Tag Archives: Sports Hernia

Athletic Pubalgia – Nick Markakis and Ryan Zimmerman

A surgery this week to Baltimore Orioles outfielder Nick Markakis caught my attention. His case is very interesting and something I thought I’d share with you all. Markakis initially injured himself last September while stealing 2nd base when his belt buckle dug into his pelvic area and caused him immediate pain. This injury was re-aggravated while diving for a catch in right field on the last game of the year, causing him the inability to remain in the game. After the season was over Markakis had an MRI and was diagnosed with a bone bruise and instructed to rest. After adequate rest time, and no change in his symptoms, another MRI was perform and muscle tears in his rectus abdominus (Athletic Pubalgia ) were diagnosed, and recently surgically repaired.

Baltimore Orioles - Nick Markakis

Earlier in the 2011 season Washington Nationals third baseman, Ryan Zimmerman, underwent a similar surgery to repair torn muscles in his abdominals. Zimmerman didn’t have a specific injury to his abdominals, however continued to have persistent abdominal pain that progressed and was eventually diagnosed as Athletic Pubalgia.  Although he was told 6 weeks, it was nearly 12 weeks before Ryan Zimmerman was back in action for the Nationals.

Although Athletic Pubaligia, is often called a “sports hernia” it is not a hernia. The term “sports hernia” is sort of an umbrella term that refers to any tear of muscle, tendon or ligament in the lower abdomen or groin. These tears can occur with quick sudden changes in direction, forced hip movement with the foot planted, or with forceful exertion of the abdominal muscles. It is commonly found in athletes who participate in sports that involve repetitive twisting and turning such as football, baseball, soccer, ice hockey, rugby and tennis. It can cause abdominal/groin pain, increased pain with sprinting or twisting, pain with coughing or sneezing, pain during and after activity and minimal pain at rest.

Muscles and Tendons Involved in Athletic Pubalgia

There are several muscles of the abdomen and groin that attack to the pelvic bones and serve to stabilize the joint during twisting motions. In the picture to the left you can see the rectus abdominus (your six pack muscles ) attach to the bone of your pelvis, as well as your External Obliques, the hip flexor and groin muscles. You can see that with repetitive swinging, tremendous amount of stress will be placed on this structures and eventually micro tears and tears can occur. It has been theorized that an athlete may be prone to this injury if muscle imbalances are present with strong adductor (groin) muscles and weak abdominal muscles. The strong going muscles can create a pull that can overpower the abdominals and make these muscles prone to tears.

The surgery to repair these torn muscles is similar to reconstruction of the knee. The surgeon with re-attach the muscles down to the bone using sutures that will provide stability. After the surgery, the athlete can expect to be walking the same day, however will be limited in lifting and baseball activities for up to 6 weeks. The most important part of rehabilitation for Nick Markakis, as well as anybody else, is to address the imbalances that contribute to this injury. If those imbalances are not addressed in rehabilitation he may continue to have pain and possibly re-tears in the future. This could be the reason it took Ryan Zimmerman longer than expected to return. Markakis will be focusing on stabilizing with his abdominals (rectus, obliques and transverse ) more, and firing his going muscles less.  My guess is Markakis will be at 100% be the second week of the regular season, should everything go as planned in rehab.

Thats all for now. Hope that makes sense.

Football playoffs means baseball season is right around the corner. GO NINERS.




Sueki, Derrick, and Jacklyn Brechter. Orthopedic Rehabilitation Clinical Advisor. Maryland Heights, MO: Mosby Elsevier, 2010. Print.

“MLB News | MLB.com: News.” The Official Site of Major League Baseball | MLB.com: Homepage. Web. 08 Jan. 2012. <http://mlb.mlb.com/news&gt;.

Home Page. Web. 08 Jan. 2012. <http://coreperformancephysicians.com/&gt;.