Sports Hernias: What Are They?

Playing-Soccer

 

Despite its name, a sports hernia is actually not a hernia at all. The definition of a hernia pertains to the protrusion of an internal organ through the structures that contain it. True hernias are often found in regions where the organ isn’t contained by bone and where weakened or torn musculature exists. True hernias can be felt, or palpated, and this protrusion is visible to the naked eye.

 

So, Then, What Is a Sports Hernia?

In a sports hernia, there is no protrusion of internal organ, meaning it cannot be felt or seen. Instead it is caused by tears in tendons or muscles that attach to the pelvis and/or the femur. By definition, the term “sports hernia” is considered a misnomer. A more appropriate name for this condition is “athletic pubalgia,” so we’ll use that term here.

 

How Does It Occur?

There are many ways you can sustain athletic pubalgia, but most come down to overuse of smaller muscles or using muscles for a job they aren’t meant for. For example, the most commonly injured muscle is the external oblique, and it is often disrupted where the muscle attaches to the aponeurosis, which is a layer of flat, broad tendons that attach the muscle to the bones – in this case, the external oblique to the pelvis. Aponeuroses are found all over the body but are most common in the abdomen.

 

Who Gets Athletic Pubalgia?

Although athletic pubalgia can occur in any one, it is most commonly seen in athletes due to the repetitive nature of their movements. It is especially common in sports that consist of repetitive twisting (like in soccer), suddenly changing directions (football), pushing off (hockey), and prolonged turning (track). It rarely occurs suddenly, but likely has been building for a period of time. Similarly, the pain seems to creep in until it reaches the point where it prevents someone from doing normal activities.

 

Do I Have Athletic Pubalgia?

If you suspect that you may be experiencing athletic pubalgia, schedule an appointment with your doctor and, if you have direct access, schedule an appointment with a physical therapist. It can be difficult to diagnose and may require surgery to do so, but a quick checklist that you and your physical therapist can use may help to rule in or rule out the condition. The criteria for athletic pubalgia include:

 

  • Deep groin and/or abdominal pain
  • Pain that goes away with rest
  • Increase in pain when the area is touched or pushed
  • Increase in pain when pulling the leg into resistance, sudden change in direction, twisting, kicking, accelerating, or decelerating
  • Increase in pain when performing sit-ups, especially slowly
  • Pain that is on one side of the pelvis
  • Increase in pain with coughing or sneezing
  • Increase in pain when sitting for too long

 

*If you have any of these symptoms, it is important to contact your doctor for an evaluation.

 

How Is It Diagnosed?

Athletic pubalgia is difficult to properly diagnosis and, therefore, treat effectively. It can be truly diagnosed only through a minimally invasive surgery. The surgeon investigates the problem area with a camera (endoscope), and if they find it is a muscular and/or tendinous tear that is causing the discomfort, they will often perform laparoscopic surgery using the same small incision(s) to reattach the structures or repair and reinforce them with mesh lining.

 

Do I Need Surgery?

First, it’s worth mentioning that not all cases of athletic pubalgia need to be treated with surgery. Oftentimes, it is possible to manage this injury with conservative treatment. However, it should be noted that conservative treatment usually requires a slow recovery and leaves a higher chance for reinjury compared to surgery.

 

Prior to the investigative surgery, a person often goes through a trial of conservative care. Conservative care can include imaging, resting, icing, anti-inflammatory medications or injections, and physical therapy. In physical therapy, the main objective is to rule in or rule out other diagnoses through testing, assessing a patient’s signs and symptoms, controlling pain, and addressing deficits found at the patient’s initial evaluation.

 

Takeaway Points.

Sports hernias are not true hernias by definition and for accuracy should be referred to as athletic pubalgia. Oftentimes, athletic pubalgia is treated conservatively and is suspected when other diagnoses and treatments have been excluded. The purpose of imaging and visiting your physical therapist prior to surgery is to rule out other, more common injuries. If conservative care doesn’t seem to be effective, it is best to discuss concerns with your physical therapist and schedule an appointment with a surgeon. From here they can best confirm the presence or absence of athletic pubalgia through a minimally invasive procedure, but you can decide if surgery is right for you.

 

Physical therapy is very beneficial for identifying and addressing muscle imbalances and movement patterns, which can very likely lead to the soft tissue injury. Your physical therapist should tailor your treatment so you smoothly transition back into your recreational activities, sports, and/or job without pain.

 

Further Reading:

 

  1. A. F. Kachingwe and S. Grech. “Proposed Algorithm for the Management of Athletes with Athletic Pubalgia (Sports Hernia): A Case Series.” Journal of Orthopaedic & Sports Physical Therapy 38, no. 12 (2008): 768–781.
  2. C. A. Unverzaqt, T. Schuemann, and J. Mathisen. “Differential Diagnosis of a Sports Hernia in a High School Athlete.” Journal of Orthopaedic & Sports Physical Therapy 38, no. 2 (2008): 63–70.
  3. C. M. Larson. “Sports Hernia/Athletic Pubalgia: Evaluation and Management.” Sports Health 6, no. 2 (2014): 139–144.

Headaches and Neck Pain? Here’s How Your Physical Therapist Can Help!

Neck-pain-and-headaches

 

What Is a Cervicogenic Headache?

A cervicogenic headache is another name for a headache that originates from somewhere in the neck (a.k.a. the cervical spine). This is called “referred pain,” which means that you perceive the pain in a region of your body that is different from where the source of the problem actually exists. This occurs because some of the nerves that supply the neck also supply structures in the head. If you are experiencing a headache along with neck pain, then the issue might actually be with your neck.

 

The neck is made up of vertebrae that form joints that allow for movement in your neck. During certain movements of your neck, the joints, muscles, ligaments, and nerves could be getting stretched, compressed, or irritated beyond their normal tolerance. This can cause pain that is interpreted as a headache. A head/neck injury in the recent past, such as a whiplash injury or a concussion, could also refer pain that is perceived as a headache.

 

Common Symptoms.1,2,3

If you are experiencing a cervicogenic headache, you may experience one or more of the following symptoms:

  • Usually one-sided neck pain and a headache that wraps around from the base of the neck, up the back of the head, and into the front of the head
  • Headache that is not constant
  • Headache that is brought on or aggravated by certain neck movements or spending a lot of time in the same position (such as driving or sitting at a computer)
  • Tenderness at the base of the head or upper neck when pressing on it firmly
  • Discomfort in the arm that is on the same side as the head/neck pain
  • May also be associated with light-headedness, dizziness, nausea, ringing in the ears, and decreased ability to concentrate

 

Possible Causes:2,3

  • Muscle imbalances, weakness, or tightness
  • Poor posture associated with repetitive or prolonged positions at work/home, sleeping, and so on
  • Previous neck or head trauma
  • Stress

 

What You Can Expect From Your Physical Therapist:1

  • An evaluation that will examine the range of motion, strength, and posture of your neck and other surrounding body regions
  • Hands-on techniques such as stretching, pressing, and positioning to help move your neck to assess mobility
  • Exercises focusing on improving the activation, strength, and endurance of the muscles surrounding and supporting the neck
  • Patient education about your condition, what your PT can do to help, and what you as the patient can do at home to help improve

 

It is important to remember that every individual’s body is different and that everyone perceives pain differently, so if you think that you might be having cervicogenic headaches but aren’t quite sure, schedule an appointment with your physical therapist to be evaluated!

 

Please note: If you experience any of the following symptoms, it is important to call 9-1-1 for immediate medical attention, since they may be a RED FLAG for a more serious condition:2

 

  • Headaches that are progressively getting worse over time
  • Sudden onset of severe headache
  • Headaches associated with high fever, stiff neck, or rash
  • Onset of headache after a head injury
  • Problems with vision or severe dizziness

 

References:

  1. D. Childs et al., “Neck Pain: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health from the Orthopedic Section of the American Physical Therapy Association,” Journal of Orthopaedic & Sports Physical Therapy 9, no. 38 (2008): A1–34.
  2. Page, “Cervicogenic Headaches: An Evidence-Led Approach to Clinical Management,” International Journal of Sports Physical Therapy 6, no. 3 (2011): 254–266.
  3. “Headache (Cervicogenic),” PhysioAdvisor.com, http://www.physioadvisor.com.au/9273650/cervicogenic-headache-neck-headache-physioadvi.htm (accessed March 8, 2016).

Flying Somewhere This Spring? Here Are Some Healthy Tips to Remember!

Take-off

 

1.) Hydrate, hydrate, hydrate! Drinking between 8 and 10 glasses of water per day is recommended, especially when going on an airplane. Airplanes are very dry, and you don’t want to kick off your trip with dehydration (symptoms of which include muscle cramping, headaches, body aches, and nausea).

 

2.) Bring a travel pillow. Airplane seats are certainly getting comfier; however, when resting on a plane, the neck needs extra support to prevent the “neck flop” (we’ve all seen and probably done it). A travel cervical pillow keeps your neck and mid-back in good alignment as you dream of your vacation plans. And don’t forget the kids! Their little necks need support as well.

 

3.) Minimize swelling. Move your ankles and feet in fun alphabet shapes periodically throughout the flight. This will help decrease any swelling that can occur in your calves, especially if you struggle with circulation.

 

4.) Straighten up! Take that extra sweater you packed and carefully roll it into a log shape. This will serve as a lumbar roll for your low back to maintain good seated posture during the flight.

 

5.) Luggage love! Keep your luggage “symmetrical” on both sides of you, if possible. Try carrying one bag on one shoulder and holding one suitcase in the other hand. This will help keep your spine straight as you walk (or run) through the airport.

 

Enjoy your travels!

What Is Tarsal Tunnel Syndrome?

By: Kevin Stevens, SPT

 

The tarsal tunnel is located on the inside aspect of your ankle on both feet (see the image below). The “tunnel” is a passageway for tendons, nerves, and blood vessels to pass from your calf to the bottom of your foot. With normal foot alignment, the tunnel has enough space to allow all the components in the tunnel to move freely without being compressed or putting on too much tension. However, pronated feet (also called “flat feet”) put excessive stress on the tarsal tunnel. Now why is this a problem?

 

What’s the Big Deal?

As it pertains to this discussion, the main player in tarsal tunnel syndrome is the tibial nerve, which is the nerve for the muscles and sensory receptors in the bottom of the foot. Likewise, common complaints that correspond with tarsal tunnel syndrome include both sensory and muscular changes, such as: numbness and tingling in the heel and/or bottom of the foot and weakness of toe muscles. Similarly, activities that involve moving the affected foot, such as walking, swimming, and standing, can cause pain. With all of these problems, what can we do to fix it?

 

So How Can You Fix This?

Currently, the literature is limited in the area of tarsal tunnel syndrome; however, there is some research to support both surgical and conservative treatments. Surgery involves relieving pressure in the area by cutting the “roof” of the tunnel (or the flexor retinaculum). Additionally, some surgeons elect to free up the tibial nerve and its branches from anything that may be adhered to the nerves. On the other hand, physical therapy offers a more conservative approach and can help to correct the issue of “flat feet” by supporting the arch of the foot, decreasing any inflammation with the use of modalities (which can include electrical muscle stimulation, traction, heat, ice, etc.), and breaking up any adhesions to the nerve using exercises aimed at targeting the tibial nerve and its branches.

 

For more information on tarsal tunnel syndrome or any other musculoskeletal complaints, contact Sports PT of NY at info@sptny.com.

 

 


 

References:

  1. T. Mullick and A. Dellon. “Results of Decompression of Four Medial Ankle Tunnels in the Treatment of Tarsal Tunnel Syndrome.” Journal of Reconstructive Microsurgery 24, no. 2 (February 2008): 119–126.
  1. P. Ward and M. Porter. “Tarsal Tunnel Syndrome: A Study of the Clinical and Neurophysiological Results of Decompression.” Journal of the Royal College of Surgeons of Edinburgh 43, no. 1 (February 1998): 35–36.
  1. M. Yalcinkaya, U. Ozer, M. Yalcin, and A. Bagatur. “Neurolysis for Failed Tarsal Tunnel Surgery.” The Journal of Foot and Ankle Surgery 53, no. 6 (November 2014): 794–798.
  1. J. Tennant, C. Rungprai, and P. Phisitkul. “Bilateral Anterior Tarsal Tunnel Syndrome Variant Secondary to Extensor Hallucis Brevis Muscle Hypertrophy in a Ballet Dancer: A Case Report.” Foot and Ankle Surgery 20, no. 4 (December 2014): e56–e58.
  1. A. Kosiyatrakul, S. Luenam, and P. Phisitkul. “Tarsal Tunnel Syndrome Associated with a Perforating Branch from Posterior Tibial Artery: A Case Report.” Foot and Ankle Surgery 21, no. 1 (March 2015): e21–e22.
  1. Y. Kavlak and F. Uygur. “Effects of Nerve Mobilization Exercise as an Adjunct to the Conservative Treatment for Patients with Tarsal Tunnel Syndrome.” Journal of Manipulative and Physiological Therapeutics 34, no. 7 (September 2011): 441–448.
  1. D. Diers. “Medial Calcaneal Nerve Entrapment as a Cause for Chronic Heel Pain.” Physiotherapy Theory and Practice 24, no. 4 (July 2008): 291–298.
  1. A. Alshami, A. Babri, T. Souvlis, and M. Coppieters. “Biomechanical Evaluation of Two Clinical Tests for Plantar Heel Pain: The Dorsiflexion-Eversion Test for Tarsal Tunnel Syndrome and the Windlass Test for Plantar Fasciitis.” Foot & Ankle International 28, no. 4 (April 2007): 499–505.