Management of severe lower abdominal or inguinal pain in high-performance athletes

The purpose of this study was to gain insight into the pathophysiologic pro cesses of severe lower-abdominal or inguinal pain in high-performance athle tes. We evaluated 276 patients; 175 underwent pelvic floor repairs. Of the 157 athletes who had not undergone previous surgery, 124 (79%) participated at a professional or other highly competitive level, and 138 patients (88% ) had adductor pain that accompanied the lower-abdominal or inguinal pain. More patients underwent related adductor releases during the later operativ e period in the series. Evaluation revealed 38 other abnormalities, includi ng severe hip problems and malignancies. There were 152 athletes (97%) who returned to previous levels of performance. The syndrome was uncommon in wo men and the results were less predictable in nonathletes. A distinct syndro me of lower-abdominal/adductor pain in male athletes appears correctable by a procedure designed to strengthen the anterior pelvic floor. The location and pattern of pain and the operative success suggest the cause to be a co mbination of abdominal hyperextension and thigh hyperabduction, with the pi vot point being the pubic symphysis. Diagnosis of "athletic pubalgia" and s urgery should be limited to a select group of high-performance athletes. Th e consideration of other causes of groin pain in the patient is critical.