1. Understanding Sports Hernia
Michael Boyle

2. 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 outcome stats.
Many of the “repairs” being done today will look like the lateral releases or the 80’s.

3. 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.

4. 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.

5. 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”?

6. The Three I’s Ingest Inject Incise
Make sure you have exhausted all options prior to surgery.

7. A Different Thought?

8. Solution?

9. Trim the Door or Fix the Cause?

10. 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?

11. The Problem
The sports hernia is like a “shin splint” or a “groin pull”
Sports hernia is a non-specific diagnosis

12. 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

13. Groin Pulls?
Groin is another non-specific term used to describe all of the muscles that flex and adduct the hip.

14. 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)

15. Flexion / Adduction

16. 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.

17. Fake Hip Flexion w/ Pelvic Implications

18. “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.

19. Potential Rationale For Neglect
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?

20. Potential Training Related Causes
Technology- bikes, climbers, rowers
Sports hernias were relatively unheard of 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.

21. 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

22. Long Adductors

23. Short Flexors- Sagittal

24. Prevention 1- Screening
FMS, Hurdle Step appears to be the key problem pattern

25. Prevention
2- Aggressive soft tissue work. Regular maintenance

26. Prevention
3- Static Stretching/ Hip Mobility

27. Prevention
4- Proper Warm-up ( Dynamic Mobility)

28. Activation

29. Prevention
5- Run don’t jog, avoid technology

30. Prevention
6- Slideboard in the off-season

31. Prevention
7- Sled Crossovers

32. Prevention
8- Single Leg Strength

33. Functional Anatomy

34. Prevention
9- Specific Strength-P1 Limit Compensation

35. Add Stability Demand

36. Add Flexion/ Adduction Component

37. Multi-planar Deceleration

38. 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?”

39. Anti-Extension?

40. Anti-Rotation

41. Diagonal Patterns

42. 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.