Athletic Pubalgia

Pain & Rehab Forum [Moderated]
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Hello BBM Rehab Team,

I appreciate your help, as I have been dealing with severe pain in the groin and abdominal area for over two years. I had bilateral inguinal and umbilical hernia surgery June 2025 (written about it previously). I have still been experiencing pain, so my surgeon ordered a pelvis MRI in May 2026.

Impression: There is subtle heterogeneous signal intensity identified within the rectus abdominis aponeurosis insertion at the pubic symphysis bilaterally with mild associated edema, concerning for subtle underlying moderate grade strain/partial tears. My surgeon commented that there may be possible athletic pubalgia.

Currently, I am experiencing pain just below the belly button radiating down—it feels it is radiating down through my genitalia and my inguinal area and testicular area are sore to the touch and painful. I am considering of possible issues with the mesh or other problems with the previous umbilical hearnia surgery. Thus, my hernia surgeon says that the pelvis MRI does not show his umbilical region and he wants it evaluated. He is to order a CT A/P with IV contrast for Periumbilical pain and groin pain. Otherwise he says it sounds like I may have some sport’s hernias based on the previous MRI.

What do you think about about what may be causing this pain that I described? What do you feel about this course of action?

**If it is actually athletic pubalgia, what does actually PT look like to help treat a sports hernia? I want to mention that there are no tears or edema of the adductor tendons—just very minor tears on each labrum.

Thank you for your help! Have a blessed day!

Paul

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Hey Paul,

Athletic pubalgia/sports hernias are typically managed in much the same fashion as some other issues we have discussed in the past. It is pretty hard to determine how much the rectus abdominis, adductors, inguinal contribute to the manifestation of symptoms. We tend to parse it out into establishing the things we can still do in training and continuing with those without much interruption. For movements where issues may be more present, we can modify to find what is most tolerable whether that being altering stance/ROM/tempo and use a graded exposure approach from which to build those back up. We do quite often put in some specific adductor and ab work, but once again, this is contingent upon the balance of what is most tolerable and what we need to work on more from an exposure principle. It also depends on the equipment to which you have access as this is where an adductor machine can come in handy. That being said, a lateral lunge/cossack squat/Copenhagen variation can also be a descent starting point.

There isn’t a one size fits all algorithm to addressing this and it is selecting exercises where we can get some biased loading to the area as a means of driving some tissue adaptation, but also trusting movements, and feeling comfortable moving again.

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Thank you for the reply, Dr. Miles! I have a few follow up questions.

  1. Since “It is pretty hard to determine how much the rectus abdominis, adductors, inguinal contribute to the manifestation of symptoms,” do you think the CT that was ordered will help in this determination?

  2. Would muscle testing in-person also help make this determination and/or help serve as a guide for program structure? I am trying to determine if it would be beneficial for me to come visit you again in Cincinnati?

  3. Would a structured program be similar to what you prescribed previously, as in staring with an isolation/training movement, then an exposure movement, followed by a movement that is different in nature?

Thanks and have a blessed day!

Paul