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Sports Hernia and the Runner | Boddicker Performance

Filed under: corrective exercise, injuries, Running

Sports Hernia and the Runner

by on Jan 23rd, 2009

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In my career, one thing has stood in the way of me being able to train consistently and race well.  It’s caused me to miss more days of training and caused more frustration for myself, coaches, and teammates than anything else I’ve experienced.  There is nothing worse than getting through a winter, ready to step onto the track and run some personal bests, only to have the rug swept from underneath you sending you crashing to the floor along with the fitness you worked so hard to develop.  It’s happened to me, and it seems to be happening more and more among the running community.  So what am I talking about?  Athletic pubalgia or sports hernia.

Again this week, I am inspired by Mike Boyle and his articles Understanding Hip Flexion, and Understanding Sports Hernia Parts I and II.  In Part II, he goes into his rehabilitation strategy with sagital plane movements progressing to frontal plane motion and finally adding in some transverse plane motion while concurrently increasing anterior hip range of motion and velocity steadily.  He mentions that velocity is the killer to an otherwise successful rehabilitation program.  Now instead of reading the whole series of articles to you, I’m going to add in my two cents that will help runners overcome the pain and limitations of sports hernia with minimal chance of recurrence.

1.)  Take the time to rehab proactively.  The tendency is to just rest and maybe cross train a bit until the pain goes away.  The athlete and support team erroneously assumes that the issue is healed because the pain is gone, and beings to train hard again, leading to a recurrence. Instead of just resting and haphazardly cross training, an athlete needs to address tissue quality, length, and function of the tissues above and below the injury site at first.  This means you’ll need to get a good soft tissue therapist, make friends with a foam roll, and find someone who can help you fix the inefficiencies that led to your problem to begin with.

2.)  Avoid pool running.  The motivated athlete will almost always want or NEED to train, and because people have read about the benefits of pool running, that’s ususally their go to method.  The problem with pool running, though, is that it puts to much stress on the already dysfunctional hip flexor complex and interferes with proper recovery and the necessary regrooving you should be doing for you hip flexors.

3.)  Pay attention to your posture throughout the day.  Nothing new here.  You spend an hour or two a day training, but you’ve got the rest of the day to screw up what you’ve accomplished.  I have found that sitting with a flexed spine and for long periods of time greatly increase pain and interfere with recovery.  Stand up frequently and move around often.

4.)  Activate your posterior chain.  Sitting for long periods takes your glutes out of the equation, which is not a good thing.  First, they are your main motors of hip extention during the running gait, they protect your back, and, most importantly in hip pain cases, they pull the head of the femur back (something that the hamstrings cannot do) during hip extention.  This is called anterior femoral glide syndrome, and can create significant pain due to the repeated contact of the femoral head and the hip socket.

5.)  Speed kills.  Nothing will bring a recurrence of hip pain back around like increasing movement velocity too quickly.  We need to gradually allow the body to adapt to higher and higher speeds.  Once a runner can jog pain free, we’ll let that happen in small doses.  Then slowly over time, we will begin to add 10k, 5k, and maybe 3k paced runs with significant recovery periods to allow the athlete to run faster, but without too much metabolic waste build up.  If an athlete insists he is ready to go mid-season, we’ll usually race them up in distance. Overall volume is limited as well.

6.)  Watch the ice.  For athletes who live in a cold climate where it frequently ices and snows, care must be taken to avoid running and walking on ice.  Too much stress is placed on the adductors to provide stability over ice, and will interfere with good recovery.

7.)  Avoid hills.  At least initially, it would be a good idea to keep off the hills, especially harder or faster repetitions as it is far too stressful on the recovering area.  Throughout my career, I have vascillated between a love of hill repetitions for the metabolic demand and lower speeds, and a hatred due to the stress they put on the hip.  I’ve now concluded that a healthy, well maintained hip flexor/adductor complex can handle hills just fine, while the poorly taken care of hip should stay completely away from hill repetitions.

8.)  Pay attention to details.  Complete a proper dynamic warm up before all runs.  Take care of tissue quality.  If it hurts, stop.  Keep control of your speed.  Stretch what’s needed.  Activate the right tissues.  The little things will get you healty and injury free a lot quicker and ideally forever.

9.)  Don’t be afraid to take a step back.  If you have progressed quite well and can begin to run a bit more and faster, but then start to feel a little more pain, take a step back.  Again, it’s far better to take a few days or weeks more taking care of your body then getting pretty fit before the season and then injured, only to miss the rest season with another stint of rehab.

There you have it.  Nine tips to get you back running pain free and more powerful than ever.  Again, thanks to Mike Boyle for the inspiration and your outside the box thinking.  If you have any questions, please let me know.

Train hard, train smart,

Carson Boddicker

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Leave a Comment »10 Comments
  • Tim March 7, 2009

    Carson — Thanks for the good info. I’m 58 yrs old, and was still playing basketball until 2 weeks ago. Seems like I probably have the sports hernia.

    Yours is the only website I can find that considers living without surgery. I’ve looked and looked for web posts of people with good surgical outcomes, but find only posts of people that had problematic outcomes with surgery. But it’s not in my nature to be attracted to surgery as a solution to such a delicate complex problem anyway.

    Anyway, I think I’ll be trying to do it your way. I especially noted your advice about not sitting all day. All of us who use the internet probably do a lot of sitting. Maybe that’s why sports hernia is getting so common these days (merely surmising, of course). An injury that would normally heal becomes chronic with sitting all day..

    Thanks very much for a good article that seems to make sense to me.

    Tim

  • Donnie April 9, 2009

    I agree with Tim. It is just ironic that I develope these symptoms of a sports hernia around the same time that I spend countless hours on facebook. Anyway, Carson thanks for the information. I just went to a doctor today and was told to give up running for a few months. I am devastated but just want this thing to heal. Also, to be able to get out of bed normally instead of rolling out.
    About running…..my pain in the groin area seemed to only be noticeable after the first mile….then it would subside. Is that normal?

  • Carson Boddicker April 10, 2009

    Tim,
    I believe that if you’re willing to take the time to do things right, surgery is not necessary. One piece of advice that will be huge to your return is to enlist the help of a qualified soft-tissue practitioner. A few things to ask before hiring one: their experience with similar cases, willingness to work in the high adductor/inguinal fold area, and also the style of work that they will use. Unfortunately there are many LMTs who are simply uncomfortable doing work on the adductors or when they do it is imply a little bit of efflurage, which is not deep or aggressive enough to make a big difference. Furthermore, a well designed corrective exercise program including mobility, self-soft tissue work, strength, and stability work is irreplaceable in regaining function quickly.

    Regards,
    Carson Boddicker

  • Carson Boddicker April 10, 2009

    Donnie,
    Absolutely. Glad you stopped by. As to the sitting, I have found a correlation between time spent sitting and recovery time. It simply reinforces typical lumbo-pelvic dysfunction.
    Are you saying that the pain is only present the first mile and then it goes away or that you feel no pain for the first mile but then you begin to feel the pain?

    -CB

  • tom April 17, 2009

    Carson, thanks for the encouraging information. I’ve had a sports hernia for two months now and was also undecided about the surgery vs rehab options. REading your post has made me decide to try the rehab route. I find I can do light runs at the moment with only minimal flaring up, but my question is: are swimming and/or yoga good options for rehab? Does anyone else have an opinion/experience with this?

    Tom

  • Carson Boddicker April 18, 2009

    Tom,

    Thanks for reading. Glad I could be of some assistance. Light runs can usually be accomplished without issue a few weeks post-injury, however, as much as people don’t want to stop, the light running can actually make things a bit worse from a motor patterning and activation standpoint. Unless you are really hammering the psoas and glutes with some activation work (generally) as well as considerable soft tissue and ROM work on the adductors and lower hip flexors, you’re just reinforcing the patterning that led to issue in the first place. I wrote a post a while back about returning to running following injury, and would recommend that you try some quicker 60-80m extensive tempo runs in place of most of your easy running and also hammer the appropriate mobility, stability, and strength work in the weight room.

    As to yoga and swimming. It depends. Typically, I’m not a huge fan of yoga simply because there is a delicate balance between mobility and hypermobility, and yoga tends to strive for hypermobility in the wrong places. I have noted in many cases of SH in runners that due to a loss of hip range of motion in extension (weak glutes, tight hip flexors), they begin to try to get that extra range by going into external rotation and lumbar rotation. While external rotation is not necessarily a bad thing, it tends to greatly reduce an athlete’s ability to internally rotate the femurs, which is a risk factor for SH injury and recurrence. Swimming can be beneficial to a degree, however, I’ve found that the breast stroke kick to be too much for the adductors, which tend to be really balled up in SH. In a flutter kick, you’re also not getting a whole lot of hip extension ROM and your flexion ROM is too small. Again, if you’re doing the right things outside the pool you can mitigate it, but without the interference of running or swim, you’ll be able to correct things much more quickly and then you can just train to maintain what you’ve achieved. Typically for conditioning purposes, which for a runner with SH (stereotypically he hasn’t had an off-season for the last 10 years) I sometimes may keep at very little, I’ll use high rep medicine ball work, bodyweight circuits, jumping rope, and various barbell combinations or a mix of all the above modes.

    Let me know if I can help you any further.

    Best regards,
    Carson Boddicker

  • Evan Kern October 24, 2009

    Sports Hernia patient recovering from bilateral surgery where they inserted mesh to both sides. 6 weeks out I could do light running. 8 weeks out mileage started to increase. 14 weeks out felt like I could turn it back up a notch. 16 weeks out, bam, I am feeling symptons of the Sports Hernia again. I also tried a year of Physical Therapy prior to surgery without any luck. Anytime I take an extended period of time off I can get back out and slowly increase my mileage only to have the symptoms return, prior to surgery and after surgery. I am assuming the repetitive motion of running aggravates the injury and I am feeling as if there will be no resolution to the problem. It took almost a year to diagnose the Sports Hernia and although I hear about all of the professional athletes coming back from Sports Hernia surgery none of them are runners with that continuous repetitive motion to the same area. Anybody have any thoughts!! Not sure if have just aggravated the injury and need time off but it took over six months off last time just to train for less than two months for it to reoccur!!! Very disheartening!!!!

  • Mark January 6, 2010

    Not sure if this is my problem or not… Pain in lower ab muscles (not groin) primarily when I run.

  • Pattie Beers February 15, 2010

    Hi I had surgery in Philly in Nov for an athletic pupalgia I was told I had a large tear and alot of scar tissue. Dr M told me he repaired it and cleaned up all of the scar tissue. The first few weeks the original pain was gone just real sore from surgey. Now three months in I am back to the original pain I can’t even bend to brush my teeth without pain. I had surgery on my foot years ago and they told me that I made alot of scar tissue that was really tough. Could this be causing my pain and if so am I doomed to suffer all of my life. Can anyone give me some input or hope. Thankyou Pattie

  • Shams Mirza September 11, 2010

    Carson, i am a 44 year old guy with active sports life style. I Jog and lift weights. A week back, i believe i have developed symptoms of Sports Hernia, although i can still run and lift weights without pain. All I want to know is whether I should take a complete rest and for how long or should I continue to engage in jogging and lifting weights especially squats.

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