Understanding “Sports Hernia” (Athletic Pubalgia): The Anatomic and Pathophysiologic Basis for Abdominal and Groin Pain in Athletes

Recent publicity and some scientific reports suggest increasing success in treating an entity called “sports hernia,” more accurately named athletic pubalgia. The primary purpose of this article is to portray what we believe to be the key concepts for understanding this wide variety of abdominal and groin injuries that afflict high-performance athletes. These injuries have been plaguing athletes for a long time, and past treatments, based on concepts of occult hernia or simple strains, have generally failed. The former concepts do not take into account the likely mechanisms of injury or various patterns of pain that these athletes exhibit. The authors believe that the concept of a “pubic joint” or “pubic dynamic complex” is fundamental to understanding the anatomy and pertinent pathophysiology in these patients. Many injuries can now be treated successfully. Some of the injuries require surgery, and others do not. In most cases, decisions regarding treatment and timing for return to full play require proper identification of the problems and consideration of a wide variety of medical, social, and business factors.