Athletic pubalgia

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Athletic pubalgia, also called the sportman's hernia or sports hernia, Gilmore's groin or groin disruption, is a medical condition of the groin affecting sportspeople^[1]. Jerry Gilmore recognized the syndrome in 1980 and developed a surgical repair technique. It is a syndrome characterized by chronic groin pain in athletes and a dilated superficial ring of the inguinal canal. Soccer players are affected most frequently, and both recreational and professional athletes may be affected. A hernia cannot be found on physical examination or medical imaging, and is not present during surgery; thus the term hernia is a misnomer^[2].

The symptoms of a Sports hernia, or Gilmore's groin, are characterised by pain during sports movements, particularly twisting and turning. This pain usually radiates to the adductor muscle region and even the testicles, although it is often difficult for the patient to pin-point.^[3].

Following sporting activity the person with a Sports hernia will be stiff and sore. The day after a football match, getting out of bed or a car will be difficult. Any exertion that increases intra-abdominal pressure, such as coughing, sneezing or sporting activity can cause pain. In the early stages, the person may be able to continue playing their sport, but the problem usually gets progressively worse.^[3].

Pain in the groin and pelvis can be referred from a number of problems, including injuries to the lumbar spine, the hip joint, the sacro-iliac joint, the abdomen and the genito-urinary system, so diagnosis of a hernia requires skilful differentiation. .^[3].

The diagnosis of Gilmore's groin is based on the patient's history and clinical signs. The most notable clinical sign is dilation of the superficial Inguinal ring on the affected side, which can be palpated by the examining doctor when the scrotum is inverted with the little finger. Typically, there is specific pain on coughing and sneezing, as well as sitting up and squeezing the legs together.^[3].

The exact lesion may differ, but common pathologic findings at operation are ^[4] :

• torn external oblique aponeurosis
• tear in the conjoint tendon
• conjoint tendon torn from pubic tubercle
• dehiscence between conjoined tendon and inguinal ligament
• tear in the fascia transversalis ^[2]
• abnormal insertion of the rectus abdominis muscle
• tear of the abdominal internal oblique muscle from the pubic tubercle
• entrapment of the ilioinguinal nerve or genitofemoral nerve^[5]

Several of these lesions may occur simultaneously. Also, many athletes have concomitant weakness or tearing of the adductor muscles of the hip.^[4]

The exact incidence of this entity is unknown: some believe it is the most common cause of chronic groin pain in athletes, while others argue that it is only rare.^[6][7] Conservative therapies (gentle stretching and a short period of rest^[8]) may temporarily alleviate the pain, but definitive treatment exists of surgical repair and rehabilitation^[4][6]

Rehabilitation following surgery is extremely important. - An example of a rehabilitation protocol developed for elite level soccer players following surgery with Jerry Gilmore can be found here.

[edit] Notable cases

Well-known sufferers include:

• Patriots quarterback Tom Brady^[9]
• England cricketer Ashley Giles^[10]
• Philadelphia Eagles quarterback Donovan McNabb,^[11]
• Los Angeles Galaxy soccer players Joseph Ngwenya and Benjamin Benditson^[12]
• Kilmarnock F.C. midfielder Danny Invincibile^[13]
• Toronto Maple Leafs forward Kyle Wellwood^[14]
• Buffalo Sabres Co-Captain and forward Daniel Briere^[15]
• New York Islanders center Shawn Bates ^[16]
• Calgary Flames forward Darren McCarty ^[17]
• New England Revolution forward Pat Noonan ^[18]
• Nashville Predators winger J.P. Dumont ^[19]

[edit] Notes

1. ^ Ahumada LA, Ashruf S, Espinosa-de-los-Monteros A, Long JN, de la Torre JI, Garth WP, Vasconez LO. "Athletic pubalgia: definition and surgical treatment". Ann Plast Surg 2005;55(4):393-6. PMID 16186706
2. ^ ^{a b} Joesting DR. "Diagnosis and treatment of sportsman's hernia". Curr Sports Med Rep 2002;1(2):121-4. PMID 12831721
3. ^ ^{a b c d} "Gilmores Groin". PhysioRoom.com.
4. ^ ^{a b c} "The Gilmore Groin & Hernia Clinic". Retrieved November 24, 2006.
5. ^ eMedicine sports/162
6. ^ ^{a b}
7. ^ Fredberg U, Kissmeyer-Nielsen P. "The sportsman's hernia--fact or fiction?" Scand J Med Sci Sports 1996;6(4):201-4. PMID 8896091
8. ^ GPnotebook 53477314
9. ^ "Brady's groin may be hurt". The Boston Globe, January 31, 2006. Retrieved December 3, 2006.
10. ^ "Angus Fraser: England play with fire over fitness for Ashes tour". The Independent, 13 September 2006. Retrieved December 3, 2006.
11. ^ J Cluett. "Donovan McNabb - Sports Hernia". Retrieved December 3, 2006.
12. ^ "Los Angeles Galaxy mini bios". November 10, 2005. Retrieved December 3, 2006.
13. ^ "Players will put on a United front to get back winning". Daily Record, 17 January 2007. Retrieved January 19, 2007.
14. ^ Sportsline. 42 Kyle Wellwood, C. Retrieved March 7, 2007.
15. ^ SBR Forum. Sabres' center to have surgery for sports hernia. Retrieved March 7, 2007.
16. ^ Yahoo! Sports. Shawn Bates: Done for Regular Season. Retrieved March 7, 2007.
17. ^ NetScape Sports. Kobasew and McCarty out of action. Retrieved March 7, 2007.
18. ^ Yahoo! Sports. Revolution's Noonan to have surgery for sports hernia. Retrieved March 21, 2007.
19. ^ Sports Illustrated. Sabres' Dumont out with hernia. Retrieved March 21, 2007.