This groin injury is a relatively rare condition and is characteristic of active athletes. It was first described in 1980 by the London surgeon Jerry Gilmore, who developed a surgical technique for its treatment that bears his name. It is also known as athletic pubalgia, pubic pain in athletes, and Gilmore’s syndrome, but the term Gilmore’s groin injury is more appropriate, since, strictly speaking, no true herniation is actually observed in this case.
This syndrome is characterized by chronic groin pain in athletes and widening of the external opening of the inguinal canal. It is most often seen in soccer players, hockey players, and rugby players, and can develop both in amateur athletes and in professional athletes. Physical examination and imaging studies do not prove the presence of a hernia, and none is found during surgical correction of the condition either. The term hernia is used incorrectly in this case, but it has remained in the literature because surgical correction of sports hernias involves surgical reconstructions similar to those used for inguinal hernias.
The symptoms of a sports hernia are associated with pain during sports and movement, especially with hip extension, twisting, and turning. The pain usually radiates to the adductors and the testicles, but it is not uncommon for the patient to have difficulty pointing to the exact location of the pain.
After exercise, the affected athlete usually feels stiffness and pain. Any effort leading to an increase in intra-abdominal pressure, such as coughing, sneezing, or sports activity, can provoke pain. At first, those affected are able to continue exercising, but over time the complaints progressively increase.
The diagnosis is based on the history and physical examination. The patient usually reports pain when coughing and sneezing, as well as in a seated position and when pressing the two legs together.
Various lesions are observed, but the following intraoperative findings are usually found:
- Tear of the aponeurosis of the external oblique abdominal muscle
- Tear of the conjoint tendon (tendo conjunctivus, falx inguinalis)
- Avulsion of the conjoint tendon from the pubic tubercle
- Dehiscence between the conjoint tendon and the inguinal ligament
- Tear of the transversalis fascia
- Avulsion of the internal oblique abdominal muscle from the pubic tubercle
- Entrapment of the ilioinguinal or genitofemoral nerve
Conservative treatment involves stabilizing and strengthening the muscles of the pelvic area. Rest for 6-8 weeks is required. This may allow active sports activity to continue for a short period, but it is not a definitive solution to the problem. Ultimately, a point is usually reached at which the affected person cannot continue to practice their sport actively, because their physical capacity decreases significantly, and surgical treatment with correction of the hernia becomes necessary.
The exact frequency of the condition is unknown. According to some authors, it is the most common cause of chronic groin pain in athletes, while according to others, the condition occurs extremely rarely.
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