Dominic Stone
Core muscle injury (CMI), also known as athletic pubalgia or a sports hernia, is an injury to the abdominal or groin muscles, or the tendons that attach muscles to the pelvis. It is caused by forceful and repetitive movements, such as kicking or frequent speed changes, and is common in athletes who play soccer, football, and hockey. The injury can occur suddenly or over time and is not limited to athletes, as it can also be caused by activities such as walking or jogging. The primary symptom of CMI is chronic pain in the lower abdomen and/or groin, which may worsen during physical activity. Treatment options include rest, medication, physical therapy, and in some cases, surgery.
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What You'll Learn
Core Muscle Injury Symptoms
Core muscle injuries (CMI) are tears or micro-tears in the muscles of the core, which includes the muscles from the chest to the mid-thigh. The abdominal muscles, oblique muscles, and thigh muscles are all considered core muscles. The most common symptoms of CMI are deep, chronic pain in the groin or lower abdominal muscles. This pain often resolves with rest but flares up during exercise or exertion. The location of the pain can vary, moving around the core over time before treatment.
CMI can cause increased pain or discomfort with activities such as sprinting, kicking, sidestepping, or lifting. It can also make movements like walking, bending forward or sideways, and standing up straight more challenging. The pain may also affect normal activities such as coughing, sneezing, or rolling over in bed.
In some cases, CMI can be accompanied by inflammation of the pubic bone (osteitis pubis), which can cause tenderness and pain in the pubic area. Additionally, there may be concomitant adductor longus tendinopathy, which should be investigated as part of the diagnosis.
The diagnosis of CMI can be challenging, and it often requires a high level of clinical suspicion. Imaging techniques such as ultrasound or MRI may be used to rule out a hernia and confirm the diagnosis of CMI. Dynamic ultrasonography is becoming an increasingly used diagnostic modality, while MRI is preferred for its higher sensitivity and specificity.
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Diagnosis
Core muscle injuries are a common occurrence in athletes and the general population. They are caused by a variety of factors and can result in a range of symptoms. The injury involves damage to the muscles in the abdomen, pelvis, and lower back. It is important to seek treatment right away if you are experiencing any pain or discomfort in your core muscles.
The diagnosis of a core muscle injury begins with a physical examination by a doctor. The doctor will take a detailed history, including information about any previous injuries, and perform a physical exam to assess the patient's range of motion and muscle strength. They may also order imaging tests such as an MRI, ultrasound, or X-rays to rule out other injuries and confirm the diagnosis of a core muscle injury.
MRI (magnetic resonance imaging) is a preferred method for diagnosing core muscle injuries as it is more sensitive and specific than other imaging techniques. However, dynamic ultrasonography is also becoming increasingly used as a diagnostic modality. In some cases, X-rays may be ordered to rule out fractures or other bone injuries.
The physical examination will typically include standard strength tests of the hip muscles and tests to measure the flexibility of the hip and thigh muscles. The patient's ability to isolate or contract specific muscles will also be assessed. A thorough examination of hip and low back movements may also be performed to determine the extent of the injury and rule out other potential injuries.
If you are experiencing symptoms of a core muscle injury, it is important to consult a medical professional for an accurate diagnosis and proper treatment. Physical therapy has been proven to help patients recover from pain and improve their strength and flexibility. However, in some cases, surgery may be recommended if conservative treatment options are unsuccessful.
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Treatment
Non-surgical Treatment
The first recommendation for most patients is a conservative course of treatment for four to six weeks. This includes rest, ice, and anti-inflammatory medication. Physical therapy is often prescribed as a first-line treatment, with a focus on muscle retraining, strengthening, manual therapy, and return-to-sport drills. Muscle retraining involves teaching patients to target and move their abdominal and hip muscles, as certain muscles may not be working well due to the injury. Strengthening exercises are introduced once the patient is experiencing less pain, focusing on targeted hip and core strengthening that does not aggravate the injury. Manual therapy involves hands-on techniques to stretch and mobilize affected soft tissue and joints, improving hip-joint mobility and flexibility while reducing pain. Return-to-sport drills are gradually introduced, with movements specific to the patient's sport or activity, such as running and light sport-related drills.
Surgical Treatment
If non-operative management is unsuccessful and groin pain persists after four to six weeks, surgery may be recommended. Surgical repair for core muscle injuries involves suturing the muscle attachments to the bones and adjacent ligaments to stabilize the pubic joint. Surgery can also address adductor involvement through an adductor compartmental decompression and/or repair, which treats inflammation by releasing the connective tissue that ensheathes the adductor muscles. Early surgical intervention for severe core muscle injuries can facilitate a quicker return to pre-injury athletic performance.
Post-Surgical Treatment
Following surgery, physical therapy can aid in regaining strength and flexibility. This includes targeted treatments to address issues identified during evaluation, such as poor hip strength and flexibility, and difficulties activating or turning the abdominal muscles to stabilize the pelvis.
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Prevention
Core muscle injuries (CMI) are a common occurrence in athletes who play sports with a lot of kicking or frequent speed changes, such as soccer, football, and hockey. It refers to pain in the groin region, where the abdominal muscles attach to the pubis. This injury has also been called a sports hernia, athletic pubalgia, or Gilmore groin.
While diagnostic technologies have improved, it is still challenging to identify the cause of chronic groin pain due to the overlap of symptoms between different disorders. Magnetic resonance imaging (MRI) is often used for diagnosis, but it may underestimate the extent of a core muscle injury.
- Rest: Allow your muscles to heal and prevent further damage. Rest can help reduce inflammation and promote healing, especially when coupled with ice therapy to reduce pain and swelling.
- Compression: Wrap or compress the injured area with a bandage to support the muscles, reduce pain, and aid in healing.
- Develop and Maintain Core Strength: Engage in regular exercise and stretching to strengthen your core muscles. This includes exercises such as planks, glute bridges, leg raises, and mountain climbers. A strong core will help stabilize your trunk and pelvis, improving your posture and reducing the chance of injuries.
- Protective Gear: When participating in contact sports or strenuous physical activity, always wear appropriate protective gear to safeguard your core muscles and prevent injuries.
- Maintain Good Posture: Be mindful of your posture, especially during repetitive lifting or bending motions. Poor posture can place unnecessary strain on your spine and increase the risk of injuries.
- Take Breaks: During long periods of strenuous physical activity, remember to take breaks to rest your body and reduce the risk of overexertion.
- Abdominal Bracing: Practising abdominal bracing can help you effectively engage your core muscles. This technique prepares your core to brace against impact and protect your spine, especially during accidents or falls.
By taking these preventative measures, you can significantly reduce the chances of experiencing a core muscle injury and its associated pain and discomfort.
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Risk Factors
Core muscle injury (CMI) is an injury to the abdominal muscle and thigh muscle (adductor longus) where they attach to the pubic bone. It is also known as athletic pubalgia or a sports hernia. It is characterised by chronic pain in the groin or lower abdominal muscles, which may worsen during physical activity.
Athletic Activity
Athletic activity is a significant risk factor for core muscle injury, particularly sports that involve a lot of kicking or frequent speed changes, such as soccer, football, and hockey. The repetitive nature of certain sports movements, such as swinging a golf club, can also contribute to CMI. The condition most commonly affects male athletes between the ages of 26 and 28, with females making up only 5-15% of CMIs. This gender disparity is likely due to the types of athletic activities that males tend to engage in during their youth, which are often more aggressive and competitive.
Forceful and Repetitive Movements
Forceful and repetitive hip and pelvic movements, such as twisting, jumping, and kicking, can lead to CMI. This is especially true if these movements are performed improperly or without proper sports conditioning. Overstretching the abdominal or inner thigh muscles, for example, by overextending at the waist or performing a split, can also contribute to CMI.
Muscle Imbalances
Imbalances in muscle strength, such as a weakness in the abdominal muscles or a strength imbalance between the hip and abdominal muscles, can increase the risk of CMI. This is why athletes are advised to focus on a balanced approach to core strengthening and to avoid overusing one particular muscle group.
Nerve Injury
In some cases, nerve injury may be a contributing factor to CMI. Treating only the muscle and tendon damage without addressing nerve injuries can lead to continued pain and discomfort.
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Frequently asked questions
A core muscle injury (CMI) is an injury to the abdominal muscle and thigh muscle (adductor longus). It involves a weakening or tearing of the deep layers of the lower abdominal wall or the tendons that attach muscles to the pelvis.
A core muscle injury is often brought on by repetitive, forceful motion of the pelvis. It can also be caused by overstretching abdominal muscles by overextending at the waist, or overstretching inner thigh muscles while performing a split.
The primary symptom of a CMI is chronic pain in the lower abdomen and/or groin. The pain may worsen during physical activity and often resolves when resting but flares up when exercising.
Treatment always starts with conservative measures, including rest, activity modification, anti-inflammatory medications, and physical therapy. If these are successful, the patient may then move on to an exercise program focused on stretching and strengthening to prevent another CMI. If pain persists, a corticosteroid injection may be administered.
