Sports Hernia Diagnosis

Diagnosing a sports hernia is challenging, as it can often be difficult to distinguish from other causes of groin pain. Special imaging techniques are generally used to help make the diagnosis, however, imaging only helps provide clues to the injury while the diagnosis is mainly based on clinical exam and the patient’s history.
A sports hernia or core muscle injury is a very challenging condition to correctly diagnose for most medical professionals, especially early when symptoms first occur. This contributes to the delay in diagnosis and treatment in many cases. First, most do not have much experience with this condition and will often attribute the pain to a muscle strain or pull.

The diagnosis really depends on 3 factors:

1. The patient’s history of worsening inguinal groin pain or adductor pain with activity.
   
2. Pain localized to the inguinal crease or adductor on clinical exam. While, I used several exam maneuvers to isolate the injured structures, there are 2 main maneuvers that are used to support the diagnosis of a sports hernia or core muscle injury.
   • Resisted sit-up: For this maneuver, I have the patient lie on the exam table and perform a slow, sit-up lifting just the shoulder blades off the table. I will gently press in the inguinal creases to evaluate for pain and a bulge. Either of these findings in the inguinal crease will support a diagnosis of a weakened inguinal floor, thus a sports hernia.
   • Resisted adduction of the thighs: The patient will lie on the exam table with their heels together and knees bent. The knees will then fall outward into a butterfly stretch, I will then press on the knees as the athlete brings their knees together. If there is pain in the adductor tendon insertion at the pubic bone, then this supports the diagnosis that an adductor injury is present and may benefit from surgery.
3. Imaging studies: The most useful imaging studies will be an MRI pelvis with the athletic pubalgia protocol and the dynamic ultrasound. These two studies will be able to pick up most of the typical core muscle injuries.