This is exactly why I am discouraged from seeking out medical opinions from sports medicine specialists. I don't even know where to start.
I am not sure how to get the operating report into this response. I have it as a pdf file. Not sure how to attach it. If I get a chance, I will type it in though it is fairly long.
For my part (I've posted a couple of times on this board, mainly in frustration), Dr. Ogilvie-Harris (orthopaedic surgeon) and Dr. Mathew (general surgeon - they work together, with Dr. OH doing the diagnosis and adductor release and Dr. Mathew performing the hernia-type repair), both in Toronto, repaired a "significant tear" (also described as being "just shredded") to my abdominal wall (using a mesh patch) and a ligament (I don't remember the name of the ligament, but it's a little one right at the top of the pubic bone, not the inguinal ligament), and performed an adductor release. The mesh patch is used instead of a suture alone because having just stitches keeps you in hospital longer and increases the risk of a rupture post-surgery due to pressure on the abdominal wall. The adductor release doesn't involve cutting the tendon right off the bone so it just hangs there; what they do is slice the tendon partway through so it's still attached, but effectively elongated as the "gap" left by the incision fills in with scar tissue (I would guess that this part of the surgery would be a v. bad idea except for the desperate, which I was after 5.5 yrs with the same d### injury and virtually no exercise).
I am much, much better than I was pre-surgery, but by no means even close to running again at almost 11 weeks out. As a matter of fact, Dr. OH did not lead me to expect that I would be - he suggested that running again after this type of injury and procedure would be overly optimistic. As things were pretty bad before the procedure (basically could not walk), I am satisfied with that answer.
Hernia gal, Thanks again for trying to help everyone. Would it be o k to send you an e mail? I'm on pretty strong pain pills for my problem right now, but I live in an area where they just simply do not know about this problem, so my approach is going to be to match up what I've got, to what can be done without giving it a name like sports hernia or anything else. Ya see what I mean?
Thanks Walk. With the abdominal repair, did it involve the deep rectus abdominus only or did they also work on the inner / outer obliques at all? I know you said they put in mesh, but do you think they reattached the recuts ab. or pulled it down and snugged it up in such a way that it would influence the position or tilt of your pelvis? What's the reason for the adductor release, if they're repairing the abdominal or core trunk damage? Your rignt, that part does sound scarry. I've seen a few articles that say the iliacus and psoas or hip flexor, one or both of these is a big contributing factor to the injury? Did they do anyting to the iliopsoas? You think the abdominal repair is the same thing as a "tummy tuck?"
Thanks again Walk
Here's a summary of my OR report. Hope you understand it and hope it helps you
SIGNIFICANT FINDINGS: Patient did have evidence of tears in a mild fashion near the rectus insertion site. However, at both adductors there are significant rents with the tendinous portion and in doing the epimysiotomies some extra fluid expelled. This was relative convincing from the standpoint of understanding her problem.
DETAILS OF PROCEDURE: ….. In this operation, i.e. pelvic floor repair, the anterior pelvis floor i.e. the pubis and its ligamentous attachment was stabilized; rather than the posterior inguinal floor itself like a hernia. A three dimensional plan was designed so that the anterior abdominal attachments to the pubis and adjacent ligaments were reattached and/or reinforced. This was accomplished by creating a broad band distal end of the rectus abdominus muscular fascia and attaching it directly to the pubis and portion of the inguinal ligament, staying as anteriorly as possible in order to provide pure anterior pelvic support. The focus was not on closing the internal ring where a hernia would develop or would cause a weakness in the inguinal floor. The sutures were placed in a rear vertical line so that the rectus was attached as medially as possible, as close a possible to the pubis. The internal ring itself was left loose. As part of the procedure he posterior layer of sutures was placed as posteriorly as possible onto the rectus fascia so that the real line of support, i.e. second row of sutures, could achieve maximal anterior pelvic stability. A search occurred for a real inquinal hernia because an indirect hernia or a small direct hernia would not be repaired by this technique. In the course of the technique the original insertion site of the rectus muscle was checked after the sutures had been secured to see if there waa any apparent residual weakness to compare to the new insertion of the rectus. Therefore, a third row of sutures was necessary. The reaction that had been created by the repeated micro-trauma, which is the cause of the injury, was not dissected in its entirety for fear of disrupting whatever attachments were left and natural.
Branches of the iloinguinal nerve were dived bilaterally because these would hae gotten in the way of the repair. The round ligament was surrounded and divided between 2-0 silk sutures. The lateral edge of the rectus muscle was brought down to the pubis and inquinal ligament with reinforcement sutures to achieve a satisfactory vertical attachment. The procedure was performed in two layers principally with interrupted 2-0 silk suture for the posterior layer and interrupted figure –of-eight 0 tycron suture for the anterior layer. Reinforcement 0 tycron sutures were used to further stabilize the anterior pelvis more superficially and interiorly. These were carefully placed from the rectus sheath onto the pubis and inguinal ligaments. Then the external oblique aponeurosis was re-approximated with running 2-0 chromic suture, interrupted 3-0 dexon and the fatty tissue with 4-0 subcuticular dexon.
For the adductor component procedure, the following considerations were necessary. First of all, the weakness of the abdominal musculature has created a compartment syndrome caused by the unopposed action of the adductor muscles in a relative sense. Second, considerable inflammatory reaction had occurred at both the insertion site of the adductor onto the pubis as well as along the posterior aspect of the adductor compartment where the teeth-like prominences of the superior edge of the inferior pubic ramus was located. In addition, the third consideration was that the abdominal musculator be additionally stabilized from below by suturing the cut end of the proximal adductor epimysium to the pubis and reattached rectus muscle above. It was necessary to ensure that the ilioinguinal nerve was not entrapped at this stage in this portion of the repair. Chromic sutures are used to perform this portion of the attachment stabilization. The components of the repair include this stabilition from below; a complete cut of the entire anterior and lateral epimysium i.e. the covering of the muscle of the adductor. It was important to keep well as muscle itself intact as well as free up the adductor muscles from each other and from the underlying tissue to complete the correction of the compartment syndrome. During this process edema was released related to the entrapment. The junction of the adductor into the pubis is dissected throughout its medial and lateral course. A small vein overlying the repair was mobilized and dissected away from the site of subsequent incisions. Then debridement of calcium and fibrosis was performed. …………….
A tunnel was made on the right and left side down to the adductor longus muscle and tendon. A muscle and tendon was dissected to its junction with the pubis and with identification of adjacent structures. Multiple longitudinal incisions were made into the pubis and junction tendons to achieve a satisfactory possibility for a neovasularity. Approximately 20 cuts were made on each side. Complete anterior and lateral epmysial releases were performed 3 centimeters distal with the muscle still attached. ……….
Thanks for the report. You win the prize babe for the most significant, helpful post in this whole thread, no doubt about it. Have not seen such involved work since the 6 million dollar man, as it sounds like they really rebuilt you. Thanks alot for sharing this info. If it's not too personal, did you have pelvic pain on the posterior side that ran from the sacrum down to the pelvic floor on the back side? On the front side, I gather the pubic bone is a little below the belly button, and again if it's not too personal Gal, did your pain go lower on the front side, I guess from the belly button area right down to the pelvic floor between your legs but still in the groin area? I know it sounds too personal but it would really help me figure out whats going on in my case and if what they call a sports hernia operation would help. One more ? From the report it doesn't say anything about the hip flexor, sometimes called the iliopsos, being damaged. Did anyone ever mention this to you? I'm asking only because the information I have been getting says a sports hernia is often caused by a damaged hip flexor that rotates forward and rips away the much weaker abdominal muscles. I wonder if people doing "tummy tuck" operations could do something like this, because this sounds pretty complicated?
Thanks again Gal, your a Sweetheart
I agree, Hernia gal did a great and very generous service to or for everyone who has this problem. Cheers for Hernia gal!! I read the posts, and wonder what you all think of Dr Joesting in MN?? I hear alot of Meyers and Cattey stuff, but it sounds like this guy might also be a major player, and not just someone mucking around a little? From looking at H gal's post, it looks like there are alot of little things that can go wrong?
Hi again - you know what, I'm actually not too sure about the details of the abdominal wall repair - I'm going to try and get a copy of my report from the Dr. and post it too. My adductor was damaged at the origin as well as the abdominal damage (the tendon was partially separated from the bone and shortened from chronic strain); I think the problem is the abdominal defect led to chronic strain which led to worse tearing in the abdomen ... I'll keep you posted.
I would be very interested in seeing what was done in the operation. This stuff is fascinating. Thank you very much for the effort, can't wait.
thx for everyone's posts, they have been quite helpful. to be honest though, i am not confident that i will ever be 100% to play basketball ever again. i simply cannot believe that this surgery is such a crapshoot. in fact, i will address this to Dr. Myers next week. how can this be? i've had lower abdominal pain for about 6 months. at first it was just sore but it got to the point where i couldn't play basketball. My groin has been sore for about the same amount of time. Moving laterally is extremely painful. PT did not work neither did any rest. anything more specific i should ask Dr. Myers? thx in advance.
can ya share at least in general the kind of exercises you did to make the comeback?
Finely a name to my condition; or at least narrowing it down. Been reading this thread after googling my abdomen soreness. Maybe it's Osteitis Pubis or Gilmore Groin, but at least not cancer!
My pain started a few months ago in my lower left ab. I also had symptoms of polyps, so sure enough, I got a colonoscopy and they took out a couple (benign) polyps 3 weeks ago. However, my soreness was still in the lower abs. Been running still, but not as often or long (4-5 mi 3x/week from 6+ mi 3-4x/week). After reading this thread and also other sites about Osteitis Pubis I think/fear my running days will have to be put on hold for some time. I hope I caught this early enough that with rest/ibuprofin/certain exercies that I can run again in some weeks/months.
Anyway, my soreness does radiate from left to right to middle, but seems to be mostly in lower left. Had been getting worse the last couple of weeks, but I thought it was due to colonoscopy...maybe just coincidence? I plan to go to doc to (maybe) verify condition in a few days.
My question is, can this condition radiate from the left, or do most folks who have this condition mainly feel it from the lower middle region?
so how are things now? I had a sports hernia surgury May 19th in Denver with Dr. Steigman who apparently repaired a tear, released a pinched nerve and laid some of that mesh down. Couple times I thought I might have messed up his work..once I stummbled and ahmm once having sex the night after (that was pleasure pain sheww)
Now 4 weeks out and things are tight, even a little painful particularly in the left groin and inner thigh..where I was not even injured or operated on, still get some aches and tenderness here and there and it still feels kind of like the sport hernia..then again.. it is hard to tell if it is still injured or if I am yet feeling the effect of the surgery.
Does this sound similar to your post op experiences?
have you found coming back to exercise okay? I was given little guidence on what I could do or not do...only to wait 3-4 weeks. All I have done is walk until this week. Now just light strength training and walk/jogs on soft dirt.
Things are great. I had the surgery on April 26th. It's like a miracle to be without that pain in my groin. I just got done rehab. The only thing a little sore is the inner thigh with the adductor release. I am taking the running slowly. That is the key. Meyers has a very specific rehab protocol he gives you. Meyers does not use the mesh. Your doc should have given you a rehab protocol. I feel like a new person.
I copied some of his protocol.
WEEK 4 No sit-ups or biking
BEGINNING Posterior pelvic tilt (5-6 sec. hold) sets of 10
RESISTIVE EXERCISES Mild resistive exercises – Pool exercises
• Pool walking: forward and backward (3-5 laps initially)
• Standing hip adduction/abduction, flexion, extension (30 reps each)
• Partial squats (30 reps)
• Heel raising (30 reps)
• Side bending (4 times for 30 seconds each)
• Hip extension stretch (4 times for 30 seconds each)
• Psoas, groin, hamstring, quads
WEEK 5 Progressive resistance exercises
GETTING BACK TO Hip flexion/adduction/abduction/extension with body weight - when sets of 10-10-15
NORMAL SHAPE accomplished, weights may be increased in 2lb increments
• Running backward/forward, cariocas, side slides (3-5 laps initially), jumping jacks (legs only), scissors, swimming (flutter kicks only – NO BUTTERFLY STROKE)
Jogging ½ mile – 1 mile (include backward runs and increase in ¼ mile increments) and the following agility drills: 50 yard agility drills for every ¼ mile
Strengthening: Abdominal crunches
• Sprinting – 50 yards with gradual 25 yard warm-up and 23 yard cool down. Gradually build up speed avoiding sudden stops and starts
• Figure 8’s
• Lunges – 3 sets of 10
• Pylometrics – shuttle, rope jumping
• Add sport specific activities as follows:
*Soccer (dribbling, passing). No shooting or long volleys.
*Running (hills, sprints)
• Upper body exercises can be incorporated in a progressive fashion – 20 minutes
• Stairmaster – 20 minutes
Week 6 Scrimmage, progressive controlled contact (mild pain expected particularly after
PLAY exercising…if you experience sharp and/or severe pain modify exercise program to eliminate trigger point). Do not do more sit-ups or crunches this week.
Well it's about damn time this thread addressed something other than to say, I had it, we had it, they had it, and isn't it wonderful. Same crap for for almost 15 pages, before getting specific. Thanks again hernia gal and walk. Walk any word on posting your op. report? What ever happened to waves to ya, as this boy was something else.
Nice attitude calling others posts here who aren't helpful to you "crap". Mine, for example, might not have been helpful, but it sure helped me just to put my worries down here and to ask a question. I think most of us here just feel better knowing we are not alone in our pain and delimma and that there is actually hope for a fix so we can get back to our passion of running, etc.
We all want to know the answers and are glad that others here have actually posted what they went through and even shared specific information. However, your attitude in calling 15 pages of all our worries and questions and highly personal stories of how this has effected all our lives as "crap" was really unwarrented and reflects poorly on you.
You're right. That was uncalled for, my apology.
Hi I just had Sports Hernia Surgery in Montreal from Dr. Brown. My tear was about 4 inches long and he catagorizes it out of 5 on how bad it is and mine was a 4. After surgery I could not feel the ache in my groin anymore which was good and it has been 5 days after and still no sign of the ache. I had some post op bleeding though so recovery will take just a bit long as the swealing is pretty nasty but things are improving day by day. I am confident that I was in good hands as I had 2 pro hockey players having suregery the same days as me. So I will try and keep all up to date on my progress but if you want to ask questions email me at [email protected]. Make sure the subject is Sports Hernia so it does not get tossed in the trash. Thanks and good luck to you all.
I'm still working on posting my op report - the hospital is mailing it to me so should have it up here in the next week or so.
Update on recovery: I'm now at the 12 week mark. Physio is good - slow, but I'm starting to get a lot more comfortable with daily activities, walking, etc., and my right leg is not as noticeably skinny. Strength and range of motion are both increasing steadily. As I've mentioned before, my rehab protocol has been a lot more conservative than what some others have been posting, but my injury was also quite severe (I was NOT still able to run or participate in any sports as some others seem to have been) and strength/mobility quite deteriorated by the time I was referred to surgery (the 6 month wait between that time and the actual procedure didn't help ... I guess the government footing the bill makes up for the loooong wait list). My exercises so far include some basic core stability stuff, adductor squeezes with pillow between knees, wall squats. And of course gentle stretching. I've been told to expect to be in PT at least till the 6 month mark.
I should add that follow-up with the surgeon has been remarkably thorough - I've had follow up visits at 1, 5, and 11 weeks, and am due back at 18 weeks, 24 weeks, 9 months, and 1 year.