Sports Hernia Repair Protocol

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Athletes who suffer from sports hernia use the following treatment protocol recommended by sports hernia surgeon Jeffery Hoadley, developed in conjunction with Scott Kneller, the Atlanta Falcons PT, DPT and Rehabilitation Coordinator, and Cara Yano, MPT at Atlanta Sports Medicine and Orthopedic Center.

 

Phase 1 Sports Hernia Treatment (1-2 weeks)

Sports-Hernia-Treatment-Phase-1AGoals:

  • Pain and edema control
  • Education on posture and TA recruitment

Precautions: (first 2 weeks)

  • Avoid trunk hyperextension, aggressive hip extension ROM
  • Avoid crunch activity (large contractions of rectus abdominis)

Exercise:

  • Cardiovascular
    • Treadmill walking (20 min)
  • ROM/Stretching
    • Gentle stretching of hamstrings, adductors, quadriceps, iliopsoas (side lying or prone on elbows), lumbar spine
  • Strengthening
    • Transversus Abdominis (TA) recruitment
    • Side lying hip abduction and extension

Sports-Hernia-Treatment-Phase-1BManual:

  • Lumbar spine rotation mobilization (if applicable) grade 1-2
  • Hip mobilization (if applicable) grade 1-2
  • Dry needling of adductors, quads (if applicable)

Education:

  • Posture: Neutral spine with sitting and standing, desk setup if applicable

Criteria to move to Phase 2:

  • Minimal pain with ADLs
  • Improving ROM of lumbar spine and hips
  • Ability to recruit TA and find neutral spine

Phase 2 Sports Hernia Treatment (2-3 weeks)

Sports-Hernia-Treatment-Phase-2AGoals:

  • Initiate TA strengthening and pelvic stabilization
  • Full ROM of L/S and hip
  • Protect surgical repair

Exercise:

  • Cardiovascular
    • Pool or land walking (fwd/bwd), bike, elliptical
  • ROM/Stretching
    • Continue stretching as above
    • Initiate more aggressive hip flexor, rectus femoris stretching (Thomas stretch: off table) *ensure pain free*
  • Strengthening
    • Progress TA strengthening: blood pressure cuff
      • Sports-Hernia-Treatment-Phase-2BDead bug progression
    • Static core training (emphasize ability to maintain neutral spine)
      • Bridging progression, quadruped progression, plank progression
    • Hip/pelvic stabilization (emphasis on gluteus medius, maximus, TA, and multifidus): Begin double leg, progress to single leg as pain decreases and strength increases
      • Rocker board, band walks, dead lifts
    • Initiate functional strengthening: Begin double leg progress to single leg as pain decreases and strength increases
      • Squat, leg press, step up

Manual:

  • Sports-Hernia-Treatment-Phase-2CLumbar spine rotation mobilization (if applicable) grade 3-4
  • Hip mobilization (if applicable) grade 3-4
  • Scar mobilization
  • Dry needling of adductors, quads (if applicable)

Criteria to move to Phase 3:

  • No pain with ADLs, ambulation
  • Full ROM of lumbar spine and hips
  • Good TA recruitment and ability to maintain neutral spine and TA contraction with standing and single leg activity
  • Minimal to no Trendelenburg with ambulation and single leg activity

Phase 3 Sports Hernia Treatment (3-4 weeks)

Goals:

  • Easy recruitment of TA
  • Good pelvic stabilization with ambulation
  • Good pelvic and lumbar spine stabilization with dynamic single leg activity

Sports-Hernia-Treatment-Phase-3AExercise:

  • Cardiovascular
    • Elliptical, increase speed/resistance bike, walking program, water treadmill jogging (progress to land as pain decreases and stability improves)
  • ROM/Stretching
    • Continue as above
  • Strengthening
    • Begin dynamic core training, initiate Swiss Ball core work (emphasize neutral spine during activities with movement or utilizing unstable surfaces)
      • Prone Swiss ball walkouts
      • Supine ball work
      • Sports-Hernia-Treatment-Phase-3BQuadruped with perturbation
      • Bridges on ball
      • Plank on Swiss ball or BOSU
      • Plank to side plank transitions
    • Standing stabilization
      • PNF diagonals with sport cord
      • Single leg rocker board with ball toss
    • Progress single leg functional activity – Add perturbation or change to dynamic surface for progression
      • Speed skater
      • Single leg squat
      • PNF patterns with lunge

Manual:

  • Continue lumbar spine and hip mobilization (if applicable)
  • Dry needling (if applicable)

Criteria to move to Phase 4:

  • No pain with ADLs, ambulation, and initiation of straight plane jogging
  • Full ROM of lumbar spine and hips
  • Good TA recruitment and ability to maintain neutral spine and TA contraction with standing and single leg activity with added challenges of perturbation or dynamic surface

Phase 4 Sports Hernia Treatment(4-5 weeks)

Sports-Hernia-Treatment-Phase-4AGoals:

  • Initiate light sport activity with focus on hip and core stabilization

Exercise:

  • Cardiovascular/Sports Activity
    • Return to light sport specific activity (no start/ stop, quick change of directions)
    • Interval bike program, land jogging, light skating
  • ROM/Stretching
    • Continue as above
  • Strengthening
    • Progress core and hip stabilization, and functional strength as above
    • Initiate plyometric training

Sports-Hernia-Treatment-Phase-4BManual:

  • Continue lumbar spine and hip mobilization (if applicable)

Criteria to move to Phase 5:

  • Symmetrical strength of hips, obliques, lumbar multifidus
  • Functional test including single leg hopping
  • No pain with return to light sporting activity
  • Full lumbar and hip ROM

Phase 5 Sports Hernia Treatment (5-6 weeks)

Goals:

  • Return to full sport activity without pain

Exercise:

  • Cardiovascular/Sports Activity
    • Hockey: initiate start/ stop, skating drills with team, shooting
    • Football/Soccer: initiate plant/pivot, change direction, start/stop, increase speed training/sprinting
    • Court Sports: initiate plant/pivot, change direction, start/stop
  • ROM/Stretching
    • Continue as above
  • Strengthening
    • Continue as above

Manual:

  • Continue lumbar spine and hip mobilization (if applicable)
  • Dry needling (if applicable)