Sports Hernia?
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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. |
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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. http://www.tetongravity.com/forums/showthread.php/264615-ITB-Issues-What-Worked-for-You 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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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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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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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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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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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. |
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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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I definitely will. Wouldn't wish this issue on anyone else. |
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Heading to Vincera first week in Janauary. Should be interesting and hopefully definitive. |
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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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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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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). |
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Yeah, I've been checked by several different providers for an obvious clinical hernia, with everyone saying negative. |
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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. |
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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) |
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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. |
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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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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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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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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. |