by NICHOLE BLEUMLE|PT, DPT, MS, OCS, CSCS
Inguinal hernias are caused by intestine, fat, and other internal organs pushing against the abdominal wall at the inguinal canal, located in the lower abdomen just above the groin. This pressure results in a protrusion of these structures through the wall thus causing a bulge to form.
Unfortunately, I have found in my practice that all too often patients are not referred or encouraged to seek physical therapy services after hernia repair (same trend of underutilization of rehab services with regards to most other abdominal surgeries as well). Your core is the most important component of your musculoskeletal system; if there is a dysfunction in that region you can be set up for issues in the extremities.
A well-organized trunk or “chassis” has both stability and mobility; is able to calibrate the needs of each; and can make instantaneous adjustments to optimize movement and performance. Achieving this ability and control does not happen automatically and must be the focus of a progressive rehab program.
If you suspect you have a hernia, you should discontinue all aggravating activities and seek further evaluation by a physician. Usually a physician can make a diagnosis based on your history, symptoms, and clinical exam. Sometimes additional imaging like ultrasound or MRI is necessary. For most athletes surgical intervention is the best course of treatment for timely return to sport/training.
Why They Happen
- Heavy lifting
- Straining during bowel movements
- Excess body weight
- Chronic coughing or sneezing
Some individuals are at higher risk for hernia based on incomplete abdominal wall development at birth, resulting in a weak spot in the abdominal wall (peritoneum). Also, previous history of abdominal surgeries such as appendectomy, gall bladder removal, c-section, or previous hernia repair can result in weak spots and susceptibility.
Signs and symptoms include but are not limited to:
- pain in lower abdomen/groin with lifting, straining, coughing, bending forward, running
- visible or palpable bulge (inguinal)
Strangulated (Inguinal) Hernia
If part of the intestine becomes trapped in the abdominal wall (strangulated hernia), it causes decreased blood flow to the intestines and is a life threatening emergency that requires immediate attention.
Signs and symptoms of strangulated hernia include but are not limited to:
- nausea, vomiting or both
- rapid heart rate
- sudden pain that quickly intensifies
- hernia bulge that becomes discolored or dark
- not able to push the bulge back in when lying on your back
Hernia repair is a bummer, but if you follow a solid rehab program and work with a physical therapist who understands your goals and future performance aspirations, you will be Back To The Box in no time.