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Athletic pubalgia has been known by various terms over the years, including sports hernia, core muscle injury or inguinal disruption. This condition is a result of chronic wear or overuse when the adductor, or inner thigh muscles generate greater forces than the lower abdominal muscles resulting in injury (Jose et al, 2014).
Pain is felt primarily in the groin and lower abdominals, but may radiate toward the perineum and inner thigh. Pain is exacerbated by athletic activity such as kicking, cutting, and sprinting, but improves with rest.
Despite the historical term ‘sports hernia’ being used, athletic pubalgia does not cause a visible bulge in the groin, as there is no true hernia as seen with the more common inguinal hernia.
A thorough history and a physical examination is needed to differentiate the presence of athletic pubalgia from similarly presenting injuries. A physical examination will assess the location and severity of pain while observing for tenderness. The patient will be put through various resisted movements testing the hip and core, looking for symptom exacerbation.
Diagnostic anesthetic injections may also be utilized to determine the primary source of groin pain. Ultrasound can help visualize the adductor and abdominal muscles, and magnetic resonance imaging (MRI) can help assess the bone of the pelvis for any stress reactions or bony swelling (edema). An MRI may be ordered to rule out similar pathology and confirm the presence and location of soft tissue injury.
Management of athletic pubalgia depends on pain and severity. Mild symptoms can be treated with rest, NSAIDs, and physical therapy. Nonsteroidal anti-inflammatory drugs (NSAIDs) are used for pain relief and physical therapy may be utilized once the injury has begun to heal, to improve strength and flexibility in the abdominal and inner thigh muscles.
Depending on location of injury, steroid injections into the pubic symphysis or adductor tendons can be coupled with therapy and should be considered prior to surgery (Jose et al, 2014).
More recently, PRP has been considered for treatment of core muscle injuries as a viable non-operative treatment before considering surgery (Kraeutler et al, 2021). The scientific literature regarding these regenerative injections is currently limited to case reports.
In moderate to severe cases, or in cases that do not respond to conservative treatment and steroid injections, surgical repair may become necessary to repair the torn tissues.
Jose, J., Buller, L. T., Fokin, A., Wodicka, R., Subhawong, T., & Lesniak, B. (2015). Ultrasound-guided corticosteroid injection for the treatment of athletic Pubalgia: A series of 12 cases. Journal of Medical Ultrasound, 23(2), 71–75. https://doi.org/10.1016/j.jmu....;
Kraeutler MJ, Mei-Dan O, Dávila Castrodad IM, Talishinskiy T, Milman E, Scillia AJ. A proposed algorithm for the treatment of core muscle injuries. J Hip Preserv Surg. 2021 Dec 10;8(4):337-342. doi: 10.1093/jhps/hnab084. PMID: 35505804; PMCID: PMC9052413.