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Physical Therapy Guide to Core Muscle Injury (Athletic Pubalgia )
Athletic pubalgia (core muscle injury) is often misleadingly called a sports hernia. It is a condition that mainly affects athletes who play soccer, hockey, football, and rugby, and who run track. It is more common in males than in females. A full 94% of these injuries occur gradually from unknown causes. A specific traumatic incident, such as being checked from behind while playing hockey, cause the other 6%. Stress from repetitive twisting, kicking, and turning at high speeds is a potential cause of this injury. But casual exercisers and nonathletes also can experience core muscle injury.
Physical therapists help people with core muscle injury improve strength and flexibility in the abdominal muscles and hips, and help them safely return to their desired sport or activities. If surgery is required, physical therapists help people before and after surgery, to prepare for and recover from the surgical procedure.
What Is a Core Muscle Injury?
Core muscle injury occurs when the deep layers of the abdominal wall weaken or tear. There is no defect of the abdominal wall or protrusion of abdominal contents outside the normal cavity, as with a hernia. Instead, the injury occurs where the abdominal muscles attach in the pelvis, and can cause tears in the tendons and muscles in the area. Nerve irritation also can occur and contribute to uncomfortable symptoms of numbness or tingling.
Repetitive hip and pelvic motions typical in sports can cause injury to the lower abdominal area. Imbalances between the hip and abdominal muscles can, over time, cause overuse and injury. Weakness in the abdominals and lack of conditioning also might contribute to the injury. Aggressive and unsafe abdominal exercise programs can cause or aggravate a core muscle injury.
How Does It Feel?
Chronic groin pain is a hallmark symptom of core muscle injury. It occurs in 5% to 18% of athletes. Sharp groin pain with exertion is also a typical symptom.
Pain often occurs with intense sprinting, kicking, twisting, or cutting, and decreases rapidly with rest. However, basic tasks, such as sitting up in bed, can be painful. Athletes can lose a significant amount of training and competition time due to core muscle pain or related groin pain.
With core muscle injury, you may experience:
- Sharp or stabbing pain in the groin or lower abdominal region that occurs mainly with running, sprinting, cutting, pivoting, kicking, or twisting.
- Pain felt while doing situps.
- Pain on one side of the groin.
- Pain or numbness that radiates into the inner thigh.
- Pain in the groin when coughing or sneezing.
- Little to no pain in the groin when resting, sitting, or sleeping.
- Tenderness to touch or pressure put on the lower abdominal area.
Note: If you have groin pain that isn’t relieved with rest, you could have another potentially serious medical condition involving the digestive, urinary, or reproductive systems. Consult your physician
How Can a Physical Therapist Help?
Conservative treatment of core muscle injuries includes changes to your activities and physical therapy. Your physical therapist will use treatments to target the problems found during their evaluation. They will design a personalized treatment program for you based on your condition that focuses on your goals to help you safely return to your sport or normal activity levels.
Some cases of more severe core muscle injury may require surgery. A conservative course of treatment that includes physical therapy for four to six weeks is the first recommendation for most patients. If groin pain continues after that time, surgery may be recommended. A recent study found that 50% of patients with core muscle injury recovered with conservative treatment. If you decide to have surgery, your physical therapist can guide you in regaining your strength and flexibility after the surgical procedure.
Treatment Without Surgery
Physical therapy will focus on addressing the key problems found during your evaluation. These problems often include poor hip strength and flexibility, and a reduced ability to activate or turn the abdominal muscles to keep the pelvis stable during intense activity.
Physical therapy treatments will address your condition without causing pain or making your pain worse. Your physical therapist also will teach you to modify sport or training activities that cause groin pain or hinder your recovery. Ice may also be applied to decrease pain.
Your physical therapist may advise you to:
- Avoid aggressive or painful stretching.
- Avoid kicking or sprinting.
- Avoid doing situps.
Your physical therapy treatment may include:
Icing and compression. During the early phases of injury or when you have high levels of pain, applying ice and compression to the area may decrease your pain level.
Stretching. Your physical therapist may show you how to perform hip and low-back exercises to gently stretch your muscles. They will teach you how often and how long to do these exercises to match your condition to improve muscle flexibility and decrease pain.
Muscle retraining. Your physical therapist will teach you to target and move your abdominal and hip muscles. This is a key part of your treatment, as certain muscles may not be working well due to your injury.
Strengthening. Your physical therapist will teach you targeted hip and core strengthening exercises that do not aggravate your injury once you are having less pain.
Manual therapy. Your physical therapist may perform hands-on (manual) therapy to stretch and mobilize affected soft tissue and joints based on your evaluation. Hands-on therapy can improve your hip-joint mobility and range of motion, decrease muscle pain, and improve flexibility.
Return-to-sport drills. Once you can progress without pain, your physical therapist will slowly add movements specific to your sport or activity to your treatment program. For example, you may return to running and light sport-related drills to prepare your body for the full stress of participation in your sport.
Can This Injury or Condition Be Prevented?
Core muscle injury is challenging to prevent because of the stress and strain placed on the pelvis and hips during some sports. A prevention program is recommended for people with the highest risk for a core muscle injury.
Those at high risk include males and females who participate in soccer, hockey, and football. A prevention program may include:
- Abdominal and core strengthening exercises.
- Exercises to strengthen the hip muscles.
- Exercises to improve flexibility and decrease strain across the lower abdominal area, where core muscle injury often occurs.
**Article from choosept.com
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