Hernia in a footballer
This patient played Sunday league football and due to a limited training regime was perhaps not as conditioned as he might have been for the enthusiasm he brought to the game. It was during a sprint to try and stop the ball from going for a corner that he felt a pull in his lower tummy on the right. It was not more than a pull and he was able to finish the game. However, he continued to have a dull ache and some pain down into the left thigh.
This continued for some weeks, sometimes worse, sometimes better. Coughing gradually become sore as did getting in and out of the car. It was at this point that the patient went to see his GP who decided that as there was no frank bulge there was no hernia but that he had strained a muscle and would benefit from some Physiotherapy.
On assessment, the spine was normal, as was the hip and knee. The femoral nerve was tender but most specifically there was tenderness in the lower groin just above the pubic bone to the left and a palpable hollow which signifies weakness of the abdominal wall. On coughing, there was a pulse in here which again signifies that the abdominal wall is pushing through this weakness, which is a hernia or more specifically, as Sportsman’s hernia.
A Sportsman’s hernia is distinct from a true hernia in that there is no obvious bulge but the abdomen pushes through the weakness, pressing on a couple of nerves that sit in the area when the patient is stressing the area or working hard. Such as running, coughing and sneezing.
The only solution is surgical once the diagnosis has been confirmed. The best way to do this is to have an ultrasound scan in the hands of an experienced radiologist or hernia surgeon. We work closely with Mr Rob Hicks and this is who this patient was referred to.
The diagnosis was confirmed and surgery of a laparoscopic hernia repair with a mesh was performed a few weeks later. The rehabilitation from this is straightforward. Ref 1. The first week is relative rest but with a progressive core strengthing program over the next 2 weeks normal running is resumed and this patient was back playing football at the end of the fourth week after surgery.
For more information see The Hernia Clinic