(I'm putting this here for people that search for "hernia" since there's good info inside"

HEALTHBEAT: How to identify & treat sports hernias is in dispute
By LAURAN NEERGAARD
AP Medical Writer

WASHINGTON (AP) -- For nine months, Michael Joyce played high
school football and then ran track despite groin pain so bad he
could barely get out of bed the next day. Finally doctors diagnosed
a sports hernia, a complaint among professional athletes that's now
hitting younger athletes and weekend warriors, too.

But exactly what a sports hernia is and what to do about it are
matters of dispute.

On one thing doctors seem to agree: Despite the common name,
it's not actually a hernia. The medical term is "athletic
pubalgia," and it happens when muscle or other tissue pulls away
from the pubic bone.

Only in about the past decade has this injury become a widely
accepted diagnosis within the sports-medicine field. It's a hot
topic among the pros' trainers, and seems most common among hockey
and soccer players.

If you're not an elite athlete, information's hard to come by.
Doctors who don't treat many athletes usually are unfamiliar with
it. Nor is there a diagnostic test. The diagnosis usually comes
after trying rest and anti-inflammatory drugs, and after all other
explanations for groin pain, such as more common muscle strains,
are ruled out.

Then which surgical fix to try -- sewing frayed tissue back
together through an open incision or a newer "keyhole" operation
that reattaches tissue to bone with a piece of mesh -- boils down to
the preference of the surgeon. A search of medical journals found
no published studies that compare the options to determine the best
treatment.

"There's controversy at all levels: Does the diagnosis exist?
How do you make the diagnosis? Once you make the diagnosis, what do
you do with it?" says Dr. William O. Roberts of the University of
Minnesota, past president of the American College of Sports
Medicine.

That equals frustration for patients. And while there are no
good estimates of how common the injury is, "we are seeing more
players with it," from the pros to school athletes to amateur
leagues, says Dr. Richard P. Cattey, a Milwaukee surgeon who
specializes in the laparoscopic, or keyhole surgery, repair.

What happens? A number of muscles attach to the top and side of
the pubic bone. Different strenuous leg movements can pull those
muscles until their attachments fray like a rope, develop tiny
tears or completely tear. Dr. William Meyers of Drexel University,
the field's dean and champion of the open-surgery approach, says
he's documented 18 versions of this injury.

"I couldn't roll over in bed without waking up from the pain,"
recalls Joyce, then a high school athlete from Portland, Maine, who
had never heard of a sports hernia when he began hurting last
September.

At first, doctors called it a pulled muscle. It got worse, so he
tried physical therapy and later took three months off of sports,
hoping rest would heal. Nothing worked. Eventually his doctor
diagnosed a sports hernia and sent Joyce to Cattey, at Milwaukee's
Columbia St. Mary's Hospital.

Joyce had three tears and his bone was eroding. Cattey,
operating through quarter-inch incisions, covered the damaged area
with an index card-sized piece of mesh that he screwed into Joyce's
bone. Scar tissue grows into the netting, strengthening the spot to
prevent future tears, says Cattey, who has used the procedure on
several hundred patients.

Four weeks later, Joyce played pain-free in an all-star football
game last month, and he's headed for a college team.

Meyers, who has operated on 3,000 patients since helping pioneer
open surgical repair, operates differently. An injury in one pelvic
muscle can leave the whole area unstable, he explains.

Through an inch-long incision, Meyers sews up the tears in a way
that tightens some abdominal wall attachments to the bone, and
loosens others to restore stability. His patients play again by six
weeks.

Meyers is critical of the laparoscopic approach, saying it can
cause serious complications such as injuries to nearby blood
vessels -- and that he's treated about 150 patients whose groin pain
returned because the mesh didn't fix the stability problem.

Cattey responds that patients sometimes need re-operating after
open surgery, too, and that success depends most on finding an
experienced laparoscopic surgeon.

What's a patient to do? Most specialists urge a conservative
approach first: The injury may heal with rest and physical therapy.
If not, ask surgeons how many operations they've done, how many
were successful, and how many had to be redone, says Roberts, a
family physician who has diagnosed sports hernias and, as a former
amateur hockey player, once suffered one.

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EDITOR'S NOTE -- Lauran Neergaard covers health and medical
issues for The Associated Press in Washington.

(Copyright 2005 by The Associated Press. All Rights Reserved.)
APTV-08-01-05 1202MDT