This review summarizes existing knowledge regarding sports hernia pathogenesis, differential diagnosis, conservative treatment, surgery, and post-surgical rehabilitation. Sports hernias occur more frequently in males during athletic activities that involve cutting, pivoting, kicking, and sharp turns such as those that occur during soccer, ice hockey, or football. Sports hernias generally present an insidious onset; however with focused questioning a specific inciting incident may be identified. The likely causative factor is posterior inguinal wall weakening from excessive or high repetition shear forces applied through the pelvic attachments of poorly balanced hip adductor and abdominal muscle activation. There is currently no consensus as to what specifically constitutes this diagnosis. Since it can be difficult to make a definitive diagnosis based on conventional physical examination, other modalities such as MRI and diagnostic ultrasound are often employed, primarily to rule out other conditions. Surgery appears to be more effective than conservative treatment and laparoscopic techniques generally enable a quicker recovery time than open repair. However, in addition to better descriptions of surgical anatomy and procedures, and conservative and post-surgical rehabilitation, well-designed research studies are needed with more detailed serial patient outcome measurements in addition to basing success solely on return to sports activity timing. Only with this information will we better understand sports hernia pathogenesis, verify superior surgical approaches, develop evidence-based screening and prevention strategies, and more effectively direct both conservative and post-surgical rehabilitation.
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