I was wondering if you might be of any assistance with a patient of mine. I have worked with this high school football player in the past who had an abdominal hernia and had surgery. He played football with no real concerns with this area and then started getting ready for triple jump in track when he started to feel the pain again. He finally went back to his physician and it was found that he had another hernia near the original. The MD wanted him to rest as he believed it would heal so he took 8 weeks off doing nothing. He still has the same pain. MD does not want to do anything until June 1 but this individual is to play college football next year and does not want to wait around. He is not sure if it will heal but does not know if surgery will be warranted. I have worked on his posture as he was rotated in his pelvis. What is your experience with these types of injuries and can you offer any assistance as what I might work with on him?
Yes, I’ve seen and treated a number of torsioned patients with resultant abdominal or inguinal hernias and these are some of the key treatment considerations:
There is usually a pathology (ligamentous laxity) across their hips and possibly across their iliolumbar region that does not allow their pelvic floor, pelvis and abdominal wall to move out of their torsioned patterned state (R AF IR and AF ADD) into L AF IR and L AF ADD before they exert themselves. In other words, they can’t shift fully into their L posterior capsule and get beyond the ischiofemoral ligament tightness (because they are so loose across the front of the hip) so the shifting and rotating forces that should be received via glide and roll into the L hip is transfered directly into the hernia site.
My recommendations are to first approximate and IR the L femur into the L acetabulum as strongly as possible (Right Sidelying Left Adductor Pull Back, or similar activity) prior to a passive and then active effort to stretch the L ischiofemoral ligament (usually started in L sidelying). Attempts at stretching the posterior hip without fully “seating” the femoral head first can actually stretch them out of the hip and not into it.
And then after the hip is fully seated and able to IR without compensation, FA IR with the IC adductor and anterior glute medius will be essential to hold the femoral head in the acetabulum during sidelying and eventually during L single leg dynamic stance activities. If you can’t integrate these two muscles together during single leg IR stance then its a pretty good indication that you are not able to keep the femoral head properly positioned in the acetabulum during IR and that transverse and frontal forces will be directed back into the hernia site when they exert themselves.
Regardless of whether or not this athlete will need surgery or not, he will need the above muscle integration to treat the pathomechanics that put him at such high risk for hernia in the first place.