Inguinal Ring Disruption - Clinical Features, Treatment, and Prevention

Introduction:

Inguinal disruption, also known as sportsman groin. It is chronic groin pain. It is caused due to a rupture of muscles or tendons in the inguinal canal. It causes weakness in the lingual ligament attachments. It is common among football players. The lingual ligament distinguishes between a groin hernia (bulge above the ligament) and a femoral hernia (bulge below the ligament).

What Is Sportsman Hernia?

Chronic pain in a sportsman is called a sportsman hernia, inguinal disruption, or athletic pubalgia. As the name suggests, it is not the type of hernia, and it occurs due to a rupture of the muscles. It is a pain syndrome of the lower abdomen and groin. This pain develops in sportsmen who do sports activities involving acts of turning and hitting. Seen among players whose proximal muscles of the femur or lower abdominal muscles are excessively used. Commonly occur among football, cricket, and ice hockey players.

How to Diagnose?

• Doing forceful and repetitive hip movements like twisting, kicking, jumping, and slicing.

• Doing vigorous abdominal and hip exercises.

• Lack of sports conditioning results in weakness of abdominal muscles.

• An imbalance between hip and abdominal muscles.

What Are the Clinical Features of Inguinal Ring Disruption?

• Pain is of acute onset.

• Later the pain becomes dull and burning.

• Difficult to locate the pain.

• Pain radiates to the inner thigh.

• Pain on exertion, especially when sprinting, twisting, kicking, or sitting up.

• Pain in the groin during cough and sneeze.

• Point sensitivity near the tubercle region.

• Pain in the outer inguinal ring.

• Pain on palpation in the deep inguinal region.

• Diffuse inguinal pain extending into the femur.

How to Diagnose Inguinal Ring Disruption?

• Inguinal ring disruption or athletic pubalgia is difficult to diagnose. Many injuries, such as rectal or testicular pain, pelvic fractures, and hip bone-related infectious conditions, cause pain in the groin area. Sometimes, pain due to injuries from other parts of the body, such as from the leg, can be felt in the groin area.

• To diagnose athletic pubalgia, a medical professional will do a thorough examination of the symptoms, will ask for a detailed history, and will do a physical examination of the individual.

• Physical examination includes sit-up exercises and flexing abdominal muscles against resistance. These exercises will be painful if the individual has a sports hernia.

What Are the Other Investigations?

• Magnetic Resonance Imaging.

• X-ray.

• Ultrasound.

• CT scan.

• Bone scan.

How Is Inguinal Ring Disruption Treated?

Sports hernia or inguinal ring disruption is treated either by non-surgical or surgical methods. A medical professional will first prefer a non-surgical method for treatment. Once this procedure does not respond, then they will refer for surgery. The goal of the treatment includes rehabilitation, relieving pain, restoring motion, restoring function, and returning to sports and activities. The treatment option depends on the severity of the injury, age, health, and the level of activity the person wants to return to.

What Is the Non-surgical Treatment Plan?

• Rest: A proper rest for seven to ten days will relieve the symptoms slowly.

• Ice: Ice compression is given for the first few days after injury to reduce swelling.

• Physical Therapy: Two weeks after the injury, the physician will teach exercises to improve the strength and flexibility of the abdominal and inner thigh muscles.

• Anti-inflammatory Medications: Ibuprofen helps to reduce pain and can be taken according to the physician's prescription.

• Corticosteroids: If necessary, physicians will prescribe this medication. It is an anti-inflammatory drug.

What Are the Surgical Options to Treat Inguinal Ring Disruption?

If the pain does not subside two to six months after non-surgical treatment, then surgery is the only way to get rid of the symptoms. The surgical options are:

• Laparoscopic Surgical Procedure: It is a minimally invasive procedure done with the help of a camera. The machine has a slender tool, and a camera is attached at the end. A small incision (cut) is made through which a camera is sent inside that telecasts the inner organs. Another incision (cut) is made through which surgical tools are sent, and surgery is performed.

• Open Surgical Procedure: In this procedure, the incision (cut) is made along the skin and tissues, and surgery is performed with direct vision.

• Surgical Rehabilitation: After surgery, the healthcare team will provide a rehabilitation plan to regain strength and stamina.

How Do Sports Hernia Heal?

Sports hernia or athletic pubalgia does not heal on its own. It requires surgical or non-surgical procedures for recovery. Only a mild groin injury, which is not a sports hernia, will heal on its own.

What Are the Physical Therapies?

The main goal of physical therapy is to increase the strength and flexibility of the abdominal and hip muscles without making the earlier symptoms worse. Healthcare providers will plan proper physical activities that are specific to the sports and level of injury. These include:

• Core exercises.

• Stretching.

• Swimming.

• Yoga.

• Posture stability.

• Use of medicine balls.

• Use of resistance bands.

How to Prevent Inguinal Ring Disruption?

Sports hernias are difficult to prevent due to repeated exposure to stress and strain during sports. However, physical caretakers will provide preventive measures for specific sports.

• Exercise to strengthen abdominal and core muscles.

• Exercises to strengthen hip muscles.

• Exercises to reduce the strain on hip muscles.

• Exercise to increase the flexibility of the hip and abdominal muscles.

What Is the Recovery Time for Sports Hernia?

The recovery from sports hernia or athletic pubalgia depends on the type and severity of the injury. In general, a person who underwent nonsurgical physical therapy treatment will recover within six to eight weeks. A person who underwent laparoscopic or open surgical treatment will recover between six and twelve weeks. In some cases, there may be repeated injury to the area, and surgery has to be done again.

When to Visit a Doctor?

Sports hernia will not resolve on its own. Once the person experiences symptoms, they should consult a medical professional and get treated. During treatment, when the symptoms get worse, the person should inform the healthcare provider and get treated.

Conclusion:

Chronic pain in the lower abdomen or groin region is not normal. For a person experiencing pain in this region for a longer time, be sure to visit the physician and get diagnosed at the earliest. Sports hernia will not recover on its own and needs time management. Once after recovery, it is important to follow healthcare instructions to avoid repeated injury and give time to the body to heal and return to activity.