- The Washington Times - Monday, August 1, 2005


For nine months, Michael Joyce played high school football and then ran track despite groin pain so bad that he could barely get out of bed the next day. Finally, doctors diagnosed a sports hernia, a complaint among professional athletes that now is hitting younger athletes and weekend warriors, too.

But exactly what a sports hernia is and what to do about it are matters of dispute.

Doctors seem to agree on one thing: Despite the common name, it’s not actually a hernia. The medical term is “athletic pubalgia,” and it occurs when muscle or other tissue pulls away from the pubic bone.

Only in the past decade or so has this injury become a widely accepted diagnosis within the sports-medicine field. It’s a hot topic among trainers of the pros, and seems most common among hockey and soccer players.

If you’re not an elite athlete, information is difficult to come by. Doctors who don’t treat many athletes usually are not familiar with it. Nor is there a diagnostic test. The diagnosis usually comes after trying rest and anti-inflammatory drugs, and after all other explanations for groin pain, such as more common muscle strains, are ruled out.

Then which surgical fix to try — sewing frayed tissue back together through an open incision or a newer “keyhole” operation that reattaches tissue to bone with a piece of mesh — boils down to the preference of the surgeon. A search of medical journals found no published studies that compare the options to determine the best treatment.

“There’s controversy at all levels: Does the diagnosis exist? How do you make the diagnosis? Once you make the diagnosis, what do you do with it?” said Dr. William O. Roberts of the University of Minnesota, past president of the American College of Sports Medicine.

That equals frustration for patients. And although there are no good estimates of how common the injury is, “we are seeing more players with it,” from the pros to school athletes to amateur leagues, said Dr. Richard P. Cattey, a Milwaukee surgeon who specializes in the laparoscopic, or keyhole surgery, repair.

What happens? A number of muscles attach to the top and side of the pubic bone. Different strenuous leg movements can pull those muscles until their attachments fray like a rope, develop tiny tears or completely tear. Dr. William Meyers of Drexel University, the field’s dean and champion of the open-surgery approach, says he has documented 18 versions of this injury.

What is a patient to do? Most specialists urge a conservative approach first: The injury may heal with rest and physical therapy.

If not, ask surgeons how many operations they have done, how many were successful, and how many had to be redone, said Dr. Roberts, a family physician who has diagnosed sports hernias and, as a former amateur hockey player, once suffered one.

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