Ask The Doc: Inguinal Hernia Rehab

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by NICHOLE BLEUMLE|PT, DPT, MS, OCS, CSCS

Ask The Doc: Inguinal Hernia Rehab

“Over 1 million abdominal wall hernia repairs are performed each year in the United States, with inguinal hernia repairs constituting nearly 770,000 of these cases; approximately 90% of all inguinal hernia repairs are performed on males.” 
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.
There are several types and locations of hernias, but inguinal is the most common, especially in athletic males.

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.

Inguinal hernia
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.

Rehabbing Post-Op

For most athletes surgical intervention is the best course of treatment for timely return to sport/training.
Rehabilitation to include physical therapy is just as important after hernia repair as any common orthopedic surgery — such as rotator cuff repair or ACL — repair. There are different surgical repair techniques, but they all include some degree of cutting the abdominal musculature and fascia in order for the surgeon to access the abdominal wall and repair the damaged structure. The trauma of the surgery and resulting scar tissue will result in dysfunctions such as altered motor control patterns (to include breathing), muscular weakness, and decreased mobility if not properly addressed early on after surgery. These dysfunctions can cause nerve entrapment, chronic pain, decreased physical performance and increased risk for additional future injuries.

“ In order to effectively generate force and control the hip and shoulder, the trunk must be well organized and can be thought of as a ‘chassis’ or ‘frame’ on which the primary engines are mounted.” Dr. Kelly Starrett

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

Why They Happen
Causes of inguinal hernia include anything that causes increased abdominal pressure such as:

  • Heavy lifting
  • Straining during bowel movements
  • Pregnancy
  • 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.

Inguinal Hernia

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
  • fever
  • 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.

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