Sportsman’s Groin Injuries

Recent reporting of Jesse Ryder’s groin has brought these sports injuries to our attention. Sniggering blogs and vague commentating has obscured the fact that these injuries can be devastating for professional sportsmen. Recently, doctors have been discovering more about these injuries and how to treat them.

The groin in medical terms is that area of the body near the crease between the thigh and the lower abdomen. There are a wide range of conditions that can cause pain in the area and sports medicine doctors have now acquired experience in investigating, diagnosing and treating groin injuries. The pain can be caused by damage to and subsequent inflammation of the nearby pelvic bone (called the pubis), the hip joint of the muscles in the groin, either the thigh muscles or their attachment to the pubic bone or the lower abdominal muscles.

X-rays, bone scans, ultrasound examinations and MRI scans can be used to help with diagnosis if it is not obvious on physical examination. Treatment can be in the form of anti-inflammatory drugs, rest, physiotherapy, steroid injections, injections of one’s own blood into the painful site and surgery.

My own area of expertise is in the realm of surgery for groin strains. It was discovered in Britain about 20 years ago that some sportsmen would benefit from surgery to the groin so that they could return to their sport. Clearly, for professional sportsmen, this was an enormous boon – they could continue with their career.

The surgery is directed to the lower abdomen, called the inguinal region. Whereas some patients will have a demonstrable hernia (a hole in the abdominal wall) and thus operation is an obvious choice, quite often with groin injuries, there is no hernia and yet the same hernia operation somehow strengthens the muscles in the area or realigns them and alleviates the pain. Surgery is a last resort for anyone, but where all other measures have failed and the pain has persisted for months unabated and prevents the sportsman pursuing his career, there is an imperative to explore this option.

I am careful to have other causes of the pain excluded, usually by referring the patient to a sports medicine doctor and to be sure that the pain is coming from the inguinal muscles (called the conjoined tendon). I then repair the area using the laparoscopic technique by inserting a piece of polyester behind the muscles. It requires a general anaesthetic and a day stay in hospital. The operation, called laparoscopic inguinal hernioplasty, takes about an hour. With meticulous patient selection, I have had nearly a 90% success rate so that these men (the condition occurs virtually only in men) can return to their sport and their careers. The recovery can be very fast as demonstrated by one of my patients who played for New Zealand in the Rugby sevens two weeks after surgery, having not been able to play at all before surgery.