Let’s Talk About the Groin Area: No More Taboos

Chicago Bulls’ Wendell Carter, Jr., Major League Baseball’s Cliff Lee and the National Football League’s Donovan McNabb, what do they have in common besides being elite athletes? They have all suffered core muscle injuries that required surgical intervention. Despite how debilitating these injuries can be and these athlete’s star power, core muscle injuries don’t get the same billing as other type of sports injuries like anterior cruciate ligament tears or an injury to the ulnar collateral ligament.

William Meyers, M.D., founder of the Vincera Institute in Philadelphia, and a leader in core muscle injuries, told OTW that a big reason for this is what he calls the sex distraction. Because the core includes the pubic bone, people get uncomfortable and sometimes giggly when talking about it. Hence the popularization of the term sports hernia to refer to core muscle injuries, despite the fact there is actually no hernia involved at all.

Meyers prefers the term “athletic pubalgia.” He explained that the core which he identifies as from mid-thigh to mid-chest is very complex covering a lot of organs, blood vessels, bone and muscles, and when an injury here is left undetected it can be career-ending for an athlete.

Another reason these injuries don’t get much attention in mainstream medicine he said was because of how doctors are trained. He explained that there is too much focus on specialties like orthopedics, gynecology or dermatology and not enough of cross-training or bridging of specialties.

“Orthopedic doctors are afraid to get in there because they were not trained on blood vessels or the bladder for example,” he said.

“This has been a no-touch area of medicine and we just need to get over it. Orthopedic surgeons working with athletes need to be more aware of how weakness and injury in the core has repercussions in other areas of the body.”

The Complexities of the Core

First, what are core muscle injuries? They generally involve small tears of the muscles attached to the pubic bone. They can result from a trauma or from overuse. Dancers can experience one from hyperextending during a split.

Pain can present in different ways too. For some patients, it is a shooting pain in one area and for others it is a pain that moves around.

Common symptoms according to the Vincera Institute website include: “Abdominal or groin pain after an acute injury, Abdominal or groin pain that worsens (or gets progressively worse) over weeks, months or even years, Chest or rib pain, Fleeting pain that appears or disappears on one or two sides, Pain that moves from abdomen to groin or thigh, Increased pain or discomfort with exertion such as sprinting, kicking, sidestepping or light or heavy lifting, Increased pain or discomfort when coughing, sneezing or turning over in bed.”

The most common core muscles injuries include tears to the rectus abdominus, otherwise known as the abdominals, tears to the adductor (thigh muscles) and iliotibial tract syndrome where you experience pain around the iliotibial band on the outer sides of the thigh. Core muscle injuries are complex because there are over a hundred different combinations of them and just as many variations on the types of surgeries needed to treat them.