The role of the team physician and athletic trainer, including non-operative management

Abstract

In order for a patient to receive a timely diagnosis of sports hernia or athletic pubalgia, athletic trainers and physicians must be mindful of the signs and symptoms of this frustrating entity. Once the physician confirms the diagnosis, athletic trainers provide the first line of treatment by attempting non-operative management of the condition. The design of the rehabilitation program should be preceded by a thorough evaluation, which includes a detailed history, postural and flexibility assessment, and dynamic movement screen. For the best possible outcome, the conservative treatment plan should combine both passive and active therapies. Passive therapies include rest, physical therapy modalities, and manual therapy. Physicians may also prescribe oral anti-inflammatories or varying types of local injections to assist in decreasing pain and inflammation. Active therapies should focus on restoring range of motion, improving motor control, increasing core stability, and correcting muscular imbalances or deficits. A rehabilitation progression is provided based on the current evidence in the literature as well as the authors' clinical experience. While a number of factors play into the decision, surgical management of sports hernia should not be considered until a patient fails to improve despite attempting a multi-faceted rehabilitation program.