ORIGINAL ARTICLE

Changes in muscle strength and pain in response to surgical repair of posterior abdominal wall disruption followed by rehabilitation

A E Hemingway¹, L Herrington², A L Blower³

¹ Cheshire Physiotherapy Centre, Altrincham, Cheshire, UK
² University of Salford, Salford, UK
³ Wrightington, Wigan & Leigh NHS Trust

Correspondence to:
Correspondence to:
Miss Hemingway, Cheshire Physiotherapy Centre, 68a Barrington Road, Altrincham, Cheshire, UK;
andreahemingway{at}hotmail.com

Background: Posterior abdominal wall deficiency (PAWD) is a tear in the external oblique aponeurosis or the conjoint tendon causing a posterior wall defect at the medial end of the inguinal canal. It is often known as sportsman’s hernia and is believed to be caused by repetitive stress.

Objective: To assess lower limb and abdominal muscle strength of patients with PAWD before intervention compared with matched controls; to evaluate any changes following surgical repair and rehabilitation.

Methods: Sixteen subjects were assessed using a questionnaire, isokinetic testing of the lower limb strength, and pressure biofeedback testing of the abdominals. After surgery and a six week rehabilitation programme, the subjects were re-evaluated. A control group were assessed using the same procedure.

Results: Quadriceps and hamstrings strength was not affected by this condition. A deficit hip muscle strength was found on the affected limb before surgery, which was significant for the hip flexors (p = 0.05). Before surgery, 87% of the patients compared with 20% of the controls failed the abdominal obliques test. Both the injured and non-injured sides had improved significantly in strength after surgery and rehabilitation. The strength of the abdominal obliques showed the most significant improvement over the course of the rehabilitation programme.

Conclusions: Lower limb muscle strength may have been reduced as the result of disuse atrophy or pain inhibition. Abdominal oblique strength was deficient in the injured patients and this compromises rotational control of the pelvis. More sensitive investigations (such as electromyography) are needed to assess the link between abdominal oblique function and groin injury.

Keywords: hernia; surgical repair; rehabilitation; groin; Gilmore’s groin

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Caudill, P, Nyland, J, Smith, C, Yerasimides, J, Lach, J (2008). Sports hernias: a systematic literature review. Br. J. Sports. Med. 42: 954-964 [Abstract] [Full Text]  
• Kragh, J. F. Jr, Svoboda, S. J., Wenke, J. C., Ward, J. A., Walters, T. J. (2005). Suturing of lacerations of skeletal muscle. J Bone Joint Surg Br 87-B: 1303-1305 [Abstract] [Full Text]