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08 July 2014

Sportsman’s Hernia - Feels like a kick in the nuts

Sportsman’s Hernia - Feels like a kick in the nuts

This turn of phrase is both literal and applicable to the wider realisation of what dawned on me the morning after a non-eventful 5-a-side football match in December 2012.

A keen sporting fellow, I have with hind sight, been rather fortunate to escape many of the afflictions that can be associated with the popular phrase “a weak core”. So that morning after the sporting night before, I had a sinking feeling that all was not right downstairs. As an MSK (Musculoskeletal) physio in Manchester City Centre, I’m fortunate to come across a wide variety of physical whoopsies. I was therefore well placed to hope that my initial fears that some form of hernia may not materialise. My gut feeling however, was literally not a good one.

Crouching/squatting down was the biggest indicator that all was not well. Coughing was a bit tender after exercise and there was palpable soreness in the lower left side of my abdomen below and inside the knobbly bit at the front of your pelvis (ASIS). I had hoped that some lower abdominals had perhaps been asked a little too much of during the football, but at the lowest point of the crouch, they are not really active.

The abdominal contents/viscera and lining of the abdominal wall is pushed downwards by compression of the stomach cavity. Any thinning/small tear/strain or relative weakness in the muscular wall can cause the intestines to push through a small window-like gap in the external casing of the abdomen. Some folk can have a small weakness which may not result in a bulge but will still cause discomfort or pain; others may have a gaping hole which can cause more of a herniation of the abdominal contents. This would be a larger hernia and can result in actual bulge you can feel or even see. These are not always painful. The sportsman’s hernia (small, non-protruding bulge) I can confirm was quite uncomfortable.

I couldn’t run or engage in kicking sports without pain. You can rest from the aggravating sports/forces, but the problem doesn’t go away. There is some support for reinforcing the core and protecting the weak lining with extra muscular support. For me, modifying my life to not kick things or run wasn’t an option…

Cycling was fine, golf smarted a little but was ok. Social cricket was OK but more due to a lack of running/form! A few weeks passed with little change, so I reluctantly took myself to the GP for onward referral to a preferred specialist. The GP suggested that an ultrasound scan would help to see the offending bulge and confirm the diagnosis. The additional x2 female student Doctors who also wanted to take a look wasn’t ideal. But I’d have to get used to this.

I sought the opinion of a well respected and recently retired General surgeon Ian MacClennan. He wasn’t a fan of ultrasound scans, he didn’t find them that helpful. The scan showed some added “activity” in that area but no hole/bulge was evident on the scan. His favoured chair based test involved trying to lift your self off of the chair using your arms only. This test is painful with a sportsman’s hernia. A more objective test involves attempting to find the perforation in the wall, by placing your finger into something unfamiliar to me, “my external ring”. An area slightly lower than the painful spot but easily found if well directed! So I had a hole on the painful side and a smaller one on the other non-painful side! His advice was to fix both while you’re there as the other side usually goes some time after you return to sport. Great.

With Ultra Sound scan and evidence of a hole in my ring I was referred to a specialist recommended by some colleagues. Mr Mo Saeed works both as an NHS (Stepping Hill) and Private consultant Manchester hernia clinic

He once again entered my external ring (!) for his own confirmation and we discussed the pro’s/cons of doing both at once or not. He only does open surgery (3 inch wound) using a mesh to plug the hole/weak area. This is stitched to the abdominal wall. I never actually saw a mesh but I believe it corresponds to a small tea strainer. For a while it felt more like one of those large metal gauzes you used in science when using a Bunsen Burner at school. The outer wound would be glued up rather than stitched.

As a non-urgent NHS operation, the waiting time was correspondingly quite lengthy. Op dates were moved around and postponed until D day arrived. About 8 months post initial injury.

The operation is performed as day case surgery. I was 1st on the list and home by just after lunch. You have to pass urine before you leave to prove all is working (I recently came across a chap who had a tube from his bladder cut in this operation!). When all downstairs is anaesthetised, this is not as obvious as you would think!

Recovery was quite quick considering both sides of your lower abdominal wall are sliced open. After walking like I’d received a free kick in the mid rift for a few days I was able to get back on a bike at 7 days, light interval walk/jog at 3 weeks and back running properly at 6 weeks. The 1st few days required some Co-Codamol and anti-inflammatories during the day and a Tramadol at night for a couple of nights to help sleep.

To address the lower abdominal/core strength deficiencies, which of course will be even worse post surgery, I enrolled in a local Pilates class that uses reformers. The class commenced at around 4 weeks post op. These medieval torture looking contraptions are great at isolating the areas you need to work, and with the right supervision is a great way of focusing your rehab. Take a look at the reformers in action at The Yoga lounge:

Football finally returned to the agenda 3 months post op once my running had reached a comfortable 10km distances and zig zags, sprints etc were comfortable. It came as quite a relief to wake up the next day and not have that nagging groin ache. The rest of me however was not quite so at ease.

To date, I am not restricted by what I can and can’t do. The scars needed a little scar tissue massage to ensure the layers of the body all move around each other without getting stuck. I can feel the mesh in certain compressive Yoga poses, but otherwise the operation has been a success.

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