Rectus Abdominis and Hip Adductor Tendons (“Athletic Pubalgia/Sports Hernia”)

Athletic pubalgia is an overuse disorder of pain in the groin and/or pubic area associated with activities that involve trunk extension, running, kicking, and cutting movements. Its etiology is multifactorial. The injury may involve the abdominal musculature (rectus abdominis, transverse fascia at the posterior inguinal wall, external oblique aponeurosis, conjoint tendon) and/or the tendons of the medial thigh muscles. The relevant anatomy includes the rectus sheath which contains the rectus abdominis muscle, and the medial thigh musculature including the adductor longus, brevis, magnus, and gracilis muscles. The typical presentation is insidious onset pain in the groin region exacerbated with activity. Physical examination findings may include tenderness over the peripubic myotendinous structures, but it may have minimal to normal findings. The pelvic MRI is the imaging modality of choice. The first line of treatment is nonoperative, but surgical management is often required. Different schools of thought have described various therapeutic approaches to address athletic pubalgia, but the focus is to alleviate pain and improve range of motion and strength with the goal of return to function.