Kategoriarkiv: Sportman’s hernia

cause-article2

Sportman’s hernia

SportNetDoc

Lower abdominal pain syndrome in national hockey league players: a report of 11 cases.

Lacroix VJ, Kinnear DG, Mulder DS, Brown RA. Clin J Sport Med 1998 Jan;8(1):5-9.

PURPOSE.
Groin injuries are a major diagnostic and therapeutic challenge in sports medicine. The aim of this review is to describe the clinical and surgical findings associated with an atypical lower abdominal pain syndrome occurring in elite ice hockey players.

CASE SUMMARIES.
Eleven professional ice hockey players from various National Hockey League teams were referred to the Montreal General Hospital between 1989 and 1996, suffering from atypical refractory pain and paraesthesia in the lower abdomen. Despite the use of conventional investigative procedures such as physical examination, ultrasound, bone scan, computed tomography scan, and magnetic resonance imaging scan, preoperative findings were consistently negative. Operative findings revealed varying degrees of tearing of the external oblique aponeurosis and external oblique muscle associated with ilioinguinal nerve entrapment. Repair of the external oblique tear, ablation of the ilioinguinal nerve, followed by a 12-week planned course of physiotherapy allowed all to return to professional ice hockey careers.

DISCUSSION.
While soft tissue injuries are the most common cause of groin pain in the athlete, tears of the external oblique aponeurosis and superficial inguinal ring have rarely been cited as a consistent cause of lower abdominal pain in athletes. Inguinal nerve entrapment is also rare in patients without a history of previous lower abdominal surgery.

RELEVANCE.
These 11 cases emphasize the importance of including another diagnostic possibility in the differential diagnosis of chronic overuse injuries of the lower abdomen.

cause-article1

Sportman’s hernia

SportNetDoc

The sportsman’s hernia–fact or fiction?

Fredberg U, Kissmeyer-Nielsen P . Scand J Med Sci Sports 1996 Aug;6(4):201-4.

This review is based on the results of 308 operations for unexplained, chronic groin pain suspected to be caused by an imminent, but not demonstrable, inguinal hernia: the ‘sportsman’s hernia’ (SH). No differences in perioperative findings between cured and non-cured athletes were found. However, there was a remarkable difference between the various perioperative findings in the studies. It was characteristic that further clinical investigation of the noncured, operated athletes gave an alternative and treatable diagnosis in more than 80% of cases. Herniography was used consistently in the diagnostic process in all the studies on SH. However, in 49% of cases hernias were also demonstrated on the opposite, asymptomatic groin side. In conclusion, the final diagnosis (and treatment) often reflects the speciality of the doctor and the present literature does not supply proper evidence to the theory that SH constitutes a credible explanation for chronic groin pain.

examination-article

Sportman’s hernia

SportNetDoc

Sportsman’s hernia.

Fon LJ, Spence RA. Br J Surg 2000 May;87(5):545-52.

BACKGROUND.
Sportsman’s hernia is a debilitating condition which presents as chronic groin pain. A tear occurs at the external oblique which may result in an occult hernia. The definition, investigation and treatment of this condition remain unclear.

METHODS.
A systematic Medline search was performed and all literature pertaining to chronic groin pain, groin injury, sportsman’s hernia and sportsman’s groin from 1962 to 1999 was retrieved for analysis.

RESULTS.
The costs of computed tomography and magnetic resonance imaging are such that their routine use for assessment of patients with groin pain cannot be justified. They may, however, be employed in difficult cases to help define the anatomical extent of a groin injury. Plain radiography, ultrasonography and scintigraphy should be the usual first-line investigations to supplement clinical assessment. Herniography may help in situations of obscure chronic groin and pelvic pain. There is no consensus view supporting any particular surgical procedure for sportsman’s hernia. A number of reports have been published describing different repairs of the posterior inguinal wall deficiency. Appropriate repair of the posterior wall results in therapeutic benefit in selected cases.

CONCLUSION.
The diagnosis of sportsman’s hernia is difficult. The condition must be distinguished from the more common osteitis pubis and musculotendinous injuries. Early surgical intervention is usually, although not always, successful when conservative management has failed.

KONDITION

step4

Sportman’s hernia

[Back]

Training ladder for:
“SPORTSMAN’S HERNIA”
(SPORTSMANN’S HERNIA)

STEP 4
The rehabilitation program is built up in the same manner as other chronic groin injuries, as “Sportsman’s hernia” is seldom a normal, uncomplicated inguinal hernia.
KONDITION
Unlimited: Cycling. Swimming Running on a soft surface.

UDSPÆNDING
(10 min)

Lie on your back. Draw the injured leg up towards your head so that the muscles in the back of the thigh become increasingly stretched. Perform the exercise with outstretched as well as bent knee. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be performed standing with the injured leg outstretched on a chair while the upper body is bent slightly forwards.

Stand with support from the back of a chair or the wall. Using your hand, bend the knee and draw the foot up and your knee slightly backwards so that the muscles in the front of the thigh become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be done lying down. If you lie on your stomach you can draw the foot up by using a towel.

Lie on your side on a table. Bend one leg up under your body and let the other hang over the edge of the table so that the muscles in the outer side of the thigh become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be done standing by placing the outstretched injured leg behind the good leg at the same time as bending over the injured leg.

Lie on your back with one leg outstretched and the other bent with the foot on the other side of the outstretched leg. Draw the knee up towards the opposite shoulder so that the buttocks become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Squat with the injured leg outstretched behind you as far as possible with the foot on a box. Thrust your hip forward and down without swaying your back so that the front of the hip becomes increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Stand with your hands on your hips and slowly sway your back, pushing slightly with the hands to increase the sway, so that the stomach muscles become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

KOORDINATION
(5 min)

Seesaw. Balance on two legs, possibly using a hand as support against the wall, balancing subsequently on one leg without support. Look straight ahead and keep knees bent.

Stand on the injured leg with your upper body bent forwards at 90 degrees. Lift the good leg in a straight line behind you. When you feel comfortable with the exercise, it can be made more difficult by closing your eyes.

STYRKE
(45 min)

Sit on a chair with elastic around the ankle, facing the elastic. Lift the leg and slowly bend and stretch the knee.

Sit on a chair with elastic attached to the ankle. Raise the leg and slowly stretch and bend the knee.

Lie on your side on a mattress or bench. Flex the lower part of the leg and stretch the upper part. It is important to completely stretch the hip. Lift the upper leg upwards with the heel pointing towards the ceiling. Gradually increase the load by attaching a sandbag to the ankle.

Lie on your side on a mattress or bench. Stretch the lower leg whilst the upper leg is slightly bent. Lift the lower leg stretched upwards. Gradually increase the load by attaching a sandbag to the ankle.

Stand with the elastic around the injured leg, facing away from the elastic. Move the leg forwards and slowly backwards. The elastic can be moved up and down the leg depending upon the strength of the knee – the stronger the knee, the lower the elastic should be.

Go down on all fours with elastic around one foot. Attach the elastic to the wall, lift the leg and draw the knee forwards so that the elastic is tightened.

Lie on your back with a ball or firm round cushion under the injured leg. Lift your backside up from the floor and stretch the healthy leg. Hold the position for a few seconds.

Lie on your stomach across a chair and bend both knees. Tighten your buttocks and lift your legs upwards.

Lie on your back and place your hands behind your neck. Move your head and knees towards each other. Remember not to pull on your neck during the exercise.

Lie on your back and place your hands behind your neck. Alternately move your right elbow towards left knee, and left elbow towards right knee.

Stretching is carried out in the following way: stretch the muscle group for 3-5 seconds. Relax for 3-5 seconds. The muscle group should subsequently be stretched for 20 seconds. The muscle is allowed to be tender, but must not hurt. Relax for 20 seconds, after which the procedure can be repeated. The time consumed for stretching, coordination and strength training can be altered depending on the training opportunities available and individual requirements.

KONDITION

step3

Sportman’s hernia

[Back]

Training ladder for:
“SPORTSMAN’S HERNIA”
(SPORTSMANN’S HERNIA)

STEP 3
The rehabilitation program is built up in the same manner as other chronic groin injuries, as “Sportsman’s hernia” is seldom a normal, uncomplicated inguinal hernia.
KONDITION
Unlimited: Cycling. Swimming. Light running.

UDSPÆNDING
(10 min)

Lie on your back. Draw the injured leg up towards your head so that the muscles in the back of the thigh become increasingly stretched. Perform the exercise with outstretched as well as bent knee. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be performed standing with the injured leg outstretched on a chair while the upper body is bent slightly forwards.

Stand with support from the back of a chair or the wall. Using your hand, bend the knee and draw the foot up and your knee slightly backwards so that the muscles in the front of the thigh become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be done lying down. If you lie on your stomach you can draw the foot up by using a towel.

Lie on your side on a table. Bend one leg up under your body and let the other hang over the edge of the table so that the muscles in the outer side of the thigh become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be done standing by placing the outstretched injured leg behind the good leg at the same time as bending over the injured leg.

Lie on your back with one leg outstretched and the other bent with the foot on the other side of the outstretched leg. Draw the knee up towards the opposite shoulder so that the buttocks become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Squat with the injured leg outstretched behind you as far as possible with the foot on a box. Thrust your hip forward and down without swaying your back so that the front of the hip becomes increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Stand with your hands on your hips and slowly sway your back, pushing slightly with the hands to increase the sway, so that the stomach muscles become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

KOORDINATION
(5 min)

Seesaw. Balance on two legs, possibly using a hand as support against the wall, balancing subsequently on one leg without support. Look straight ahead and keep knees bent.

Stand on the injured leg with your upper body bent forwards at 90 degrees. Lift the good leg in a straight line behind you. When you feel comfortable with the exercise, it can be made more difficult by closing your eyes.

STYRKE
(45 min)

Sit on a chair with elastic around the ankle, facing the elastic. Lift the leg and slowly bend and stretch the knee.

Sit on a chair with elastic attached to the ankle. Raise the leg and slowly stretch and bend the knee.

Lie on your side on a mattress or bench. Flex the lower part of the leg and stretch the upper part. It is important to completely stretch the hip. Lift the upper leg upwards with the heel pointing towards the ceiling. Gradually increase the load by attaching a sandbag to the ankle.

Lie on your side on a mattress or bench. Stretch the lower leg whilst the upper leg is slightly bent. Lift the lower leg stretched upwards. Gradually increase the load by attaching a sandbag to the ankle.

Go down on all fours with elastic around one foot. Attach the elastic to the wall, lift the leg and draw the knee forwards so that the elastic is tightened.

Stand with the elastic around the injured leg, facing away from the elastic. Move the leg forwards and slowly backwards. The elastic can be moved up and down the leg depending upon the strength of the knee – the stronger the knee, the lower the elastic should be.

Lie on your back with a ball or firm round cushion under both feet. Roll the ball backwards and forwards in a steady pace while lifting your backside.

Lie on your stomach across a chair and bend both knees. Tighten your buttocks and lift your legs upwards.

Lie on your back and place your hands behind your neck. Move your head and knees towards each other. Remember not to pull on your neck during the exercise.

Lie on your back and place your hands behind your neck. Alternately move your right elbow towards left knee, and left elbow towards right knee.

Stretching is carried out in the following way: stretch the muscle group for 3-5 seconds. Relax for 3-5 seconds. The muscle group should subsequently be stretched for 20 seconds. The muscle is allowed to be tender, but must not hurt. Relax for 20 seconds, after which the procedure can be repeated. The time consumed for stretching, coordination and strength training can be altered depending on the training opportunities available and individual requirements.

KONDITION

step2

Sportman’s hernia

[Back]

Training ladder for:
“SPORTSMAN’S HERNIA”
(SPORTSMANN’S HERNIA)

STEP 2
The rehabilitation program is built up in the same manner as other chronic groin injuries, as “Sportsman’s hernia” is seldom a normal, uncomplicated inguinal hernia.
KONDITION
Unlimited: Cycling. Swimming. Jogging.

UDSPÆNDING
(10 min)

Lie on your back. Draw the injured leg up towards your head so that the muscles in the back of the thigh become increasingly stretched. Perform the exercise with outstretched as well as bent knee. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be performed standing with the injured leg outstretched on a chair while the upper body is bent slightly forwards.

Stand with support from the back of a chair or the wall. Using your hand, bend the knee and draw the foot up and your knee slightly backwards so that the muscles in the front of the thigh become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be done lying down. If you lie on your stomach you can draw the foot up by using a towel.

Lie on your side on a table. Bend one leg up under your body and let the other hang over the edge of the table so that the muscles in the outer side of the thigh become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be done standing by placing the outstretched injured leg behind the good leg at the same time as bending over the injured leg.

Lie on your back with one leg outstretched and the other bent with the foot on the other side of the outstretched leg. Draw the knee up towards the opposite shoulder so that the buttocks become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Squat with the injured leg outstretched behind you as far as possible with the foot on a box. Thrust your hip forward and down without swaying your back so that the front of the hip becomes increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Stand with your hands on your hips and slowly sway your back, pushing slightly with the hands to increase the sway, so that the stomach muscles become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

KOORDINATION
(5 min)

Seesaw. Balance on two legs, possibly using a hand as support against the wall, balancing subsequently on one leg without support. Look straight ahead and keep knees bent.

STYRKE
(45 min)

Lie on your back with knees bent. Lift your head and shoulder 15 cm from the floor and hold the position for a few seconds. Repeat 10 times.

Lie on your back with legs bent and a ball between the knees. Squeeze the ball between the knees while lifting your head and shoulders 15 cm from the floor, and hold the position for a few seconds. Repeat 10 times.

Sit on a chair with elastic around the ankle, facing the elastic. Lift the leg and slowly bend and stretch the knee.

Sit on a chair with elastic attached to the ankle. Raise the leg and slowly stretch and bend the knee.

Stand with the elastic around the injured leg, facing away from the elastic. Move the leg forwards and slowly backwards. The elastic can be moved up and down the leg depending upon the strength of the knee – the stronger the knee, the lower the elastic should be.

Stand on the healthy leg with the elastic around the inside of the injured leg. Move the injured leg from side to side in a slow smooth movement. Moving the position of the elastic lower down the leg can increase the load.

Stand on the healthy leg with the elastic around the outside of the injured leg. Move the injured leg from side to side in a slow smooth movement. Moving the position of the elastic lower down the leg can increase the load.

Lie on your stomach across a chair and bend both knees. Tighten your buttocks and lift your legs upwards.

Lie on your back with a ball or firm round cushion under both feet. Raise your backside up from the floor and hold your feet on the ball. Hold the position for a few seconds.

Go down on all fours with elastic around one foot. Attach the elastic to the wall, lift the leg and draw the knee forwards so that the elastic is tightened.

Stretching is carried out in the following way: stretch the muscle group for 3-5 seconds. Relax for 3-5 seconds. The muscle group should subsequently be stretched for 20 seconds. The muscle is allowed to be tender, but must not hurt. Relax for 20 seconds, after which the procedure can be repeated. The time consumed for stretching, coordination and strength training can be altered depending on the training opportunities available and individual requirements.

KONDITION

step1

Sportman’s hernia

[Back]

Training ladder for:
“SPORTSMAN’S HERNIA”
(SPORTSMANN’S HERNIA)

STEP 1
The rehabilitation program is built up in the same manner as other chronic groin injuries, as “Sportsman’s hernia” is seldom a normal, uncomplicated inguinal hernia.

The indications of time after stretching, coordination training and strength training show the division of time for the respective type of training when training for a period of one hour. The time indications are therefore not a definition of the daily training needs, as the daily training is determined on an individual basis.
KONDITION
Unlimited: Cycling.

UDSPÆNDING
(10 min)

Lie on your back. Draw the injured leg up towards your head so that the muscles in the back of the thigh become increasingly stretched. Perform the exercise with outstretched as well as bent knee. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be performed standing with the injured leg outstretched on a chair while the upper body is bent slightly forwards.

Stand with support from the back of a chair or the wall. Using your hand, bend the knee and draw the foot up and your knee slightly backwards so that the muscles in the front of the thigh become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be done lying down. If you lie on your stomach you can draw the foot up by using a towel.

Lie on your side on a table. Bend one leg up under your body and let the other hang over the edge of the table so that the muscles in the outer side of the thigh become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be done standing by placing the outstretched injured leg behind the good leg at the same time as bending over the injured leg.

Lie on your back with one leg outstretched and the other bent with the foot on the other side of the outstretched leg. Draw the knee up towards the opposite shoulder so that the buttocks become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

KOORDINATION
(5 min)

Stand on one leg on the floor or a mattress. Look straight ahead and keep the knee slightly bent.

STYRKE
(45 min)

Lie on your back with legs bent and a ball between your knees. Squeeze your knees together for 25 seconds, and rest for 10 seconds before repeating.

Stand with the injured foot on a cloth on a smooth surface, with toes pointing straight ahead. Slide the injured leg sideways and back again. Repeat the exercise with the toes pointing to the side.

Sit on a chair with elastic around the ankle, facing the elastic. Lift the leg and slowly bend and stretch the knee.

Sit on a chair with elastic attached to the ankle. Raise the leg and slowly stretch and bend the knee.

Stand with the elastic around the injured leg, facing away from the elastic. Move the leg forwards and slowly backwards. The elastic can be moved up and down the leg depending upon the strength of the knee – the stronger the knee, the lower the elastic should be.

Stand with the elastic around the injured leg, facing towards the elastic. Move the leg backwards and slowly forwards. The elastic can be moved up and down the leg depending upon the strength of the knee – the stronger the knee, the lower the elastic should be.

Stand on the healthy leg with the elastic around the inside of the injured leg. Move the injured leg from side to side in a slow smooth movement. Moving the position of the elastic lower down the leg can increase the load.

Stand on the healthy leg with the elastic around the outside of the injured leg. Move the injured leg from side to side in a slow smooth movement. Moving the position of the elastic lower down the leg can increase the load.

Lie on your stomach across a chair and bend both knees. Tighten your buttocks and lift your legs upwards.

Lie on your back with bent legs. Lift your hip from the floor and hold the position for 5 seconds. Rest for 5 seconds before repeating.

Stretching is carried out in the following way: stretch the muscle group for 3-5 seconds. Relax for 3-5 seconds. The muscle group should subsequently be stretched for 20 seconds. The muscle is allowed to be tender, but must not hurt. Relax for 20 seconds, after which the procedure can be repeated. The time consumed for stretching, coordination and strength training can be altered depending on the training opportunities available and individual requirements.