Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

34. Patient with Groin Pain After an Athletic Event
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Table 34.1. Sports hernia repair postoperative protocol.
Phase I: Immediate postoperative phase (weeks 0–2)
Pain and edema control, gentle stretching, walking
Phase II: Intermediate postoperative phase (weeks 2–3)
Gentle strengthening/pelvic stabilization, light exercise (pool, bike)
Phase III: (Weeks 3–4)
Range of Motion, strengthening, dynamic core training, straight plane jogging
Phase IV: (Weeks 4–5)
Light sport specific activity, plyometrics, interval bike training
Phase V: (Weeks 5–6)
Return to full sport activity
General recommendations
Avoid trunk hyperextension for first 2 weeks
Avoid hip extension past 0° for first 2 weeks
Avoid crunch and lifting activities for first 6 weeks
Pain and edema control, ice 3–4 times per day as needed for first week, as
needed thereafter
Return to work and sport to be determined on an individual basis by the
physician and physical therapist
Outcomes and Discussion
Chronic groin pain in the athlete can be disabling and in some cases
career-ending. The exact cause is debated but is theorized to be due to
repetitive loading of the pubic symphysis, leading to symphyseal degeneration
and loss of mechanical stability. Shearing forces across the pubic
symphysis are more prominent in athletes with an imbalance between
the strong adductor muscles of the thigh and the relatively weaker lower
abdominal wall musculature. These factors are believed to cause weakness
and attenuation of the transversalis fascia portion of the posterior
wall of the inguinal canal. Weakness in the inguinal floor can lead to
localized bulging and compression of the genital branch of the genitofemoral
nerve, which is believed to be a source of pain in these patients.
Other proposed pathophysiologic mechanisms of injury remain an area
of debate and include disruption of the conjoined tendon as well as tears
of the rectus abdominis and adductor longus aponeurosis at the point of
insertion on the pubis [ 1 ].
A number of surgical approaches have been utilized to address the
above anatomic abnormalities. All focus on repair or reinforcement of