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<v ->Let's talk about the pathogenesis of sports hernia

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and the different subtypes.

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Sports hernia occurs due to repetitive overuse syndrome

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with muscular imbalance,

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and muscular imbalance is an issue

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elsewhere in the body as well.

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Here we may have muscular imbalance where the

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abdominal musculature like the rectus abdominis

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is overdeveloped relative to the adductors.

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You know, people doing too many sit ups

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and not enough leg or hip flexion or adductor strengthening

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so the upper abdomen can be involved.

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The lower abdomen can be involved,

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such as the adductor longus.

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Here's the adductor longus.

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Here's the adductor longus tendon

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and the adductor longus tendon

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fuses with the rectus aponeurosis

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to form this structure right here

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which is known as the pre-pubic plate.

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Well see, the pre-pubic plate plays a very important role

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in the central form of sports hernia syndrome

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or what I call the mid-form.

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So I got the upper central form

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involving the rectus abdominis,

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the mid-central form involving the pre-pubic plate,

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and then as we've seen here, the lower central form

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involving the adductor longus and its origin.

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Then we go off to the side, we got lateral involvement.

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It could involve the linea semilunaris.

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We'll see what that is in a moment.

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It could involve more lateral musculature

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such as the obliques, the external and internal oblique,

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and it could even involve the hip area,

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the musculature in particular.

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It can also involve this green structure right here

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which is the inguinal ligament.

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You can tear partially the inguinal ligament.

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A very tough diagnosis to make.

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Many authors have excluded any pathology around the hip.

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Even muscular pathology from the clinical syndrome

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of sports hernia.

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On the other hand, many patients in my personal experience,

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present with sports hernia syndrome.

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The inability to generate power.

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The inability to flex the hip

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with something as simple as a labial tear.

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But bear in mind, there's some controversy

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when you're in the hip capsule,

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some have excluded this from sports hernia syndrome.

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One last caveat.

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Behind the pre-public plate

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sits the pubic mechanism.

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Now, the pubic mechanism

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consists of a pubic capsule.

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One of the first things to go

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in overuse syndrome is the capsule.

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It degenerates, it separates,

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and that allows micro-movement of this structure.

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This is also known as Athletic Pubalgia.

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You'll hear individuals merge the two syndromes.

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Sports hernia syndrome with Athletic Pubalgia.

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Some segregate it as soft tissue disease

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versus bony disease.

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Some merely lump them together.

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We're gonna approach Athletic Pubalgia

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and osteitis pubis as a separate entity

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for educational purposes.

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Let's move on, Dr. P out.