Gilmore's Groin

Gilmore's Groin can also be known as a Sportsman's Hernia, athletic pubalgia, slap shot gut, and a sports hernia. However, a true Gilmore's Groin has nothing to do with a hernia. It occurs when excessive strain is placed on the groin and pelvic area, through kicking sports such as soccer and rugby. We talk to Jerry Gilmore himself who first identified this groin injury in 1980.

Symptoms

Symptoms of Gilmore's groin include groin pain that's increased by running, sprinting, twisting, and turning. After training the athlete may be stiff or sore. The day after training or playing the athlete may have groin pain when turning or even getting out of a car. Coughing and sneezing may also cause groin pain.

It is claimed that in 30% of athletes there is a history of sudden injury but the majority indicate it to be a gradual overuse injury. Is it a hernia? There is NOT a lump and so should not be thought to be a hernia.

What is Gilmore's groin?

Gilmore's groin was first identified in 1980 by Consultant Surgeon Mr. Jerry Gilmore, as a cause of longstanding groin pain. The condition is sometimes called the Sportsman's Hernia (or sports hernia), however, such symptoms of a hernia are often misdiagnosed as there is not actually a hernia present. Other more suitable alternative names include groin disruption and sportsman's groin. It is common in sports were a great deal of strain is placed on the groin and pelvic area through twisting and kicking movements. Players from sports such as soccer, football or rugby are most commonly injured.

Gilmore's groin is quite a complex condition, hence why it was not fully understood until relatively recently and why many cases are misdiagnosed as a groin strain or a hernia. The injury occurs at the junction of the leg and the torso. It involves the area (called an aponeurosis) where the abdominal muscles (Internal obliques, External obliques, and Transversus abdominis) converge to form the inguinal ligament. The external oblique muscle has an archway through which several nerves and vessels pass. In Gilmore's groin, a groin muscle tear causes this archway to open up much wider. Further tears in the obliques cause them to lift up and away from the inguinal ligament, leaving the transverse abdominis muscle unsupported.

Treatment of Gilmore's groin

What can the athlete do?

Although it is often possible to continue training with a Gilmore's groin the condition is likely to get gradually worse. Conservative treatment involves strengthening the muscles of the pelvic region with a focus on core strengthening. See a sports injury professional and/or surgeon who can make an accurate diagnosis.

What can a doctor or surgeon do?

For athletes that have not responded to a thorough rehabilitation program, surgery is indicated, which is usually successful. Following surgery, a 4 to 6 week rehabilitation period is usually required before returning to play. The rehabilitation program will be aimed at gradually improving the strength and flexibility of the pelvic muscles and will avoid sudden twisting and turning movements which may aggravate the injury.

Physiotherapy

Physiotherapy for Gilmore's Groin has changed throughout the years as originally it was only the professional sportsman that was operated on and they had daily access to a physiotherapist. The key to recovery after the operation is related to rehabilitation, the key being that the fitter the patient is before the operation, the quicker they will recover.

Mr. Marsh talks about the rehabilitation program which been modified into stages to adapt to all levels of fitness from the professional athlete to the amateur.

Cores strengthening

The muscles to be strengthened are known as the core muscles and include Transversus abdominis and Multifidus. These act as stabilizing muscles for the trunk and pelvis. The Transversus abdominis muscle stabilizes the trunk by acting as a natural corset and the Multifidus muscles run along the spine attaching to the vertebrae. It is usual to contract both of these muscles together to increase the stability of the spinal column.

First, you should learn how to contract, or 'engage' your core muscles. You can then gradually progress the difficulty of exercises you perform whilst maintaining core contraction.

Groin strengthening

It is also important to strengthen the groin muscles, known as the adductors. There are both short and long adductor muscles and so these exercises should be performed with the knee both straight (long adductors) and bent (short adductors) to work both sets.

Whilst core strengthening is performed initially, these exercises can begin as soon as they are pain-free to perform. Start very gently, allowing plenty of recovery time (2 days initially) between sessions. If there is a pain, then stop immediately.

Stretching exercises

We recommend seeking professional advice before undertaking any rehabilitation program. Stretching for Gilmore's groin should aim to maintain or improve the flexibility at the hip joint as a whole. Therefore it is important to stretch not only the groin muscles but also the hip flexors, hamstrings, and glutes.

Standing groin stretch

Stand with a wide stance. Bend the knee of the leg you are not stretching and lean towards that side. You should feel a stretch on the inside of the straight leg. Hold for 20-30 seconds and repeat 2-3 times. This exercise stretches the long adductor muscles.

 

Short adductor stretch

Sit on the floor and place the soles of your feet together. Place your elbows on your knees and apply a downward pressure until you feel a stretch on the inner groin. Hold for 20-30 seconds and repeat 2-3 times.

 

Hip flexor stretch

Place one knee on the floor and the other foot flat on the floor in front of you. Push your hips forward, keeping your back upright, until you feel a stretch at the front of the hip. Hold for 20-30 seconds and repeat 2-3 times.

 

Hamstring stretch

Sit on the floor with the back upright. Lean forward from the hips until you feel a stretch in the hamstrings at the back of the thigh. Hold for 20-30 seconds, and repeat 2-3 times.

 

Gluteal stretch

Lay on the floor on your back. Bring your knee up towards your chest. Pull the knee in towards you and across your body, towards the opposite shoulder. You should feel a stretch in the buttock. Hold for 20-30 seconds and repeat 2-3 times.

Strengthening exercises

Below are strengthening exercises used in the rehabilitation of Gilmore's Groin injury following surgery. Always seek professional advice before starting any rehabilitation program.

Strengthening the transversus and multifidus muscles

Kneel on all fours. Relax and allow the stomach to sag down. Very gently pull in your tummy so that your belly button moves closer to your spine. Do not contract too hard or other muscles will come into play. You should be able to hold this contraction whilst breathing or having a conversation. Begin by holding the contraction for 5 seconds, repeat 20 times. Perform the exercises twice a day. Gradually increase the duration of contraction up to 10 seconds. To increase the exercise still further, perform the static contractions in other positions such as sitting or standing.

Crunches

Lie on your back with the knees bent. Slide your hands up your thighs to your knees, then hold for 5 seconds. Alternatively, you can place your hands on your temples. Repeat 6 times.

Single leg raise

In a sitting position, raise the straight leg a few inches off the floor. Hold for 5 seconds before slowly lowering the leg back down. Repeat 10 times. This exercise can be progressed by moving the leg out to the side.

Static groin contraction

The first place to start when strengthening the groin is with static contractions. Place a ball between the knees and squeeze inwards, hold for 5-10 seconds, rest and repeat. You should also do this with straight legs and the ball between the ankles to work the long adductors.

Hip adduction holds

Lay on your side, with your trunk straight, with the top leg rested on a chair as shown. Raise the lower leg off the floor, keeping the knee straight. Lift as high as you can, hold for 5 seconds and lower back to the floor.

Lunges

Stand with a wide stance, one leg in front of the other. Bend the back knee down towards the floor and the front knee forwards over your foot. Keep your back upright throughout. Stop before the back knee touches the floor. Perform 5-10 reps. Progress to lunging forward holding a medicine ball in outstretched arms and then twist in alternate directions, right then left.

Ball rolls

Lay on your back with a swiss ball between your bent knees. Spread your arms out on the floor for balance. Roll first to the left then to the right. Repeat 10 times (5 each side).