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As much as 10% of the population will develop some type of hernia at some point, yet the condition is often grossly misunderstood. Some assume it’s life-threatening—after all, hearing “your organs are pushing through your abdominal wall” is quite shocking. Others regard the diagnosis as no more than a nuisance—after all, plenty of people get hernias, and they turn out just fine. So which is correct? Dr. David Albin’s answer: It depends. Dr. Albin, who is both a triathlete and a hernia specialist with more than 12,000 hernia surgeries to his credit, often encounters athletes who are eager to know if they can continue training with a hernia diagnosis. Here, he answers common questions about hernia, training, and racing.
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In a nutshell, what is a hernia?
A hernia occurs when there is a tear in the muscles of the abdominal wall. When strain occurs in this region – say, from picking up heavy objects, sneezing, straining to use the restroom, or simply overusing the same muscle – a small sac of intestines or fatty tissue protrudes through the tear. This can happen gradually or suddenly.
From an athletic standpoint, it is also important to distinguish a sports hernia from the typical hernias that develop. A sports hernia arises from damage to the supporting structures of the groin or abdominal wall, but there is no true herniation of tissues. The condition is treated differently than other types of hernias. Both typical and sports hernias can occur in athletes. There is no way for a hernia to simply heal itself or put itself back in place. When left untreated, they can enlarge over time. Some require surgery to prevent dangerous complications.
What are the tell-tale symptoms of a hernia?
Some hernias are asymptomatic, meaning there are no symptoms. The majority of hernias cause some level of pain. Typical hernias usually develop a bulge, most commonly in the groin, known as an inguinal hernia, or in the belly button, known as an umbilical hernia. This bulge usually has a squishy feeling. The bulge tends to appear while standing, or with exercise, and disappears while lying down.
Less commonly, the hernia can produce a potentially life-threatening condition known as strangulation. The symptoms are more severe and very apparent. Pain intensity is extremely high and unrelenting. It is also associated with nausea, vomiting, fevers, and inability to produce a bowel movement. Treatment is immediate emergency evaluation and surgery. Fortunately, this condition only occurs in 1% of patients per year who have hernias. The most important factor in preventing formation of this condition is to ensure that the hernia is soft and reducible with manual pressure.
Can triathlon training cause a hernia? If so, what exercises are most likely to cause it?
Triathlon training has not been specifically associated with hernia formation. It would be more common to develop a groin or abdominal injury, such as a muscle strain. On some occasions, a sports hernia may form. Activities that increase the risk of sports hernia formation include cutting and pivoting movements, or repetitious acceleration and deceleration. This could occur in the triathlete who has to combat uneven terrain, or obstacles that require a rapid dynamic shift in leg and abdominal forces, which puts undue tension on the groin. More common would be the natural progression of aging in the triathlete, since hernias become more prevalent over time. Hernia development peaks at 65 years of age. Older individuals are seeking healthier lifestyles these days and triathlons are a great outlet. It’s therefore expected that a certain percentage of these older athletes will develop hernias. Also, triathletes who live a more arduous lifestyle may develop hernias sooner. Many first responders are drawn into the allure that triathlons offer, as well as athletes involved in more extreme sports. In these athletes, it is more the nature of what they do, than the triathlon itself, that puts them at risk.
If someone is diagnosed with a hernia, is it a good idea to continue exercising?
If a triathlete develops a hernia that causes pain symptoms with a severity that prevents appropriate training, or has the symptoms of hernia strangulation, training should be discontinued immediately. However, up to one-third of patients diagnosed with a hernia will have minimal to no symptoms. For these individuals, evaluation by a hernia surgeon is still recommended. A surgeon can assess the hernia, and work with the athlete to determine appropriate training, and help determine how soon surgery will be necessary. In most instances, for athletes with minimal to no symptoms, training can be resumed with accommodation.
If one does choose to train with a hernia, what are some precautions they can take to avoid making things worse?
There is a subset of patients who already have known hernias that are asymptomatic; meaning that their hernia causes no symptoms. Patients have told me that they had been diagnosed by their doctor years ago with a hernia that did not bother them. These athletes don’t need to have their hernias repaired, as long as the hernia remained painless or does not increase in size.
Once a hernia newly forms, there is no training regimen that can make it go away. The decision to proceed with definitive surgical care is usually made between the surgeon and the athlete. Everyone’s symptoms and severity may be different, and the triggers of discomfort can vary. Some triathletes with minimal to no symptoms and a small, controlled hernia may enjoy almost all their training without issues, while others may be more restricted. Some use hernia belts as an attempt to control the hernia; however, it is more for symptom management and only serves as a segue to eventual surgery. Progression of the hernia varies, but around 70% of those diagnosed with a hernia will eventually proceed to surgery over a 10-year period due to worsening discomfort, or increasing hernia size.
What are some ways triathletes can prevent a hernia (either before they happen, or from returning after it has healed)?
Performing core exercises such as abdominal exercises will prevent hernias. Also, lifting properly using leg muscles with a straight back is preventive. A strong core is overall beneficial, but don’t overdo it. I have seen some athletes perform sit-ups using a 45 lb. plate in the gym. Instead, use no more than a 10 lb. medicine ball, and increase the repetitions. I advise athletes to use core strengthening exercises two to three times a week.
The safest way is to work with a personal trainer. However, not all triathletes have access to a personal trainer, so another option would be to use a training program. Avoid overtraining as this may result in an injury, as well as a hernia. If you feel that you are injured, back off on your training regime and apply cold compresses to the injured area until your symptoms significantly diminish or subside.
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Once an athlete has had hernia surgery and it has been surgically repaired it is very unlikely that the hernia will reoccur in the same location. The same-side hernia recurrence rate after surgery is 1 out of 200. However, athletes who have already developed a hernia are prone to the development of another hernia in a different location (usually the opposite side of the body) by virtue of their training and lifestyle. Therefore, prevention is of upmost importance.