals, but the cats sure seem to have a good time.)

I tried breast stroke a few times (just one 25M length at a time) and it was feeling pretty good - and getting better with each successive attempt. One of the major symptoms had been painful adductors with the thrust motion of the stroke.

Activities include: swimming, gym workouts (longer duration with some lunges and both free and front squats), walking 6xPW and cycling no more than 2xPW.

The PT gave me some more exercises:

Side-laying ab/adductor with hip in extension. I use a theraband with 1 end of the loop in fixed atop the doorjam and my ankle/foot through the other end of the loop. I lay on my side and take each leg through 25-35 degrees of motion for abduction and adduction.

Assisted abdominal curls: I use the looped theraband around my feet and hold the band at my side with my hands. I concentrate on raising and lowering myself by vertebral segment.

Free squats: Spread feet 6-8 inches wider than hips. Keeping abs slightly engaged, lower butt until thighs are just above parallel to floor. Hold lowered position for 30-45 sec while engaging glutes. Then do 10-12 dynamic squats ensuring that the glutes are recruited before rising.

I wanted to make sure that I offer this disclaimer: I never had an MRI, which is reportedly the only way of officially diagnosing a Sports Hernia. From what I have read, even the definition of sports hernia is subject to debate.

Update #6

Progress continues, albeit at a slower rate. Still a solid 70% improvement compared to condition at OP.

Still no running. Did a long and high intensity bike ride (37 miles) and that was a mistake. It set me back a bit. I will reduce bicycling to 1x per week with the wife at her pace (easy). I am beginning to think that cycling is part of the muscle imbalance.

Soreness and tenderness continue in the abdominal area although it has migrated from the inguinal crease area to the belly button area.

PT did some needling in that area and it has made a difference.

It appears PT is now addressing the hip muscle strength imbalances. The adductors are being used as hip extensors because the glutes aren't firing properly. Quads are actually trying to stabilize the hip.

Workouts will focus on glute activation and stabilization.