Anyone familiar with hockey knows that groin injuries are a common issue. The skating stride as well as the aggressive stops and starts places tremendous strains on the groin muscle complex, making it susceptible to a variety of injuries. These injuries range from the commonly seen “pulled groin”, to an abdominal oblique strain, to the sports hernia.
A “pulled groin” is a strain of the muscle-tendon unit of the upper inner thigh. These injuries are very common. Recovery time can vary from “day-to-day” to several weeks, and recurrence is common. However, surgery is rarely if ever required. Abdominal oblique strains, or a strain of the “stomach muscles” are less common, and tend to recover well with time and PT.
Sports hernias, also called athletic hernias, are a different animal. The exact structure injured is not 100% understood, but most experts agree it is the transversalis fascia of the abdominal wall. This is the tissue layer deep and to the side of to the abdominal muscles, or “abs”. A rent or thinning of this tissue layer can come on suddenly, or develop in a nagging sort of fashion, and become painful enough that the athlete cannot effectively stop, push off or accelerate. Maneuvers such as sit ups and even chin ups may cause pain in the lower abdomen, near the thigh crease of the groin. Once identified, sports hernias can initially be treated with rest and physical therapy. However, surgery is frequently required to fix the hernia, a procedure that is very similar to regular hernia repairs that are seen in children and older men. That surgery can be done through and open incision, or, on occasion, laproscopically, using a camera and tiny incisions. Players can usually get back on the ice in about 6-8 weeks.
There are other entities described which may or may not be a sports hernia, but also cause groin pain and can require surgery. “Gilmore’s groin”, “slap shot gut” and “hockey groin syndrome” are all terms that have been given to pain around the groin, with suspected injury to the tendons of the external oblique abdominal muscles or the deep abdominal wall fascia, where they attach to the front of the pelvis. Some have theorized that “slapshot gut” occurs when the heel of a reinforced, rigid hockey stick hits the ice, the force is transmitted across a vulnerable abdominal wall (which may have a subtle muscle imbalance in certain skaters), causing a tear in these structures. They theorize this is why players who do not take slapshots (goalies) do not get this injury. Others still believe it is the act of skating itself that causes the injury.
Osteitis pubis is still yet another entity that causes pain in the groin. This shows up on MRI (the other injuries often don’t) as edema or a stress reaction in the pelvic bone where the abdominal muscle attach. This is a more minor condition and does not require surgery.
Like many injuries, prevention is key. Can we prevent sports hernias? The answer is unclear, but core strength of the abs, hips and low back are thought to be crucial for many conditions and in many sports, and ought to be the focus of a workout routine.
Authored by Kenneth Swan, MD
Check out this Ohio Health Sports Medicine video for more information.
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