Mystery hernia, maybe, I dunno

Medical Q&A [Moderated]
1

Hey fellas,

Longtime listener, first time caller. Sorry for the novel you’re about to read but thank you for it. I’ve got what’s theorized as a spigalian hernia that usually only announces its presence hip hinging 200+ lbs, eg. squats and DLs. This comes from training in 2019 and trying a fitness personality’s rec’d bent over row - good warning on who to listen to. It was from the DL/Pendlay position but keeping constant tension by not lowering to the ground. I felt a lot of work on my core, then a tearing sensation in my abs and a hot feeling. Stopped right there, went to do something else. I trained later and felt it tear more while DLing, I think, and a protruding sensation. I felt the same protrustion when training squats at a later session, and also doing Pendlay rows. Out of the gym, I’d randomly feel hot and cold sensations in that area for a time after the fact, then just some uncomfortable feeling when I’d be walking for a bit, those went away too. I went to a sports physician, he’s the one that called it a spigalian hernia, had him check for an inguinal just in case but thankfully nothing there. He sent me for an ultrasound with someone he considered really good, found nothing. Got a CT scan, I think (the one fluid has to be drunk for), nothing. Then I got a laparoscopy, surgeon found nothing. A referring physician had the idea of palpating while I lifted something heavy to cause the protruding sensation but there wasn’t anything heavy enough in the office. All the while I was training movements that didn’t antagonize it into protruding 'cause I didn’t wanna test my luck, or just been off training 'cause of work and Cov2. Besides the sport physician, it’s been hard getting to a solution when I get comments about having no reason to lift so much, how they don’t know anyone else that can lift that much when I mentioned it comes out at 200+ lbs and I could lift more, or that they’ve never had a patient like this and I’m basically a zebra to them.

What do?

2

I can’t give you specific medical advice, but if this were me, I would work back towards training normally and use our injury rehab-type approach, e.g. finding an entry point, slow titration of intensity and volume with concomitant return towards preferred exercises.

Additionally, it doesn’t sound like you have a hernia, and if you do, it’s not one that’s large enough/complicated enough to require urgent management. If it gets worse upon return to exercise, you should see your doctor.

3

Yeah, I had it in mind you can’t give me specific advice like my GP would. I can live the rest of my life normally, it just gets symptomatic at that weight and I like lifting more than that weight. I was hoping for advice on where to look/how to approach it/advocating for myself since the clinicians here just don’t know or wanna know.

Thanks for your response. I’m looking up the injury/rehab articles and podcasts, are there any specific ones you’d refer to? I’m guessing you had Austin’s “Pain in training: what do?” article in mind.

4

It does not seem like the clinicians are avoiding working you up to understand what’s going on better. It doesn’t seem like a issue that would bar you from training, though you may have to temporarily modify how you go about training in the interim.

The process of finding an entry point and progressing is covered in Austin’s article, yes.