Understanding Sports Hernia Michael Boyle www.bodybyboyle.com - - PowerPoint PPT Presentation

Understanding Sports Hernia

Michael Boyle www.bodybyboyle.com

Buyer Beware

• The hip is the new shoulder.
• New technology now allows hip surgery

that was not previously possible.

• Do your homework. Don’t believe
• utcome stats.
• Many of the “repairs” being done today

will look like the lateral releases or the 80’s.

• Dr. James Andrews
• “want an excuse to operate on a

baseball players shoulder? Just do an MRI”.

• This probably applies to hockey players

hips.

• Don’t lose a finger for a hangnail.

Trauma vs Overuse

• Surgery for trauma ( acute onset) is

usually necessary and successful.

• Surgery for gradual onset often does

not target the causative factors and has a limited success rate with a progression to other issues.

Standard Procedures Include:

• Multiple incisions to “release” adductors.
• Q- Can scar tissue creation promote

motion?

• Labral repairs including “reshaping the

bones with osteoplasty and rim trimming”?

The Three I’s

• Ingest
• Inject
• Incise
• Make sure you have exhausted all
• ptions prior to surgery.

A Different Thought?

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Solution?

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Trim the Door or Fix the Cause?

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Gray Cook

• “ I think a good rehab program without

surgery would have the same outcome as with surgery if you could get the player to stop playing”.

• Surgery may be forced rest?

The Problem

• The sports hernia is like a “shin splint”
• r a “groin pull”
• Sports hernia is a non-specific

diagnosis

What We Know

• Sports hernias seem to “acquired”.
• The injury generally begins with a “groin

pull” and progresses to an abdominal issue.

• Not a classic inguinal hernia

Groin Pulls?

• Groin is another non-specific term used

to describe all of the muscles that flex and adduct the hip.

Hip Flexors and Adductors

• 7 muscles can flex the hip or assist in

hip flexion ( 2 are classified as adductors)

• 5 muscles can adduct
• 2 adductors are “flexor/ adductors”

(pectineus and brevis)

• 3 are extensor adductors
• 1 is also a heavy neutralizer ( magnus)

Flexion / Adduction

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The Plot Thickens

• Hip flexor weakness leads to strain of

the flexor/ adductor group.

• Strain of the flexor/ adductor causes

excessive pelvic motion as compensation

• Excessive pelvic motion causes

migration of symptoms to the adbomen.

Fake Hip Flexion w/ Pelvic Implications

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“Benign Neglect”

• The “groin pull” is often viewed as a

nuisance to be tolerated.

• A “training camp injury”. In fact, it is the

first step that begins the process

• Step 2 is the minimization, the benign

neglect, that facilitates the process.

Potential Rationale For Neglect

• 1. Culture?( training camp injury)
• 2. Time constraints?( soft tissue work is

labor intensive)

• 3. Reliance on modalities?
• 4. Skill issues?( many trainers are not

comfortable performing soft tissue work)

• 5. Location of lesions?

Potential Training Related Causes

• Technology- bikes, climbers, rowers
• Sports hernias were relatively unheard
• f until the advent of aggressive bike

programs.

• Hockey players dislike running and the

aerobic demands of many misinformed teams may have caused a slippery slope phenomenon.

• The bike conditions the circulatory

system but, not the muscular system responsible for hip flexion.

Other Contributing Factors

• Lack of Hip Internal Rotation or HIRD
• Excessive frontal plane flexibility with

limited sagittal plane flexibility ( long adductors, short flexors) Peter Freisen- Carolina Hurricanes

Long Adductors

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Short Flexors- Sagittal

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Prevention

• 1- Screening
• FMS, Hurdle

Step appears to be the key problem pattern

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• www.functionalmovement.com

Prevention

• 2- Aggressive soft tissue work. Regular

maintenance

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Prevention

• 3- Static Stretching/ Hip Mobility

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Prevention

• 4- Proper Warm-up ( Dynamic Mobility)

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Activation

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Prevention

• 5- Run don’t jog, avoid technology

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Prevention

• 6- Slideboard in the off-season

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Prevention

• 7- Sled Crossovers

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Prevention

• 8- Single Leg Strength

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Functional Anatomy

Prevention

• 9- Specific Strength-P1 Limit Compensation

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Add Stability Demand

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Add Flexion/ Adduction Component

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Multi-planar Deceleration

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Rehab

• Gradual return to normal training
• Think of rehab as a velocity continuum

from slow to fast.

• Many concepts will be similar to low

back rehab or hip labral rehab.

• Proper, well thought out, progression is

key.

• “Does It Hurt?”

Anti-Extension?

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Anti-Rotation

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Diagonal Patterns

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Conclusion

• We need to understand sports hernias

and look to prevention

• #1 is the avoidance of “benign neglect”

and the progression of the process

• #2 is the increased use of soft tissue

techniques versus modalities

• #3 is putting a prevention program in

place.