Sports Hernia: Athletic Pubalgia

The syndrome’s features include disabling lower abdominal/inguinal pain at extremes of exertion.  Sometimes patients remember a distinct injury during exertion.  Usually, the abdominal pain involves the inguinal canal near the insertion of the rectus muscle on the pubis.  Pain can progress weeks, months, even years and involve the adductor longus tendons and the contra lateral inguinal or adductor regions.  Pain can be minimal at rest and begin unilaterally or bilaterally.  It may be fleeting, appearing and disappearing on one or the other side or involving both abdominal and adductor components.  There may be pain with coughing, sneezing, turning over in bed at nighttime, sprinting, kicking, sidestepping, and performing certain maneuvers specific to your athletic activity.

Although the diagnosis of athletic pubalgia can be difficult, a working understanding of the pelvic anatomy, and the mechanism of injury greatly assist the physician in diagnosis and treatment. Since the signs and symptoms are limited, a thorough history and physical assessment is essential to the diagnosis of athletic pubalgia.  On physical examination, most patients exhibit pain with resisted hip adduction and pain with resisted sit-up.  There may be pubic or peripubic tenderness along with some degree of significant tenderness along the adductor tendons near the pubis. 

In addition to a detailed history and physical examination, Magnetic Resonance Imaging (MRI) is an important diagnostic tool.  This imaging test can reveal other problems, such as “soft” musculoskeletal findings, tiny avulsion fractures, peculiar edema patterns, on the side or sides of the injury, or intrinsic hip pathology.

Several other diagnoses must be considered in patients with groin pain such as:  musculoskeletal disorders, inflammatory bowel disease, prostatisis, aspectic necrosis of the hips, herpes, pelvic inflammatory disease, endometriosis, rectal or testicular cancer.

The information on this page was provided by the offices of William C. Meyers, M.D., Alma Dea Morani Professor, Chairman of the Department of Surgery, and Senior Associate Dean for Clinical Affairs at Drexel University College of Medicine.