If a sports hernia is not properly addressed, it can also lead to a protrusion, causing an inguinal hernia or even abdominal hernia. A balanced exercise program is essential for the recovery process. Keep reading to learn more about sports hernia exercises.
Also known as athletic pubalgia, it is a bit of a misnomer since it is different from the other types of hernias. Rather than a protrusion of tissue, such as with an inguinal (groin) hernia, it simply implies that there are muscle tears in the lower abdomen or groin secondary to overexertion. This is most common in athletes but can happen with daily activities too.
Safe Stretches & Exercises for Sports Hernia
A combination of stretching and strengthening will restore coordination of the entire core to treat, manage, and prevent future injuries in the groin or abdominal wall.
Stretching the affected muscles around the core that may be tight and imbalanced can give some much needed groin pain relief. The focus will be on stretching the sore groin and other larger muscle groups in the hip to boost local flexibility and range of motion.
Butterfly Stretch
You can use your hands or a stretch strap for this one. The focus is on the commonly sore inner thigh muscles, or hip adductors. The stretch strap is best if you can’t reach your feet comfortably or you want to deepen the stretch.
Start by sitting on the floor
Place the bottoms of your feet together with the hips rotated outward and knees pointing away from each other - how high your knees are off the ground will depend on your general flexibility
Next, bring the heels closer to your butt, as far as is comfortable, until a stretch is felt in the inner thighs
For a deeper stretch, bring the knees closer toward the floor by using your elbows for overpressure
Hold for 30+ seconds for 2-3 sets total
Kneeling Hip Flexor Stretch
Tight hip flexors, the large muscle groups that cross the front of the hip and pelvis, can throw the entire core out of balance. A gentle hip flexor stretch can be powerful for relief and recovery.
Start by long kneeling on the floor with both legs
Bring the foot opposite of the hip you want to stretch forward and place it flat on the ground in front of you - with the hip and knee both at approximately 90 degrees of bend
Make sure the knee on the ground is directly under the hip to start
Next, think about sending your hips forward (as you shift your weight forward) until you feel a stretch along the entire front of the hip
You can try a cushion under the knee for comfort too
Don’t forget to keep the hips square throughout to prevent rotation of the spine
Hold for 30+ seconds for 2-3 sets on each leg
To intensify the stretch, you can shift deeper or add a gentle side bend toward the knee that is in front
Alternatively, you can also try this stretch in standing if kneeling is not tolerable.
Standing Quad Stretch
This simple stretch is also a great addition to your stretching routine. The quads are notoriously tight with groin pain and can even exacerbate the issue.
Stand in a comfortable position with the feet hip width apart
Use a chair or wall for balance as needed
Lift one foot off the ground and bend the knee so that you can grab the top of your ankle with the hand on the same side
Once you have secured your ankle, gently bring the heel closer to the butt with the guidance of your hand
Pull until you feel a gentle stretch in the front of the thigh
Keep the knee under the hips or slightly behind- if it is possible without arching the back
Do not let your hips hike to one side or low back arch during this stretch
Hold for 30+ seconds for 2-3 sets on each leg
Hamstring Stretch
Hamstring tension can play a large role in groin pain because of the influence it has on the pelvis. Grab a stretch strap, towel, or belt for this stretch to get started.
Lie on your back and wrap your stretching tool around the mid foot of the leg you want to stretch
With a straight knee, bring your entire leg up toward your chest
Continue pulling until you feel a stretch in the back of the leg and hold
Focus on staying relaxed and hold for 30+ seconds for 2-3 sets on each leg
Strength
Addressing the strength of the core muscles is a key factor in recovering from and preventing continued issues with a sports hernia in the future. Plus, there are so many great benefits to core strengthening for improving your endurance, coordination, and quality of life. All these exercises address sustainable core strength.
Finding Your “Core”
Before getting started with any type of core routine, you need to learn to properly activate your lower core muscles, also known as the transverse abdominis. A sports hernia is often secondary to poor core stability - so going back to the basics can be very beneficial. Starting here will prevent any future core muscle injuries as well.
Start by lying on your back with the knees bent, feet flat on the floor, and hands just inside your hip bones for monitoring
Then, tighten your abs as you bring your belly button toward your spine
If you’re having trouble finding these muscles, imagine someone is about to punch you or forcefully blow your air out to feel your muscles tighten
If you’re struggling with finding these muscles, you can start by simply tightening and holding for 3-5 seconds for 10 reps at a time, don’t forget to breathe!
When you’re ready, and comfortable, you can progress to the other core exercises in this program
Double Leg Toe Taps
This basic exercise can be difficult if you are dealing with groin pain or a weak core, which is common with a sports hernia. Make sure you understand how to master tightening your core before starting this one.
Lie on your back with the abs tight
Bring both knees up toward the sky while keeping your back relatively flat - a slight arch is okay for the lumbar spine but nothing more
Then, bring both your feet back down to touch the floor
Your back should stay stable and flat against the floor with minimal wobbling
Repeat for 10-15 repetitions for 2-3 sets
If this move is too hard - simply modify to one leg at a time
Clam Shells
Groin pain related to a sports hernia can also be caused by an underlying imbalance in the hip rotators - particularly the external rotators. One of the larger muscle groups associated with hip rotation is the gluteus medius. This exercise will give the side of your butt and hip a great burn for restoring better balance in relation to the inner hip.
Lie on your side, with the hip you want to work facing up
Make sure the hips, legs, shoulders, and feet are all stacked directly on top of each other
Have the knees and hips bent so that the knees are in front of the body and the feet are in line with the rest of the body
Finally, lift the top knee up toward the ceiling while keeping the feet together
Do not let the hip or trunk roll back - if it is, try to better control your core by keeping the lower abs tight or make the motion smaller
Repeat for 10-15 repetitions for 2-3 sets on each leg
Bird Dog
This classic exercise is great for training full body coordination while keeping the core activated. Plus, it works your hip muscles for an added benefit to your groin.
Start by getting on all fours with your hands directly under the shoulders
Push your hands “down” into the ground to activate the shoulders and keep them from sagging
Keep the abs tight and back relatively flat
Then, lift one leg and the opposite leg at the same time- extending them both as far as possible (arm forward and leg extended backwards)
Hold the end position for 1-2 seconds before slowly returning to the starting position and repeating
Make sure there is no rotation in the spine or arching of the low back throughout
Focus on one side at a time, repeat for 10-15 repetitions on each side for 2-3 sets
If this move is too hard to control- you can start with just the legs
Plank
A plank is always a great way to get the core, and pretty much the entire body, working all at once. This high level exercise should only be completed with good form and if it's pain free. You can start on your elbows and knees and then progress to your elbows and toes when you feel ready and in control.
Start by getting on your hands and knees
Place both your forearms on the ground with your elbows directly under the shoulders
Push the elbows into the ground to bring tension to the shoulders and mid-back
Make sure the entire body is aligned- no bending at the hip (butt up) or excessive arching of the low back as you shift your weight to only your knees and forearms
Keep your stomach tight and hold for 30+ seconds
Repeat for 2-3 sets total, increasing time as tolerated
Movements to Avoid
In general, high impact or other high exertion activities will be aggravating after the onset of a sports hernia. Additionally, any exercise that exerts too much force on the abdominal muscles can also be problematic. Any exercise that increases your symptoms should be avoided until adequate rest is allowed. If you are an athlete, this may mean taking a little more rest time than you’d like, but it will definitely help prevent future issues. Common aggravating movements include:
Running
Jumping
Kicking a ball
Flexion based ab exercises such as sit-ups and crunches
Heavy weight lifting
High impact sports such as baseball, football, skiing, rugby, and volleyball
How to Maximize Your Exercises
In addition to exercise, combining your recovery with other treatment options will help expedite your recovery and prevent onset of chronic groin pain. Other options to keep in mind include:
Soft tissue, muscle, and fascia massage - from the help of a massage therapist or self-massage with massage tools like a foam roller or muscle roller stick
Always start with a gentle warm up prior to exercise
Use pain modalities before or after your exercises as needed, such as ice, heat, and TENs to the groin area
If you’re feeling unsure, you can always schedule a round of physical therapy for more personalized guidance - including a home exercise program, manual therapy, extensive education and more
Ensure that you are addressing the correct injury- there are several other types of hernias to be aware of with slightly different treatment options
Staying Safe During Recovery
Recovering from a sports hernia can be straightforward with the right rest time, exercise program, and understanding of the underlying issue. These stretching and strengthening exercises are a great place to start. Additionally, if your symptoms get worse or are not improving, make sure to get in touch with your doctor or physical therapist as soon as possible for further medical advice.
JayDee Vykoukal is a Doctor of Physical Therapy, owner of the healthy habit platform Health Means Wealth, and freelance medical writer. She loves traveling and spending time with her family in nature. Her passion is helping others continue to participate in the activities they love through education and proper exercise.
Telemedicine took off in early 2020 as a way to safely and remotely treat patients. Since then, the benefits of remote treatment have become clear, causing more doctors and patients to enjoy telehealth services regularly.
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