sports hernia NOT resurfacing failure

[NYRFan19]

Sports hernia - tear of the rectus abdominus / adductor longus

Hi all.  I have never seen anything on this topic anywhere in the forums and I wanted to share my story in hopes that it may help someone else.  My story is very long, but for purposes here, I will keep my initial post brief and go into further detail if asked. 

    33 year old male
    Hip problems all my life.  Always stiff, terrible flexibility
    Diagnosed with arthritis in both hips 2010.
    2012- Bilateral arthroscopy at HSS by Dr. Struan Coleman
    2014- Arthritis became bone on bone
    2015 - Hip Resurfacing (BHR) by Dr. Su at HSS in March and    December of 2015.
  Never completely recovered from my right hip surgery of December of 2015.

***2016-
     Subsequent follow ups with Dr. Su office through 1 year out at December 2016 was continue doing physical therapy.  My issues were that I still had poor flexibility, especially in my right side, I could not return to any form of running/jogging.  I had constant lower back pain.  I was not anywhere near where I thought I would be with two new hips.  Why could I still not move? Continued doing PT on and off  through 2016, no new results.  The less activity I did, the less pain I would be in so I continued this cycle. Changes to my health insurance kept me from going back for another visit with Dr. Su after this, plus at this time in my mind, I never thought that the issue could be from my hip resurfacing since I had chosen one of the best surgeons in the world for this procedure. 

***2017- 
     pain became even worse and continued traveling further in my body.  In addition to groin pain, low back pain I now had constant hamstring tightness, glute pain and weakness.  I could no longer do a straight leg raise of any kind.  I could not run more than 30 seconds without my leg cramping up, and I would pay for trying to run with days of pain afterwards.  Something was not right. Through reading all of these posts on the forums, I had convinced myself that I had some sort of Hip Resurfacing failure.  My metal levels were a little elevated at 4.0 cobalt & 6.0 chromium.

***2018- 
     The year of doctor visits, consultations, and alternative treatments
      After feeling I may have a resurfacing failure, I emailed Xrays and MRI reports to the other prominent hip resurfacing doctors on this website here and was told in summary:

Dr. Pritchett- most likely hip impingement and the acetabular component should be revised to be deeper in the socket and change to a polyehtelene cup to avoid metal issues.

Dr. Gross- Psoas tendinitis keep doing physical therapy.  It’s most likely not impingement and its definitely not metallosis.
 
Dr. De Smet- Hip impingment.  Hip revision to revise the acetabular cup angle because he believed it may be protruding out just enough to be causing an impingement.

Dr. Wayne Colizza (NJ)- Your implants look fine, I don’t know what’s wrong with you.  This is probably the best you will be from surgery.  I wouldn’t recommend any soft tissue surgeries. My advice is don’t go have surgery in New York City and then come to me to fix you.

Sports Medicine Dr #1 â€" I think the problem is coming from your back.  Lets MRI your back.  MRI looks clean for the most part with some minor indications of problems in your low back.  Lets do injections in your back.  I’ve never had back problems in my life knock on wood so I refused these injections.

Dr. Mayman HSS-  ordered a hip MRI and suggested that it either be PSOAS tendinitis which he gave me an injection for, or a possible “sports hernia” which I never heard of before.  Recommended follow up with a sports medicine specialist.

2019**

Dr. Anthony Scilia and Dr. Michael Kelly-  diagnosed the sports hernia and confirmed it via ultrasound. Dr. Scilia surgically repaired it.  It was a tear of the rectus abdominus / adductor longus muscle junction in my right groin.  After rehab I have full range of motion now, the best I’ve had in my life.  All my pain is gone and I’m able to do whatever activities I want.  Finally enjoying the new hips that Dr Su gave me and I’m glad I didn’t listen to any of this hip revision advice. God only knows how much worse I would be. 

The overall point to my post here is that I don’t know if sports hernia is on a lot of these hip doctors radar.  This injury mimics hip joint problems in many ways.  It took a good amount of searching for me to find a specialist in my area for this injury.  And as you can see, I was smothered with all kinds of different opinions and faced with offers of major surgery again. 

[Pat Walter]

Hi Matt
I am so happy your found a solution to your hip problems.  It seems like a very long journey before a doctor found a solution.
Thank You so much for posting your story and information about your sports hernia.  Obviously it is not something most orthopedic surgeons look for or know about.  I hope your email might help others.  It is probably very unusual to have a hernia like you have, but that's what doctors are trained to do - solve pain problems.
I often post stories that are shared here on the main website.  The posts are visible to the public, which I state in the footer section. I will post your story on the main website. The information there is more indexed and people can search there easier than here. There are, however, about 2500 other articles there now, but I am hoping others with problems might find it in the future.
I do wish you the very best and hope your recovery continues to enjoy an active, pain free life.
Pat

[jimbone]

Matt-

So pleased you not only stuck it out to find the truth of your real condition but also you had such success recovering.  You are contributing to a truth all surgical/medical patients need t remember- you either need a strong advocate for you or need to be a strong advocate.  All of us are human and subject to mistakes- including even the best of our doctors- trusting our instincts, symptoms and perceptions advances the process.  Glad to hear you are healing.

[ahausheer]

Good post!

Other than general tightness and somewhat regional discomfort were there any specific movements or triggers that elicited pain?  Coughing, straining in bathroom, pain on ''resisted abduction'' of leg, pain on any particular stretch? Was there anything you could palpate or push on to elicit pain?

- trying to solve my own slightly diffuse groin pain with shallow nerve like involvement/radiation down medial thigh that started 4 months post op possibly after an introducing a new PT exercise.

[hernanu]

Excellent that you found the reason for your pain and it was fixed.

Great description, and a real service to this group; the more we know about other issues that can live in the same area, the better.

Great news about it getting better.

[evant]

Very interesting post - a sports hernia is new to me too.

Your immense prolonged resilience, under extremely difficult circumstances, to find the unique answer for you is stunning. - simply brilliant. Well done you.

Well done too of course to Dr Mayman HSS, Dr Anthony Scilia, and Dr Michael Kelly.

[Rn2md]

Very interesting post. Thank you. I wasn’t aware of sports hernias either

[jimbone]

Really great resolution of the problem.  Ever discover the cause?  Might indicate things to avoid for others.

[NYRFan19]

Thanks for the positive feedback.  If this post can help just one person here then it will be a success. I will try and answer your questions Jimbone and Ahausheer below

JIMBONE-  Dr. Kelly told me that this is a very common injury for hockey and soccer players.  I have played a lot of hockey on and off for the last 15 years.  He also told me that it is more common in males then females, and that the average time from injury to proper diagnosis by a doctor is one year.  That statement really drove home to me how relatively unknown this injury seems to be to a lot of doctors. I even had some doctors completely disregard the MRI indication that there might be an issue with that muscle.

Dr. Kelly also stated that he has seen this injury happen alongside people with Hip impingement / FAI.... as a result of the muscles taking an extra beating trying to compensate for the poor motion of the hip joint, which makes total sense in my case.  I had FAI for years that went undiagnosed which caused the early onset of arthritis

He also said that my sports hernia was probably there for a long time but was not as severe, and then some action or motion for me was the final straw that tore it for good

I know exactly when this happened.  I was rehabbing my second BHR in April of 2016 and was using the hip abduction and hip adduction machines at the gym.  while using the abductor machine--- I put a heavy weight on the machine and was trying to let the heavy weight push apart my legs to try and use the machine as a stretching tool.  As the weight spread my legs apart, I felt a very sharp pain in my right groin, and I was never the same after that. 

I told many many doctors about this moment at the gym and it was not until seeing Dr. Scilia and Dr. Kelly that it was given any consideration.  Dr. Kelly was certain the experience I described was the final nail in the coffin.

There is a lot of bad information on the internet as well when trying to search for facts about this injury.  The term "sports hernia" generates a lot of different information when you search it on the web.

A sports hernia as I'm describing is not even a real hernia at all.  An actual hernia is a tearing of your abdominal wall that creates a hole.  I guess sports hernia got its name from being in a similar region of the body.

Ahausheer-

      Yes there were a lot of issues, and they continued to build as time went on.  I never really experienced any pain while coughing, going to the bathroom, or any of the "typical" indicators for this injury that you see online.  This injury is not an actual hernia, it really should be given a different name, which I think is adding to the confusion and mystery behind it.  There was also not much pain in resisted abduction of the leg, which I know is a major test for this injury , which I think also led a lot of doctors to believe that I did not have this injury.  The act of resisted hip abduction or adduction did not hurt but I would have a weak, strained feeling in my groin right after stopping that motion.  My pelvis and groin would often make a popping and clicking noise.   I did have extreme weakness during a resisted leg raise, where I could barely resist the doctor from being able to push my leg back down and also to push my leg out or in.  I had absolutely no strength in these areas.  If I tried laying down and doing a single straight leg raise, I could barely do it.  My inner right quad would start shaking and pulsating and not even allow my leg to raise, and I felt a deep weakness and dull pain in the right groin while doing this.

These issues affected my back on a daily basis.  I could not sit in a chair without pain for more then 10 minutes.  I could not sleep comfortably in bed at night.  My lower back would be in a lot of discomfort.  I would wake up in the mornings with terrible weakness in my right leg where on some days I would almost be limping. 

My right QL muscle in my back was constantly tight and had a burning sensation.  No matter how much I stretched or went for massage, this never calmed down. 

I could not bend over and pick up my son's toys off the floor without pain in my back and a pinching in my groin.

I could barely reach 90 degrees in a squat position, and even before reaching 90 degrees, I had what's known as "Butt wink" which should not happen in a squat motion until passed 90 degrees at minimum

My hip flexion in both hips was barely at 90 degrees, and maybe reached 100 if it was forced by someone stretching me, but that would be without my back arching off the table. 

If I were to lay down flat, and try to lift my right leg straight out and cross it over to my left side, I would feel a pinch in my groin. And if I tried to get to 90 degrees hip flexion from this position, I would feel like I was hitting a wall.

I can see where some of the hip doctors would think that this had something to do with my hip joint because it was mirroring that problem.

If I were to try and bend over and pick up an object that was in front of and to the right of me, I would have to get into a weird position and was barely able to do it.

I was beginning to have the motion of someone who was 90 years old.

I could barely do a kneeling PSOAS stretch because I had no motion for that movement

Something that would flare this injury up would be squatting down and then from a catcher's type squat position, reach for something in front of me, I would feel a tear in my right groin which would flare this injury up for weeks

Another issue I had from this was extreme glute weakness and inhibition.  My glutes felt weak and I would have pain in that area when standing and squeezing them to activate.

As this injury lingered on, I would often have days where I would wake up and now my right hamstring would be in a huge knot.

I tried acupuncture / dry needling on my hamstrings, glutes, and low back in an effort to get these muscles firing properly again but this was to no avail.

I think as time went on and this injury lingered, the pain and radiated symptoms began to spread farther out into my body from the root of the source, mimicking all sorts of other problems. 

Because of the sports hernia, all muscles in this region were locked down, I guess the body's way of trying to prevent motion in this are to prevent pain.  And the longer this injury stayed, the less and less motion I had. 

I'm sorry for the long and somewhat disorganized post here.  I honestly had sooooo many different pains, symptoms, and issues with this injury that I didn't even cover all of them here.  I kind of just tried to spit them out here as they came to mind in hopes of remembering most of them

please feel free to ask any other questions, I hope this has helped someone here

[joshb7_]

Hi,

Your symptoms seem familiar. Im 16 month post bhr but still struggling in 90 degrees hip flexion, running, kicking, bending, back pain, muscle tightness etc. Almost worse in some ranges than i was pre surgery.

How did you manage to get so many second opinions from consultants? Im seeking answers from my surgery as im not at my desired athletic level.

Thanks,

Josh

[NYRFan19]

Joshb-

It was not easy to say the least.  mentally I would not settle until I found a solution. It was a very very long few years of doctor visits, physical therapy visits, chiropractor adjustments, very very expensive 5 minute active release treatments, massage, acupuncture, etc

For starters-  Doctors Pritchett, Gross, and De Smet are nice enough to offer a free consultation via email or phone. I emailed copies of my xrays and MRI report to them and they all got back to me either later that day or the very next day.  Doctors Pritchett and Desmet via email and Dr. Gross via phone call.  They also responded back multiple times with my follow up questions.  In today’s day, I thought that was awesome that they were willing to take time out of their already busy day to offer me free advice and opinion.  Although their opinion didn’t end up being correct, to be fair , they didn’t have a chance to examine me in person.

For the last 2-3 years, my time at the gym was spent doing stretches and little PT exercises trying to give myself some relief, to no avail.

It’s been so great to be able to go to the gym, and get a real workout and real sweat in lately. 

I just kept this thought in mind as I endured all of these frustrating doctor visits, opinions, and failed treatments â€"
There had to be a light at the end of the tunnel eventually if I stuck with it long enough

This road was long and very depressing

[joshb7_]

So what surgery did you get to make it better? Are you fully fit and functioning well pain free now?

[NYRFan19]

It was a repair of the rectus abdominus / adductor longus muscle.  The rectus abdominus was stitched back down to the bone, and the doctor cut the adductor longus off of being attached to the rectus abdominus, with the adductor longus left to heal to the other adductor muscles, and thus “lengthening” the muscle somewhat. 

Yes fully fit and functional now, mobility and flexibility have improved massively , there are no activity restrictions.

[jimbone]

Way to Go-

Your thread provides two important lessons all surgical candidates need to learn:   you need to be your own best advocate or have someone do that for you, and doctors make mistakes so trust your gut and hold their feet to the fire.  Lastly- don't give up.  Perseverance is what wins the day.  Wait a minute, that was three things.  Congratulations on your outcome and thank you for not just seeing this through but sharing an important set of overlooked conditions some others might benefit in learning about.  The anatomy of this procedure while well established is still difficult terrain to navigate even for skilled and experienced surgeons.  Long, hard haul for you- so glad you made it through.

[johnwitt]

NYRFan your post may have helped me indirectly.  I got a hip resurfacing with Dr Su in November 2016.  Started running again in May 2017 and for the most part everything went well -- 5Ks, 5 milers, 10Ks.  After really hard races I would be hurting, but 4 Advil and a few hours later I'd be OK.  Started training for a half marathon and overdid it doing the running portion of a half ironman relay, and then the problems got worse.  If I tried to race or run hard the hip/groin area would start to hurt within 10 minutes, and soon I would have to stop.

Had my regular checkup with Dr Su in Oct 2018 and he had me to talk to one of his assistants about how to run through it.  Nothing worked.  I went back to him in May 2019.  He mentioned a longer rest period might help.  When I insisted something was really wrong he inquired about the pain pattern.  When I pointed to the groin as where it hurt most, he put me in touch with a sports hernia expert.  I hadn't heard of it either!  Anyway, there are a few good surgeons out there.  What I learned from my guy is that it won't show up on some MRIs.  You have to get a specific kind or machine (I don't know the technical aspects). 

He diagnosed me with a bilateral sports hernia -- much worse on the side of my hip resurfacing -- plus some loose fibrocartilage that had to be reattached to the pubic bone.  He said the fibrocartilage was likely causing the pain.  It had been hanging there for a while and never got a chance to heal.  Meanwhile my hard running was making it worse.

Many people with sport hernias had an underlying hip issue.  I ran marathons for years, and several of them were on an arthritic hip. 

Again, Dr Su referred me to a sports hernia guy in May 2019 so not sure he was prompted by your experience, or maybe someone else's

I start running again at the end of October.