Athletic Pubalgia

with Richard Cattey, M.D., General Vascular and Laparascopic Surgeon at Columbia St. Mary’s

Last Updated: Nov. 1, 2003

You’ve been running five days a week since high school, and playing soccer on weekends. But lately, pain in your pelvic area has been keeping you from your normal routine. At first, you thought it was a pulled muscle, so you rested, you iced it, you tried heat. Nothing helped. Now you’re ready to face an unpleasant truth. You’re getting older and you can’t move the way you used to.

Maybe, maybe not, said Richard Cattey, M.D., a general, vascular and laparascopic surgeon at Columbia St. Mary’s. It could be athletic pubalgia, more commonly known as a sports hernia.

Richard Cattey, M.D., General Vascular and Laparascopic Surgeon at Columbia St. Mary's "It's a syndrome of athletes who get chronic groin pain and it's most commonly seen in soccer players, hockey players, football players and runners."

Dr. Cattey said anyone can develop a sports hernia depending on how often and how hard they work out. And, he said, athletic pubalgia is an equal-opportunity malady – women who work out are just as susceptible as their male counterparts.

Most of the athletes who come to Dr. Cattey think they’ve got a pulled groin. What’s actually happened is that there’s a tear in the abdominal wall where muscles insert on the bones of the pelvis, most commonly the pubic bone.

All the athletes who land in his office with athletic pubalgia have done ice, heat and rest. Many have also been through a course of anti-inflammatory drugs and tried physical therapy.

Diagnosis and treatment
The best way to identify the condition, Dr. Cattey said, is by taking a thorough history and performing a physical exam. An MRI may identify a tear, and a bone scan will sometimes show inflammation of the pubic bone.

Until eight years ago, the only way to repair athletic pubalgia was to perform an open operation and to reattach the muscles to the bone. The recovery time was three months.

Now, Dr. Cattey’s patients come to the Milwaukee Institute of Minimally Invasive Surgery for a laparascopic procedure in which he not only repairs the tear, but also reinforces it with mesh.

“It’s a prosthetic material,” Dr. Cattey said, “that looks like screening from a screen door but it’s stronger than normal tissue, so once you heal into the holes of the mesh, it reinforces the repair and makes it stronger.”

Dr. Cattey has performed the procedure on athletes as young as 13 and as old as 46. Many have been professional or collegiate athletes – the 13-year-old was an athlete who competes nationally in his sport.

The laparascopic procedure has been a boon to athletes, particularly those who compete at the elite levels.

“If you’re a professional athlete you can’t afford to take three months off,” he said, “because you’ll miss your season.” Dr. Cattey has operated on 50 collegiate and professional athletes, he said, and all have been able to continue playing their sport.

With the minimally invasive procedure, athletes are walking within two weeks of the surgery, from week two to week four they can resume aerobic activity such as biking or jogging. At four weeks, they can start lifting, sprinting and resume playing their sport.

Weekend warriors
Dr. Cattey said in addition to patients who are professional and collegiate players, he also is seeing more weekend athletes who are discovering that the pain they’re experiencing might not just be a function of age.

Then again, it might be. Sometimes Dr. Cattey discovers that, indeed, a pulled muscle is the culprit. Or, perhaps, it’s a touch of bursitis in the hip. One of the reasons he’s gotten such good results from the surgery is that he’s not the sort of surgeon who immediately rushes to the operating room.

“We’re very specific about who we take care of,” he said. “We’ll only fix you surgically if we find something that needs to be fixed surgically.”

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