DEAR MAYO CLINIC: My 17-year-old son plays high school soccer. After a recent game, he began complaining of pain in his lower abdomen that radiates down to his inner thigh. His primary care physician believes he has a sports hernia. What is this condition, and how is it treated? What other sports injuries cause groin pain?

ANSWER: A sports hernia is a type of core muscle injury that occurs when there is weakening or a tear in the lower abdominal wall or the tendons that attach muscles to your pelvis. Although it can be found in a similar location to an inguinal hernia, typically, there is no bulge of the intestine protruding through the weakened spot in the abdominal wall. For this reason, the term "sports hernia" is somewhat of a misnomer.

Because of the location and muscles and tendons involved in the injury, patients usually feel pain in the abdomen or groin that can shoot down the inner thigh. Like your son, most patients can tell exactly when the pain first started. This injury is most common in athletes who participate in sports that involve quick changes in direction or twisting of the hips, like hockey, soccer, tennis and football. Males are more likely to develop a sports hernia than females.

A physical exam, often coupled with imaging, and occasionally diagnostic injections, is needed to determine whether the pain is caused by a sports hernia or a different type of injury. MRI and ultrasound are two diagnostic tools commonly used. Occasionally, diagnostic injections are used to numb specific areas of the abdomen or groin to see whether the pain subsides. This helps narrow the potential location of the injury.

Once a sports hernia is diagnosed, physical therapy typically is recommended as a first-line treatment. For cases that don’t resolve with conservative treatment, surgery may be recommended. Similar to a traditional hernia repair surgery, a piece of mesh is placed to reinforce and strengthen the weakened or torn area. This also allows scar tissue to form, which helps the injury to heal while alleviating the pain. These repairs can be performed through an open procedure or laparoscopic, minimally invasive techniques.

In addition to sports hernias, two other conditions commonly cause groin or abdominal pain in young athletes.

Hip impingement: This broad term describes conditions in which the ball and socket of the hip joint don’t fit together properly. Hip impingement can lead to a loss of internal rotation of the hip, which can trigger pain in the groin area during or after flexing the hip. Impingement also can tear the labrum — a fibrous ring of cartilage surrounding the hip socket — which also can cause groin pain.

For mild to moderate cases, nonsurgical treatment, such as activity modification, pain medication, physical therapy and cortisone injections, often is attempted first. If that doesn’t help or if the case is more severe, arthroscopic or open surgery may be used to reshape the bones or repair the labrum.

Hip adductor injury: This includes hip adductor tendinopathy, a condition in which the tissue connecting muscle to bone becomes chronically inflamed, or a hip adductor strain, which is when the adductor tendon or muscle is torn at or near the attachment point within the hip.

A wide range of treatments may be offered based on the injury's severity or complexity. Nonsurgical options include cortisone injections to quickly reduce pain and inflammation or platelet-rich plasma injections to try to stimulate healing.

If nonsurgical treatments don’t help or the injury is more complex, an adductor release surgery may be considered. This is when the tendon is cut or lengthened near its attachment to the hip bone. The adductor is still attached through the underlying muscles, but the procedure releases tension in the tendon, allowing the strain or inflammation to heal.

Traditionally, this procedure is done through an open surgery. In recent years, Mayo Clinic sports medicine physicians have developed a minimally invasive, ultrasound-guided option that uses a cutting thread to release the adductor through a needle.

If your child is diagnosed with a sports hernia, consider consulting a pediatric surgeon or sports medicine physician specializing in this condition to decide on a treatment that best suits the situation. A multidisciplinary team approach can help patients receive an accurate diagnosis and personalized treatment plan for core muscle injuries. — D. Dean Potter Jr., M.D., Pediatric Surgery, and Jacob Sellon, M.D., Sports Medicine, Mayo Clinic, Rochester, Minnesota

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