Sunday, July 25, 2010

Hockey and Hernias, Part II: Clarification and Recommendations

(Continued from Part I)

“Groin injuries are like a box of chocolates: You never know what you’re gonna get.” -Forrest Ghimp ("h" is for hockey and hernia)

Many a hockey player—whether you’re a professional like Andrew Ference or an amateur like me—has done the hockey hobble. Most of us are familiar with groin injuries, incurred or witnessed, but far fewer are unfamiliar with or confused by terms such as sports hernia, athletic pubalgia, and Gilmore’s Groin. These conditions are discussed on the Web, but the data can be overwhelming, and in some cases conflicting, so my purpose here is to condense and categorize, to sift and to simplify. Coupling what I’ve learned from my experience with this kind of injury with the comprehensive Internet research, I hope to help those who are hindered by groin injuries.

Let’s start, then, with the general terms and drill down to the more specific:

Groin: For purposes of these posts, I’ll distinguish between lower groin (below the crease formed by the leg and abdomen; the femoral region) and upper groin (region between the abdomen and the aforementioned crease; the inguinal region). I can’t speak to lower groin injuries as my injuries were upper groin problems—except to say that abdominal muscles and corresponding nerves are connected to the lower span the two regions.

Hernia: This condition is most often caused by a weakening in the wall of a muscle. Hernias are more common in men than in women, can occur at a variety of locations, and vary in origin and cause.

Inguinal hernia: The abdominal wall was weak at birth (a.k.a. congenital hernia) or weakened later on in life (a.k.a. hernia), the latter sometimes a result of repeated pressure in sports like hockey and soccer. Two types of inguinal hernias are the direct and indirect.

Indirect hernia (a.k.a. congenital hernia, true hernia): This is the most common hernia, where the protrusion or bulge of intestines has breached the abdominal wall.

Direct hernia (a.k.a. acquired hernia): This one can often go undetected by MRIs and/or x-rays and thus is more difficult to diagnose. The fascial tissue (more on that in a future post) of the inguinal floor and/or abdominal wall is weakened. The destabilized abdominal wall may not break, however, and thus not become an indirect hernia.

The definitions above are widely accepted in the medical community, but terms such as sports hernia, Gilmore’s groin, slapshot gut, and athletic pubalgia are sometimes used interchangeably even though some believe sports hernia and athletic pubalgia, for example, are different injuries.

Despite the disagreement on definitions, the doctors who diagnose and treat these injuries have come to the same conclusion: Time does not tend to heal hernias; in most, if not all, cases no amount of rest, ice, heat, elevation or Ibuprofen will fix these conditions. Surgery is often the only solution.

The remaining question, then, is which procedure to perform. Here again, as with the symptoms and diagnoses, surgeons don’t agree on a standard procedure. A common consideration is whether or not to use mesh: Is laparoscopic (a minimally invasive procedure) surgery the solution or is a deeper trip down the inguinal canal required? And when does removing mesh make sense?

As I suggested in the disclaimer, I don’t have all the answers and can only focus on my own experience. The most important thing, for me, was to find a doctor that would understand the complexities of the diagnosis and treatment. Thus, I needed someone familiar with my symptoms and who has treated other adult hockey players.

Although my doctors, Brian Busconi and Demetrius Litwin were right for me for a variety of reasons—they both have played hockey, are well-regarded in treating groin injuries (yet perform different procedures), and they collaborated before deciding which surgery was best for me—they may not be right for you. If you’re not in New England, for example, you might want to consider other doctors. With than in mind, I suggest you at least consider the following professionals, even though a thorough Internet suggest of  each may reveal unhappy clients:

Dr. William Brown: I’ve never contacted his office, but Dr. Brown’s client list includes the San Jose Sharks.

Dr. Jeffrey Hoadley: I’ve never contacted his office, but Dr. Brown’s client list includes the Atlanta Thrashers.

Dr. Brian Busconi and Dr. Demetrius Litwin: Busconi is a pioneer in this field, and his initial studies more than ten years ago were met with incredulity and criticism from those who are now believers. Litwin, who hails from Saskatchewan, sports an impressive resume and has a terrific bedside manner. That the two collaborate should quell any qualms about inflated egos.

Dr. Scott Martin: Direct and decisive, he recommended my arthrogram, a procedure that fixed the first injury. He’s also a consultant to the NHL.

Dr. John Stevenson: He’s not a surgeon, but his specialty is his unique commitment to spending as much time as necessary finding the right surgeon, as he did for me.

Dr. David Berger: I’ve never talked to him, but he has treated NHL players such as Penguin defenseman Brooks Orpik and Bruin defenseman Andrew Ference

Dr. William Meyers: I’ve never spoken to anyone in his office, but Dr. Meyers, who works on Hahnemann University Hospital staff, has treated professionals and amateurs in many sports. Philadelphia magazine also listed him as one of the region’s Top Doctors.

Dr. Ulrike Muschaweck: I’ve never contacted her office, but she founded the Munich Hernia Center and gets rave reviews from professional and amateur athletes.

Helpful links: A short list of sites I’ve visited

Stay tuned for my findings on stretching and nutrition as a means for injury prevention. See Part III.
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