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Sports Hernia?
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By Bryan Feinstein
From Jackson, WY
Dec 22, 2013
Black Ice Couloir

Anyone had any experience with this specific injury/diagnoses? I injured something in my groin in September while stemming a bit too far with already super tired/sore legs. Diagnosed generically with an adductor strain. Over the next month things progressively got worse and there has been constant low grade groin/pubic pain and core muscle dysfunction that has been debilitating and unresponsive to physical therapy.

MRI showed a possible anterior superior labral detachment, but my clinical symptoms don't seem to fit with that. Just curious if anyone has had something similar a sports hernia before. My orthos don't seem to have much advice or knowledge and I'm looking to travel to a core specialty doctor to actually get a real diagnosis.


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By jeff lebowski
Dec 22, 2013

Bryan Feinstein wrote:
My orthos don't seem to have much advice or knowledge and I'm looking to travel to a core specialty doctor to actually get a real diagnosis.


Don't know what you mean by core specialty doctor. A doctor who specializes in 'core' muscles? They don't exist. Probably the most knowledable in this regard are some PT's. Hip injuries can be complex. And when I say hip I mean the joint AND all the soft tissues and neural structures surrounding the joint. Doctors tend to focus on the joint and attempt to find and address damaged tissue such as labral tears. If you haven't seen an ortho hip specialist then you should. Since he/she exclusively sees hips then he/she might recognize your labral separation as capable of causing your symptoms.

But in my experience sometimes patients with symptoms like you're describing are unable to receive a definitive diagnosis. They have altered muscle firing patterns (some call it 'core dysfuction') about the hip after a perceived mild trauma like a muscle strain. Often the pain is due to tonic, overworked muscles. Making sure you have full range of motion in each hip can be important. Making sure your gait is normal and you are not compensating in any way can be important. Often strengthening weak muscles like glut max and glut med can be helpful. You really need a good, experienced PT to work with to overcome these issues. Here's a thread from another forum about a gentleman with ITBS who also struggled with altered muscle firing patterns.


www.tetongravity.com/forums/showthread.php/264615-ITB-Issues>>>

Or it could be a simple inguinal hernia. Not trying to diagnose you just sharing some information learned the hard way.


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By Bryan Feinstein
From Jackson, WY
Dec 22, 2013
Black Ice Couloir

vincerainstitute.com/

This is what I have found. They do exist, just not very many, as this is a pretty specialized and new area of orthopedic and general care.

I'm also waiting to hear back from the Steadman Clinic in Vail regarding the hip issue.

I just fear that the labral tear was a incidental finding and that the real source of dysfunction is coming from something else. Since most of my pain is on the pubic bone, where the abdomen and hip tendons come together, and have already been checked for an obvious hernia, I am trying to get any more info on "sports hernia".

Obviously this is an extremely complex area of the body and a good diagnosis and treatment plan requires people that work on this everyday.


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By MJMobes
From The land of steady habits
Dec 22, 2013
modern man

I agree with Jon, PTs in my experience can figure out the weird/abnormal injuries way better than most doctors can. Right now I'm on a health plan that requires the doctor to diagnose everything and only gives the PT the power to hand me zerox copies of what to do for it and spend MAYBE 10 minutes in the same room which sucks and pisses me off. In the past I have had better insurance where the doctors would immediately send me to a PT to actually spend time with them and go over my whole body. The best was having a neighbor PT who climbed, that guy was on top of the game.


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By Bryan Feinstein
From Jackson, WY
Dec 22, 2013
Black Ice Couloir

I agree as well with that statement. Either I haven't found the right PT, as that is all I have been doing for the last 3 months, with several, or there is something more to it.


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By jeff lebowski
Dec 22, 2013

Thanks for the link Bryan. If nothing else that group does an excellent job of summarizing sports hernias. The symptoms that really caught my eye were minimal pain at rest and the classic increased pain with coughing/sneezing. Do these apply to you?


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By Bryan Feinstein
From Jackson, WY
Dec 22, 2013
Black Ice Couloir

Yeah, I had groin pain from the original injury, assumed I had strained an adductor. However, I didn't fully rest after this initial injury. This progressed into pubic bone pain/inguinal pain. I also add that the inguinal and pubic pain occurred after a few days of climbing at Indian Creek -> obviously super physical leg and core intensive climbing. Thinking I had given myself a hernia by still continuing activity while compensating, I finally went and was examined. I do not have an obvious hernia. Now everything on the left side seems to feel tight/pain at some point, I'm sure due to everything trying to compensate and protect, but the majority of the pain seems to be centered over the pubic bone. It's usually always there, and it comes quickly back with any low grade activity.

The MRI didn't show anything there, but sounds like it typically doesn't unless there is a specific image protocol used to obtain the study.

I'm not expecting to figure it out on my own or on the proj.

However, it's been keeping me from working (flight paramedic) and my normal life activities. Hence I am looking at a place like Vincera. Seems like they have more of a team complement, with physicians, imaging, and PT that are all well versed in core injuries. I didn't think anything like that existed as well and was surprised to find them.


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By jeff lebowski
Dec 22, 2013

Best of luck. I'd love to hear updates especially since the sports hernia stuff and advanced imaging they do is not common.


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By Bryan Feinstein
From Jackson, WY
Dec 22, 2013
Black Ice Couloir

I definitely will. Wouldn't wish this issue on anyone else.

Just hoping it doesn't take months to get an appointment.


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By Bryan Feinstein
From Jackson, WY
Dec 23, 2013
Black Ice Couloir

Heading to Vincera first week in Janauary. Should be interesting and hopefully definitive.


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By Stephen Burns
From Coloardo
Dec 30, 2013

So I've been experiencing something very similar to what you describe for the past four or so months. Pain started after a day of climbing with no obvious cause and I assumed I just strained an adductor. After not resting and goin on a desert climbing trip for three weeks it is, even now with rest still super messed up, all the pain in the groin/ pubic area as with you, and the whole area, ie adductor hip adductor, are all very tight. Pt I've been seeing thinks it maybe be a hip labral tear and I'm still crossing my fingers that it's not, or if it is I can get to a point that it is reletivly pain free. In curious to hear your updates for I'm out of ideas besides the MRI I can't really afford. Best of luck to you!


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By dannyhnorton
Dec 30, 2013

I had a similar injury 10 years ago from doing yoga. I saw ortho, PT, then another PT. Nothing helped, except not doing what I wanted to do, which was climb. Eventually I accepted it was a groin strain that was resistant to healing and put climbing on hold, very reluctantly. I kept trying to climb every 2-3 months when it would be reinjured immediately, unless I climbed so easy it wasn't that fun. 3-4 years later it gradually started letting me climb, usually with pain starting the day after climbing, not during activity. Now I can climb almost like I want, though Indian Creek trips result in mild groin pain 1-3 days afterwards. I did tons of self research, talked to lots of medical people, nothing helped just time. Not very helpful but sounds like you may have same, and it is slow healing process.


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By Chris Gavitt
Dec 30, 2013

I had an inguinal hernia a few years ago. Initially I thought it was a groin strain. I had constant low grade pain like you describe. It wasn't very limiting except for certain movements though(particularly squatting with weight).

My doctor initially sent me to PT. After 2 months of doing silly exercises "to strengthen my core and hips" I had no progress. I finally saw a surgeon who pushed on my abs a little and poked my balls with his index finger and told me matter of fact that I had an inguinal hernia. Despite such a simple diagnostic process from the surgeon, none of the previous doctors I saw were able to detect anything.

The bad news is that surgery is basically the only way to fix an inguinal hernia. The good news is that the surgery is minor and heals quick. Also, as long as the hernia isn't too disruptive its pretty safe to just put up with it.


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By Bryan Feinstein
From Jackson, WY
Jan 2, 2014
Black Ice Couloir

Yeah, I've been checked by several different providers for an obvious clinical hernia, with everyone saying negative.

Heading out in a few days to see Dr. Meyers. I understand that it could just be a significant amount of time to heal, but there definitely are specific things that can be fixed with surgery. Will post updates as I get more information.

Freakin almost wiped out on ice the other day in Jackson, and the other side has been sore now, but at least they will be imaging the whole pelvis. Need to move back to Arizona for a bit or something.


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By Peter D.
Jan 2, 2014

Hey Bryan, well first the credentials part I've been a PT for close to 20 years, specializing in manual therapy, myofascial release therapy more specifically. I just read thru your posts and a couple of things to think about, when we get into a stem the hip can get loaded abnormally, a subtle twist of your leg or foot can tweak things that could cause a pelvic imbalance. The adductors put a tremendous force where they insert on the pubis and ischium - ilium being the 3rd bone in the pelvic complex.

When you look at the hip/pelvis there's a lot to consider, the ilium is the larger of the pelvic bones this can rotate forward or backward or elevate. Either scenario changes the way the SI joint functions, you start to compensate other muscles shorten and the condition worsens. The pubic symphysis where the pelvis meets in the center allows for a small amount of motion primarily in rotation but it can become offset where one side is offset from the other, this in most instances is a pain generator. Then add in the way the abdominal muscles attach here there's a great deal of force applied to a small area that can further complicate things.

My guess is you have an imbalance where the ilium is out of place - rotated and or elevated as well as a shear at the pubic symphysis, that may sound bad but it just means the joint is slightly offset one side being higher then the other. There is a simple manual therapy manipulation to address this. Due to all the muscular attachments and being the center of how we move this area never gets a break. The greater the imbalance the more pain is generated as these muscles stay contracted causing fascial restrictions over time.

FYI - I had a bilateral inguinal hernia and the symptoms can be similar but are different. The labral tear can contribute but not all of your symptoms.

By way of example - I recently started lifting weights again at the gym, one day I bumped up my workout perhaps a little more then I should have but felt good while working out, the next day I had along run planned, by the end of it a small knot had developed in my belly - oh crap - then my hip and R side began to scream, a few days later I could barely put weight on my R leg without excruciating pain. The abdominal cramp made me think hernia, but I had mine repaired, so not likely. Anyway, I booked an appointment with a friend who does myofascial release she corrected the imbalances and within a few days I was pain free. In hindsight, I probably tweaked my alignment -pelvis - while lifting and running compounded resulting in a large imbalance. Correcting this and releasing the fascial restrictions things resolved quickly.

My suggestion is find a good manual therapist (PT), skilled in Myofascial release would be even better. Hopefully, the center you are going to can give you some answers.


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By jeff lebowski
Jan 2, 2014

I would love to see a study in a peer reviewed journal that demonstrates that the ilium can be 'out of place' or that any of the pelvic bones can be subluxed (ie: upslipped, elevated, forward rotated, etc)

I don't mean my post to sound accusatory or confrontational, but I am seriously looking for said evidence and haven't found it to date. I fully accept that there is movement at the SI joint and pubic symphysis. I'm also aware that there have been many studies that have attempted and failed to demonstrate the ability of a practitioner to detect this movement with their fingers.

My personal hypothesis: certain muscles in the pelvis can become hypertonic (ie: tight) which very well might reduce motion at the SI joint. However I'm not convinced that the reason these muscles become tight is because the SI joint is 'stuck' or subluxed.

I do think that soft tissue mobilizations and SI joint mobs are great treatment options. However I have yet to see the evidence that supports the whole pelvic balancing routine (often involving muscle energy technique) that some therapists do. Although like I said, maybe I'm just not looking in the right places.


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By Peter D.
Jan 2, 2014

Jon, well it does sound confrontational. I'm curious what your background and experience is to make these comments. Muscle energy is well documented in Osteopathic medicine. There is more research being done on myofascial release that supports the work a number of practitioners have been doing for decades.

Bryan if you are interested or want more information contact me off the forum, I'm not up for justifying my work on MP.

Pete


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By jeff lebowski
Jan 2, 2014

I was honestly just looking for some evidence for the existence of pelvic obliquity due to 'subluxations'. I've looked and have been unsuccessful. I know that soft tissue mobilazation and MET are well studied and accepted.


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By nessa
Jan 7, 2014

I have dealt with a hernia in a slightly different location. Mine is abdominal just above my belly button...I've had two surgeries including embedding mesh and internal stitching. PT does nothing for this particular injury b/c of the nature of the tissue affected (no real circulation through connective fascia) and stitching directly w/o mesh is relatively ineffective for anyone who is active. The most impt thing is simply to not reinjure or further tear the area, you can get by like this for years without surgery (if you aren't at risk of strangulation) and know that if you have a tear after your first surgery you are at risk for further tears later. I would definitely see a very good specialist who has dealt with hernias in athletes. Sometimes you are better off not having surgery b/c of how mush it can degrade the tissue...and with the mesh there is typically pain at the site of the mesh (I have a good friend who has had 2 mesh implants each side of his groin and he has had the same outcome as mine even though the location is different). I constantly retear mine along the mesh but since the mesh is there it can "reheal"...without the mesh the fascia just frays like cloth at the suture site. It sounds like you aren't having to actually reduce the hernia right? If you have a lump that you can push in and out that is pretty dangerous and needs to be seen quickly. Strangulation of your intestine isn't super healthy...Hope it all works out for you!


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By Woodchuck ATC
Jan 7, 2014
Rock Wars, RRG, 2008

Mesh implants on second one for me. 2006. First hernia done in 1987 was botched, left me crippled, basically useless for several years, kinda led to depression of course with no goals and no future. What a waste of a life for a decade. Second one was like a miracle job,,was up and active with no swelling or big scar within months. First was from heavy lifting of huge carpet rolls on the job,,second one showed up after some nasty climbing awkward moves, falls, contorted moves that I was not fit enough to be doing at my age. But it turned out much better at least after that surgery.


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By SamJohnson
From Windsor, ON
Jan 9, 2014

May or may not relate to your injury, but I had a sports hernia (not hernia) repair years ago, done by a previous Toronto Maple Leafs orthopod who operated on a few of these in his career. Best hope you don't have this.

Original injury (~2006?) was on left side from a collision while turning/running. Resulted in pain that built up from any attempt at running or striding motions (couldn't skate or ski). Bouldering roof problems with core tension was out of the question, though vertical climbing did not hurt.

Managed to self-diagnose rapidly, took at least 1/2 a year to get an expert to diagnose, and about 1.5 years to get it operated on (~2008). Unlike a normal hernia, all imaging (MRI, ultrasound) came back negative. The vague "sports hernia" diagnosis can have a variety of causes. In my case, upon operation they found a 3 centimeter tear of the rectus abdominus fascial tissue (won't repair) where it connects to the hips on the left side.

Over the ~1.5 years it took to get operated on I developed a different pain on the right hand side. This apparently is common among people who suffer these injuries. Although my operation successfully stopped the pain on the left hand side (original injury) the right side hip pain is still present today, so running and walking distances hurts a lot. Take home message from my perspective: typical conservative recovery approach that works for most injuries could leave you messed up if you have this.

On a positive note, I can still climb without pain. Good luck.


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By Woodchuck ATC
Jan 9, 2014
Rock Wars, RRG, 2008

Good short article in newest Climbing mag about the do's/don'ts of climbing injury recovery to typical injuries. An interesting read as 3 of the covered injuries are ones I've had or still suffer from.


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By Aaron O
From Seattle, WA
Jan 9, 2014
Angel's Crest

I was recently diagnosed with a very small abdominal hernia. I went climbing, did some strenuous routes and then two days after, I felt like I had been kicked in the groin repeatedly. I went to a hernia specialist recommended by a friend of mine who is a doc (this guy had done 3000+ hernia surgeries), which was where I got my diagnosis. His recommendation was to give it a rest for a few weeks and then slowly get back into climbing. I followed the recommendation and started climbing, which at first felt a little strenuous, but now (about 2 months later), I am feeling good. My big concern was that I have a Yosemite trip planned for June and wanted to get the surgery done now so I could train in a month or so. I will see how it goes, but no surgery is looking like the best option at the moment.


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By Bryan Feinstein
From Jackson, WY
Jan 9, 2014
Black Ice Couloir

I just had Dr. Meyers core muscle surgical repair in Philadelphia today. I again was ruled out from having a traditional abdominal/inguinal type hernia by MRI and clinical assessment. Unless he happened to fix one during surgery which is very possible that I dont remember now as propofol and versed are wonderful drugs. Follow up appointment and PT starts tomorrow.

His MRI protocol confirmed I had pathology of the adductor longus tendons and rectus abdominis. I still potentially have a labral tear and CAM lesion in my left hip, but he was pretty confident that the source of my muscle dysfunction and pain was from the core injury.

That was my initial gut feeling as well and decided to go for it.

I have to wait about 2 months to see Phillipon in Vail, CO for a hip consult anyways, so things seem to have lined up good with timing.

He said I had significant tears in many or the origins as well as a partial detachment of the left adductor longus insertion. And post surgery still believed that it would not have healed back to pre-injury status with rest/PT/etc.

Granted I know the man is a surgeon and am always a bit hesitant, but my impression is that he is a very genuine man that has a good bedside manner and took the time to answer questions, and I didn't feel forced into surgery (other than my own desire to find an answer as to how to get better).

So far the experience at Vincera has been excellent and I hope the recovery and rehab continues down that path.

He is saying 6-8 weeks and I will hopefully be back up to activity that I haven't been able to do now for 4 months. We shall see.

I'll be sure to post updates as I'm sure people are interested and this has been a long, tiring, mentally exhausting process for myself that I would love to be of assistance to others having questions.


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By jeff lebowski
Jan 9, 2014

Way to go Bryan. Glad its been a satisfactory experience so far. Thanks for the updates.


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By Bryan Feinstein
From Jackson, WY
Jan 9, 2014
Black Ice Couloir

My only regret was not getting the MRA arthrogram besides or in addition to the original 3T MRI, as it can be a diagnostic indicator of intraarticular versus extraarticular hip/groin pain since they usually inject lidocaine and cortisone. Just for an added piece of information on decided on whether to proceed with surgery.

However, it sounds from the Meyers MRI and what he actually saw and repaired in surgery that it would have likely be irrelevant in my case.

I would technically be cleared to fly back home tomorrow if everything tonight goes well, but I am staying in Philadelphia for at least a week, maybe 2, to begin their rehab program with their own people.


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