Presentation on theme: "Return to Play from Sports Hernia"— Presentation transcript:
1Return to Play from Sports Hernia ByTad Leusch MS ATC
2Quick Overview of Sports Hernias Sports hernias are different from other hernias in that they are not easily identified by an exam or imaging technology. They may only show up as groin pain that occurs during physical activity and disappears during inactivity. A tear in the Transversus abdominis is responsible for this hernia.
4What are the symptoms of a sports hernia? A sports hernia typically begins with a slow onset of aching pain in the lower abdominal region. Symptoms may include:Pain in the lower abdomenPain in the groinPain in the testicleTypically the symptoms are exacerbated withRunningCuttingBending forwardSports hernias are found in many types of athletes most commonlyHockey playersFootball playersSoccer players
5How is a sports hernia diagnosed? There are no diagnostic tests that can be used to detect a sports hernia. The diagnosis is made by the patient's history and physical examination. Other tests may be performed to rule out other causes of groin pain.
6What is the treatment of a sports hernia? Conservative TreatmentIceRestAnti-inflammatory medicationsPhysical TherapySurgeryInvolves a patch of mesh-like material, held in place with surgical tacks.Rehabilitation from surgery for a sports hernia usually takes about eight weeks.
7Subject Male 21 year old D1 College football player Position: CornerbackDemands of position: Linear running to explosive change of direction movements, backpedaling and opening of hips to change direction
8HistorySymptoms began approximately 1 year prior to August 2008 surgery dateReported to the athletic training room following practiceStated he felt a pop in his right groin during practiceNo bulge was notedNo bruising was notedStrength was 4/5ROM was equal compared bilaterally
9Conservative Management Athlete was allowed to return to play and continue normal weight training scheduleDuring this time he was receiving treatment for his pain which included:HeatModalities (estim and ultrasound)Stretching of the groin, hip flexor, abdominals, piriformisSoft tissue release techniques including:Foam rolling of leg and pelvic girdleSoftball rolling over involved side hip flexor and groin and well as piriformisStrengthening exercises such as:4 way hip movements(adduction, abduction, flexion and extension)Seated internal and external hip rotation with therabandBall squeezes with leg liftsSwiss ball core strengthening exercises
10Post Season StatusWith conservative management, athlete was able to participate in all activities but felt limited due to painDuring the 4 week winter break period, athlete was instructed to go home and restIf he felt his pain decrease, he was instructed to begin straight ahead jogging in order to maintain a level of fitness
11Progress following 4 weeks of rest When athlete return to campus, he stated that he was almost pain freeA slow return to play progression was initiated which included:Progression of linear running which went wellProgression of explosive cutting drill during which pain returned which halted progressionAthlete was re-examined in March at which time an MRI was obtainedNo hip pathology notedReceived a cortical steroid injection at the pubis symphysis which provide some relief
12With the relief of pain following injection, running progression was initiated again Athlete was able to achieve about percent of speed before pain returnedEven with a significant amount of rest, anytime athlete would state his symptoms were decreasing and activity was ramped up, pain would returnThis patterned continue on through the summer until athlete was unable to participate in any of the team workouts
13Chief Complaints that Lead to Surgery After approximately 1 year of conservative treatment, athlete was not able to fully engage in all activitiesPain became localized in the right groin areaPain with squattingPain in lower abdominal area with core strengtheningPain with explosive change of direction movementsAthlete was re-examined by the team physician and it was determined that he needed to be referred to Dr. Brad Pierce, a recognized surgeon that deals with sports hernias
14Rehabilitation following Sports Hernia Repair Research in this area is sparseProtocol is very openGenerally speaking return to full activity is projected at 6 weeksTypically we have been able to progress athletes back to full activity by weeks
15Surgeons Protocol for Rehabilitation Straight line physical activity only for first 3 weeksStart out with low impact exercisesBy week 3 athlete should be back to jogging and runningRe-introduction of sporting activities between week 4 and 6Continue core strengthening and flexibility treatments
16First 10 days following surgery Athlete was seen approximately 3 days following surgeryAthlete was in noticeable pain upon entering the athletic training roomWalked with a slightly forward hunch due to painInitial treatment consisted of ice to control painAfter approximately 10 days following surgery, athlete was able to walk with normal gait and mild pain
172-3 weeks Post OpWeek 2 athlete was able to walk on treadmill for 10 minutesExercises consisted of:Isometric core strengtheningGentle abdominal stretchingIce following rehabilitation sessionWeek 3Pace was increased on treadmill but still at a walking paceProgression of core strengtheningBody weight movement such asLungesSide lungesAt week 4 athlete began to notice an increase in painActivity level was decreased until pain subsided: approximately 2 weeks
18Weeks 4-7After pain subsided, athlete resumed progression of exercisesCore strengthening and machine upper body exercises which did not create a valsalva maneuverBody weight movements progressed into movements with weightLungesSquatsSide lungesAfter approximately 4 weeks, athlete was able to transition to weight room activities
19Weeks 8-9 At week 8 athlete began running progression Week 8 linear progression55 yard running (jogging to running)Cross Field’sBuild upsWeek 9 Add in slow tempo change of directionBox drill90 degree cutting drillsX pattern drills
20Weeks 10-12 Week 10 Week 11 Week 12, athlete was given a recovery week Weeks 10 was a progression of tempo during linear and change of direction exercisesBegin to incorporate position specific drillsWeek 11Continue drills from week 10Add reactionary change of direction movementsWeek 12, athlete was given a recovery week
21Weeks 13-16At week 13, athlete was allowed to progress into football practice activitiesIndividual drills for first 2 practicesIndividual drills and 7on7Individual drills, 7on7, and 1on1No limitations by the middle of the 16th week
22Why Twice As Long Increase in pain during week 4 Demands of the sport Mentality of the athleteAs a Sports Medicine Staff we try to account forAmount of whole body de-conditioning an athlete may haveMake sure that the athlete can tolerate activity levelMake sure not to rush return which may lead to other injuries