The Core Muscle Injury Center at Vincera brings together internationally-recognized specialists who are dedicated to the diagnosis, treatment and prevention of core muscle injuries. Our experts include orthopedic and general surgeons, medical acupuncturists, physiatrists, pain management physicians, physical therapists, yoga and nutritional specialists and massage therapists.
We have specialized programs for core problems. That is why it is important to see a trained health care professional if you are experiencing core muscle pain. For many core muscle conditions, early intervention is crucial to ensuring a prompt recovery.
Core strengthening is a vital component of the treatment and prevention of core muscle injuries. Your treatment plan is also tailored to your specific clinical needs. This ensures that you receive the individualized care that is essential to your recovery and return to pain-free athletic activities, optimum performance and health.
The pubic bone is the center of activity for the core. All of the structures that cross the hip joints are arranged symmetrically around the pubic bone. The four muscles that attach directly to the pubic bone create the harness through which the power of the legs and buttocks is transferred in functional upper body movement.
It can be frustrating when pain strikes in your lower abdomen or groin and impairs your athletic performance, prevents you from training or brings an end to your athletic activities. Initially, you may believe that you are suffering from a groin pull or strain. But if conservative therapies still leave you with recurring or persistent pain, you may be suffering from a core muscle injury—which formerly, and inaccurately, used to be called a sports hernia.
Core muscle injuries involve a tear or a series of micro-tears of the muscles that attach to your pubic bone.
Core muscle injuries can happen suddenly or start gradually from overuse. Sometimes they occur from over-stretching the abdominal muscles when hyperextending at the waist or over-stretching the inner thigh (adductor) muscles when doing a split. Also, there often are areas of fraying as well as tears that occur both within the abdominal muscles as well as the adductor muscles and other tissue attachments.
Because there are so many types of core muscle injuries, symptoms of such injuries can vary widely. Not everyone experiences the same type or level of pain. Some athletes experience chronic pain in one area, while others may experience shooting paints in more than one area. The location of the pain can also move around over time.
There are some common symptoms that may alert you regarding a core muscle injury. These include:
- abdominal or groin pain after an acute injury
- abdominal or groin pain that worsens (or gets progressively worse) over weeks, months or even years
- chest or rib pain
- heightened pain during and after activity
- minimal pain while at rest
- unilateral or bilateral pain
- fleeting pain that appears or disappears on one or two sides
- pain that moves from abdomen to groin or thigh
- increased pain or discomfort with exertion such as sprinting, kicking, sidestepping or light or heavy lifting
- increased pain or discomfort when coughing, sneezing or turning over in bed
- hindering optimal performance
- inability to perform daily activities.
Types of Injuries
Core muscle injuries can involve any of these structures, but the most common involved the:
- rectus abdominus muscle, the pair muscle that runs upward inside your abdominal wall from the front of your pubic muscle and is known as your abdominals or abs; and/or
- three adductor muscles—adductor longus, adductor brevis, pectineus—that comprise some of your thigh muscles.
However, there are quite a few more variants and syndromes. Each variant and syndrome has a slightly different injury mechanism, which accounts for the differences in symptoms. Because these injuries can involve a number of different muscles, there are 121 different combinations of core muscle injuries—and a corresponding number of surgeries to repair them.
Core muscle injury variants and syndromes include:
Rectus Abdominis/Adductor Variant
The most common variant, this involves severe, exertional pain related to the insertion of the rectus abdominis onto the pubis—in other words, where the muscle is attached to the pubic bone. Classically, a tear or an attenuation of the rectus abdominis insertion causes the syndrome as well as possible secondary pain near the adductor insertion sites onto the pubis.
Adductor Longus Variant
The main source of the pain is the adductor longus muscle.
The main source of the pain is the adductor pectineus muscle.
The pain isn’t due to a hernia, but rather to a vertical extension of the same musculofascial shredding that characterizes the more classic rectus abdominis variant.
Baseball Pitcher/Hockey Goalie Syndrome
This tends to occur in the aforementioned athletes and primarily involves scarring and fibrosis of the fascia or epimysium that covers the adductor muscles below where they attach to the pubic bone. This scarring constricts the muscle and causes pain.
Osteitis Pubis Variant
This variant involves pain caused by inflammation of the pubic bone and/or attached muscles.
The pain emanates mainly from the site where the psoas muscle, which is located on the side of the lumbar region of the vertebral column, connects with the rear of the neck of the femur bone. The pain results from bursitis—inflammation or irritation of the fluid-filled sacs that reduce friction in that part of the hip joint. The bursitis is a condition that is secondary to the instability caused by the weak attachment of the abdominal muscles to the pubic bone.
In this variant, the pain emanates more from the gracilis muscle, which extends down the inside of the thigh, than from the adductor longus muscle.
Athlete’s Rib Syndrome aka Rower’s Rib
This condition particularly affects rowers, tennis players and boxers. It occurs when the abdominal muscles that are interwoven with the lower most intercostal muscles—which run between the ribs and help form and move the chest wall—dislocates the 11th and 12th ribs and/or cartilages attached to those ribs.
Superior Rectus Variant
This syndrome is a combination of the Spipgelian and athletes rib variants.
Most common in women, this variant involves considerable pain at the site where the long sartorius thigh muscle is inserted into the pelvis, in addition to pain in the lower abdominal muscles.
Snapping Hip Syndrome
This can occur when muscles or tendons slide over one of the hip’s bony protrusions. Usually it is caused by a tightness in these muscles and tendons, and most often affects people, such as athletes and particularly dancers, who repeatedly have to bend at the hip. It is more common among young athletes because muscle tightness often accompanies growth spurts, and in women.
Round Ligament Syndrome
The round ligament of the uterus can cause pain with exertion in some women. It is important to distinguish this from other core muscle injuries and gynecologic disorders (such as endometriosis).
Adductor Avulsion Variant
The adductor longus muscle can partially or completely avulse, or tear away, from the pubic bone, resulting in considerable pain.
Adductor Calcification Syndromes
These are often seen in bull riders. Often, years after the initial injury, the calcification that results from this trauma causes severe inflammation and pain. This can also be a result of PRP (platelet-rich plasma) injections into the adductors.
Iliotibilal Tract Syndromes
The iliotibial tract or iliotibial band, is a thick strip of tissue connecting several muscles on the outer sides of the thighs. Pain in this area can be a secondary result of athletes compensating for what is primarily an abdominal muscle problem.
Rectus Femoris, Quadratus or Pectineus Syndromes
Pain can occur either primarily or secondarily along other insertion sites or bursae related to these muscles and tendons.
Core Muscle & Hip Injuries
Many hip disorders often occur together with core muscle injuries. Understanding the interactions between core muscle injuries and what is called Femero-acetabular Impingement (FAI) of the hip is at the forefront of sports medicine research—and Vincera’s orthopedic surgeons and core muscle injury experts are leading the way.
FAI occurs when your hip’s ball (the head of the femur) does not have its full range of motion within the socket (the acetabulum of the pelvis). Impingement refers to grinding that occurs between abnormal bumps on the ball and/or socket of the hip. This causes pain, damage to the cartilage/labrum and a decreased range of hip joint motion.
The Core Muscle Injury Center at Vincera is the only place where you can get surgery for both core muscle and hip injuries at the same time. Concurrent core muscle injuries and symptomatic hip impingement is not uncommon and probably remains underdiagnosed. We have established a clear relationship between the way the core muscles pull and how the femur (“ball”) sits in the hip socket. For example:
- When someone has pain from hip impingement, the core muscles often tighten, which decreases the range of motion of the hip and protects against the painful motion. These subconscious changes can lead to secondary core muscle injuries.
- Fixing an impingement (and allowing increased range of motion) within the hip can cause dramatic changes in the forces applied to, and orientation of, the core muscles.
- Changes in the forces applied by the muscles (by either injury or strengthening) can have profound impact on whether or not there is hip becomes impinged and its bones grind against each other.
At the Core Muscle Injury Center at Vincera, core muscle injuries are diagnosed following a detailed personal history, a comprehensive physical examination and an MRI of the pelvis. The history and physical examination help ensure that there are no other causes responsible for your groin pain. In particular, the physical exam will determine the source and type of pain and attempt to rule out other diagnoses including, but not limited to:
- inflammatory bowel disease (IBD)
- urologic problems
- aseptic necrosis of the hip
- other hip problems
- ovarian cyst disease
- pelvic inflammatory disease
MRI of the Pelvis
In 2006, William C. Meyers, M.D., the director of the Vincera Institute, and leading radiologists developed an MRI of the pelvis that is 92 percent accurate. This MRI also can reveal other problems, such as “soft” musculoskeletal findings, tiny avulsions fractures, peculiar edema patterns and hip injuries
This MRI is both sensitive and specific for various injuries related to the pubic bone symphysis specifically for rectus abdominis and adductor muscle injuries, and also injuries involving the hip and visceral pelvis—. Additionally, this MRI technique uses both surface and send-receive body coils, as well as oblique planes, to maximize sensitivity and specificity for bone, muscle and tendon pathology of the pelvis.
For core muscle injuries, treatment options vary depending on a number of factors, including: the severity of the injury, the performance level to which the patient wants to return and the risk of altered mechanics.
At The Core Muscle Injury Center at Vincera, we almost always begin treating our patients with traditional conservative treatment measures. These include:
- activity modification and anti-inflammatory medications
- core stability physical therapy
- therapeutic injections and procedures
- heat/ice therapies
- massage therapy
If conservative measures are unsuccessful, surgery may be required to repair a core muscle injury. Early surgical intervention of severe core muscle injuries may return players to full, high-performance playing levels very quickly. An individualized surgical plan will be developed depending on your specific condition and its severity.
Similar to knee reconstructions, surgical intervention for core muscle injuries entails re-suturing the muscle attachments to the bones and adjacent ligaments in order to provide stability to the pubic joint. The precision of the angle at which the tissue is brought together is critical for the operation’s success.
The surgeons at Vincera perform an open surgical procedure for repairing the pelvic floor. This consists of the reattachment of the rectus abdominis muscles (the abdominals) to the pubic bone. If athletes have adductor symptomshe performs an adductor compartmental release and/or repair. To directly treat the inflammation, the procedure involves the anterior and lateral release of the epimysium of the adductor fascia, the connective tissue that ensheaths the adductor muscles.
Also, for those who suffer from both hip and core muscle injuries, treatment may include surgery that simultaneously repairs both the hip condition and the core muscle injury.
Prevention & Preservation
Rehabilitation, Pre-habilitation and Prevention Programs
At The Core Muscle Injury Center at Vincera, our clinicians ensure you are provided with a comprehensive and tailored treatment plan to enable a speedy recovery. Examples of treatment plans that may be ordered are:
Pre-habilitation Programs: Being healthy before surgery enables you to recover more quickly after surgery. Depending on your history and diagnosis, your team may recommend “pre-hab,” which may consist of physical therapy, exercise physiology, yoga, nutrition, acupuncture, behavioral medicine or chiropractic visits.
Day of Surgery Physical Therapy: Your medical team is focused on the most appropriately aggressive plan to quicken your recovery. When you are discharged from the ambulatory surgery facility, you may begin physical therapy immediately, which may consist of cold laser therapy, therapeutic activities, education and ice compression.
Physical Therapy and other Post-operative Plans: Your physical therapy and other treatment plans will begin as soon as your physician clears you. Your comprehensive plan may include physical therapy, massage therapy, yoga therapy, chiropractic/manual therapies (PATCH therapy), nutrition, exercise physiology and behavioral medicine.
Prevention Programs: While we like working with you, we do not want you to have a recurrence. We work with patients closely on lifestyle and other prevention programs to educate you so you can lead a healthy life free of hip problems. Preventing core muscle injuries involves addressing the two causes of such injuries: overuse and acute injury.
Preventing Overuse Injuries
To avoid core muscle overuse injuries, athletes should strengthen all muscle groups equally and design exercises to maximize core strength in order to avoid wear-and-tear.
Preventing Acute Injuries
To avoid acute injuries caused by unusual movement or contortion, athletes should train for the “transition” scenarios that occur in each sport in which they participate. For example, baseball plays should train themselves to replicate the transitional moves that occur when pitching (or throwing) a baseball and when swinging a bat. There may be ways to incorporate training and practice techniques that train your body, minimize the huge force shifts that occur during these athletic movements and, at the same time, improve your performance.