Core Muscle Injury (Sports Hernia)

Cause:
A core muscle injury occurs where the lower abdominal muscles (rectus abdominis) and inner thigh muscles (adductor longus) attach to the pubic bone. Although these muscle groups share a common tendinous attachment, they pull in opposite directions. Repetitive twisting, cutting, or kicking motions can create tension and imbalance across this area, leading to damage and tearing of these tendon attachments.

Common Sports:
Core muscle injuries are most often seen in athletes who perform explosive or rotational movements, such as those in soccer, hockey, football, tennis, basketball, and rugby.

Symptoms: Athletes typically report groin or lower abdominal pain that improves with rest but recurs with activity and worsens with exertion. There is often tenderness over the pubic symphysis or rectus abdominis insertion. Unlike a true inguinal or femoral hernia, there is no visible or palpable bulge, which helps distinguish a “sports hernia” (core muscle injury) from a true hernia.

Treatment:

Conservative (first line):

The initial approach includes 6-12 weeks of:

NSAIDs, rest, and activity modification
Physical therapy focused on core stabilization and hip/pelvic strengthening
Addressing biomechanical factors and flexibility deficits, especially in the hip adductors.

Interventional (if conservative care fails):

Image-guided corticosteroid injection (at the pubic symphysis if degenerative changes are present)
Biological injections (platelet rich plasma or PRP) at tendon injury site

Surgical (if > 3 months of failed conservative management):

Surgical repair of rectus abdominis-adductor aponeurosis
Return to play typically occurs within 6–12 weeks post-operatively

Note: Core muscle injury can mimic or coexist with other causes of groin pain. Evaluation by a sports medicine or hip specialist is important to rule out related conditions, including:

Inguinal hernia
Adductor strain
Osteitis pubis (degenerative changes and the pubic symphysis joint)
Hip labral tear
Femoroacetabular impingement (FAI)

Core Muscle Injury (Sports Hernia)

Schedule an Appointment with a Hip Pain Specialist