Sports Hernia Investigations...

I thought I'd post this for the benefit of those who are thinking they've got what I've got (but probably don't) or just like to read lots of boring details about such things. Here was a letter to the leader in the country for dealing with Sports Hernia which details my history in the hopes of confirming the diagnosis I got from an MRI. It's got all the variables I could think of that seemed important for his input....


To:
Dr William Meyers
245 N 15th St, MS 413
NCB, Suite 7150 7th floor
Philadelphia, PA 19102

From:
John Hill

Date – 2/6/2009

Please fine enclosed:
MRI Images CD
Radiology Report

Dear Dr. Meyers,

As you can see from the attached radiology report I have been diagnosed with Sports Hernia. I have not been able to locate anyone local that can provide any confirmation of this diagnosis nor to give me any input of what I should do about it. Thru googling I’ve found your name as the one with the most experience in treating this injury so I was hoping get your opinion on the MRI to confirm (or not) the diagnosis and recommend treatment options.

Background on me:

I’m 41 years old. I’ve become a fairly competitive marathoner over the last few years starting running at age 38 after 20 years off from high school. I ran around 60-80 miles per week in training last year including 5 marathons between 2:39 and 2:47. Looking back I’d say there may have been symptoms worth mentioning going back to August/September timeframe:

August/September/October – right hip pains – especially when doing things like getting dressed where I would have to get on one foot for putting on socks or pants. Location of the pain I think was on the front about ½ way between the hip and the groin. There was not typically much pain from this while running or walking except occasionally with some random twist. Heavy lifting seemed to be an aggravator. A physical therapist at my running club did a test on me back in September and noted my right leg is much weaker than my left when I lay flat and try to lift it.

November – Ran my last marathon (PR’d it @ 2:39) – I don’t recall anything particularly of issue in the race – the mild hip pain on twists required a little gingerly treatment but having aches and pains post marathon is normal.

1 week after marathon – I had been jogging a few miles each day but on Saturday 6 days after I tried for 13 and may have done them a little fast – not really that fast but maybe on tight muscles from the marathon it was too fast – ended up walking towards the end although I don’t recall why. Also got a massage right after this run – I’ve wondered if he did something wrong.

For the next few days I could only get a few miles into a run then had pain in the butt, which I came to believe was Piriformus Syndrom.

Went thru the rest of November and December trying resting a few days then running easy but never got more than 6 miles at a time before building up pain got me to stop. Eventually thru massaging and chiropractor help the pain in the butt stopped but as I ran I would start to get a dull pain in the upper thigh and then a sharper pain down the inside of my right leg – after the sharper pain started I would stop running and head home – on a few occasions the sharper pain started again always around 4-5 miles into the run at which point I would stop running.

Once I got the MRI results I connected the piriformis symptoms to the stress fracture in the Scrum - I’ve found few runners in google searches that first thought they had piriformis syndrome then found a stress fracture in the sacrum so that seems to fit. I suspect the stress fracture is related to an abducted toe when I run (right toe goes out about an inch while left stays plum) which I am noting now as I look back on video’s of myself running – that and likely just plain overuse. Not sure if it the fracture happen at the race or in the run the following weekend.

I connected the pain down the right inner leg and the dull upper thigh pain to the Sportsman hernia – really not sure if those symptoms connect to that or not. The inner thigh pain I’ve actually felt once before exactly the same – after a fast, short 5k race back in February – for a couple weeks I had to be quite gingerly about warming up as the pain was a concern – but after warm-up of a mile or so the pain was gone and I could run whatever speed or distance without bother for it.

Stress fracture repair is easy – just rest a couple months and back to 100% - but the sports hernia is a question for which I come to you.

I’ve not run at all during January and all pain seems to be declining including the pain associated with getting on one foot when I get dressed. I did seem to re-aggravate that particular pain lifting something heavy last weekend and for the last several days that same pain when I get on one foot is back again on the right side – that seems to be diminishing. Now I’m wondering if THAT is the symptom associated with the Sports hernia and not that pain down the right leg – or maybe both are associated with it.

Anyway – the pain is not at all debilitating however as the stress fracture should now be about healed I’d like to get back in shape for racing again and I don’t know what to expect from the Sport Hernia.

From what I’ve read it appears my symptoms are mild however I get the impression the injury only gets worse – not better. Since I haven’t tried to run yet I don’t know if it limits my running but I suspect strongly it will.

Looking forward to your input.

John.

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Response from Dr. Meyer's office - can't confirm diagnosis - need to fly to Phily for an MRI specific for sports hernia (muscle or other tissue pulls away from the pubic bone) - depending on what's found can have operation same visit. Recovery I've heard from 2-weeks to 2 months. Noted was there does seem a correlation between sports hernia and hip issues.

The operation - Two options - 1) Meyers: Through an inch-long incision, he sews up the tears in a way that tightens some abdominal wall attachments to the bone, and loosens others to restore stability. His patients play again by six weeks. 2) Cattey (in Milwaukee) , operating through quarter-inch incisions, covered the damaged area with an index card-sized piece of mesh that he screwed into the pelvic bone. Scar tissue grows into the netting, strengthening the spot to prevent future tears. Option 1 from my research has been done thousands of times and Option 2 hundreds of times and the success rate appears higher with Option 1 so that's what I'm pursuing.

I'm working thru the insurance issues - clearly not a doctor in my HMO network - but then there is no such doctor since there are only two in the country so it should count as in network anyway as I'm told - but I'm still working on convincing the insurance company this is a necessary thing.

Once I convince them then I just need to convice myself :).

There it all is - all the details.....