Athletic Pubalgia may develop from overuse, increased shear forces across the hemipelvis, lumbopelvic and leg muscle strength, endurance, extensibility and coordination imbalances, loss of dynamic abdominal wall rotational stability, or congenital inguinal wall weakness. Restricted hip range of motion in addition to an imbalance in strength between the stronger leg muscles and weaker abdominal muscles increasing shear forces across the pubic symphysis and subsequent tearing of the transversalis fascia, conjoined tendon, inguinal canal, or overlying musculature. Furthermore, sports activities that involve planting the feet and twisting with maximum exertion can cause a tear in the soft tissue of the lower abdomen or groin.
Traditional conservative treatment for athletic pubalgia includes 6-8 weeks of rest followed by an active programme designed to improve strength, endurance, coordination, and appropriate hip and abdominal muscle synergistic balance. Extensibility deficiencies and imbalances at the hip and abdominal muscles must also be addressed.
Surgical exploration and repair should be considered when rest and non-surgical treatment over a minimum of 6-8 weeks has failed. When surgery is selected either an open or a laparoscopic approach can provide good results. Surgical procedures reinforce the abdominal muscles or fascia near the inguinal ligament. A wide variety of techniques can be used to reinforce the existing tissue layers with or without mesh. During post-surgical rehabilitation early sharp or sudden movements after surgery are avoided and core and leg muscle inflexibility, weakness, and poor endurance/coordination are identified and corrected. Walking is encouraged early in the post-op period with progression to jogging or running by 3-4 weeks. Recovery after a laparoscopic repair generally takes 6=8 weeks before full return to competition is permitted.
References: Caudill et al., Br J sports Med, 2008;Active P.T. Solutions; AAOS.org; www.mendmeshop.com
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Article produced by: Adrienne Peterson, Student Physical Therapist