Running Injury & Recovery

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GPs have a simple test which shows whether you have a large bulge and a true hernia. However, for the more subtle “sports” hernia this test is not sensitive enough.  

Symptoms of a sports hernia

The presentation of a hernia in runners is of pain just local to the lower tummy or groin and inner thigh and can be apparent when doing a session or when running quickly. There can be associated nervy symptoms like burning or pins and needles into the thigh and genitals. Often it only becomes painful after a period of time running or when working really hard. The symptoms usually stop pretty soon after you stop running and there is seemingly little to show for it.

The symptoms can, however, present themselves as a feeling of a loss of stability while at pace, a loss of power when running, or a recurrent back issue. These are the hardest to diagnose because there is often nothing painful in the lower abs.  

I have seen many in runners over the years with just a recurrent sacroiliac joint dysfunction or a feeling of tightness and weakness in the hamstring, adductor and occasionally the quadricep. When assessed there is sometimes little to find in the leg and the problem just rumbles on. However, on further examination if there is a hernia, treatment of this can resolve the thigh, core or sacroiliac joint problem.

What is a hernia?

A hernia is a weakness in the lower abdominal wall which allows the lower intestines to push into the hollow and press and stretch a couple of nerves that pass through it. This is why the pain can be referred as these nerves supply the inner thigh and genitals.

Stressing the nerves also shuts down the core muscles leading to the instability feelings and the pelvis or lower back problems. It is more common in males as this hollow is bigger to allow passage of vessels to the genitals. Typically, therefore, the hernias that are missed are in women where the symptoms are more subtle.

Tests for a sports hernia

This is not the forum to be able to show the specific test for a sports hernia which involves detailed palpation alongside scans. Nevertheless, I believe it is possible to show you where to press to see if you feel sore or a different anatomy.  It is also possible to show you where you can get a referred ache and where it should not be tender in a hernia.

The location of the sports hernia is just up and out from the pubic bone, just to the side of the lower rectus abdominus or ‘six-pack’ muscle. You will feel an indent or hollow.  

This will be a tad sore even when normal, but it should be the same amount of soreness on both sides. If there is a significant difference in the soreness or the hollow is bigger then suspect a weakness or hernia.

Note that the pubic bone is at the centre of the pelvis and just above the genitals and at the bottom of the abs.

Differential diagnosis

Such an elusive issue can often be hard to pin down and masquerade as different conditions. If you feel pain in the adductors 

then it can be referred from the groin/hernia. However, if it is tender to press here and to stretch then it is more likely to be a local muscle issue than a hernia.

Further you may feel ache in the top of the thigh. If it is tender to press and to stretch then it is unlikely to be a hernia referral.

For more specific tests on these muscles please see the Anterior Hip pain article. The images show where you may experience a referred type of ache, but not a sharp pain and tenderness as in a muscle injury.  

I appreciate this is not easy, so if you are in doubt, please get assessed by a Chartered Physiotherapist who is experienced in this condition in runners.  

Treatment for a hernia

The only sure method of treatment for a hernia is surgery. Once the weakness is there, it rarely resolves to allow the athlete to run as they wish. It is, however, a very well versed operation and rehab, and most people are doing some easy running at 10 days post-op and back to full training after three weeks.

Alternatively, it is possible to allow the nerve irritation to settle down with complete rest and embark on a program of core strength. This can be helpful in those who have perhaps not the best core stability but are running or playing sport anyway. Be honest with yourself.