Differential Diagnosis: Groin Strain or Sports Hernia?

Sports hernias are one of the most commonly missed diagnosed injuries in the athletic population. Due to the pain being in the groin, a sports hernia is often incorrectly diagnosed as a groin strain.

A sports hernia is a tear to the oblique abdominal muscles. Because the sports hernia does not create a hole in abdominal wall, there is no visible lump under the skin like in a traditional hernia. This leads to trainers/physicians/therapists/etc. to wrongly diagnose the injury as a groin strain. Treatment for a groin strain typically involves rest which, after time, relieves the pain. However, with a sports hernia, the pain comes back upon returning to physical activity.

A sports hernia occurs when our oblique muscles pull up (on the pubis) while our adductor muscles (also attached to the pubis) pull the femur toward our bodies' midline. This essentialy creates a game of "Tug-o-War" on the pubis. And where are our athlete's stronger, the obliques or the thigh?

Due to our leg muscles being stronger (for the most part), they win the battle, causing the obliques to tear.

A groin strain and a sport hernia usually have similar mechanisms. A strain of the groin is typically the result of a high speed movement involving the legs. A sports hernia also occurs during high speed movements, but is usually accompanied with twisting, rotating, and/or changing of direction. While any athlete can get a sports hernia, those who play football, basketball, soccer, and hockey seem to be the most likely.

Some common symptoms of a groin strain are:
-Pain with unilateral stance
-Pain going from lying to sitting or sitting to standing
-Getting into or out of a vehicle
-Increased pain with leg movements in groin

Common signs of a sports hernia are:
-Groin pain
-Chronic pain (lasting for greater than a month) that worsens when performing athletic activities
-Pain in the lower abdomen
-Increased pain with laughing/sneezing/coughing

How much time will my athlete miss?
Groin strains can usually be treated by a trainer or therapist with the athlete missing 4-6 weeks (depending on the extent of the injury).

Sports hernias may require surgery. If this is the case, it takes approximately 8 weeks before you can return to sport, and may take longer to reach your prior level of function.