This post is designed to give you hope. If you’re reading this chances are you’ve got an inguinal hernia or fear you might have. You might have already had surgery or are considering having surgery and wondering what your next steps are. If any of these are you then this article is for you!
We’ll be going into the details about what inguinal hernias really are and how they come about. More importantly we’ll be discussing what you can do about it.
To make the details seem real and relevant we’ll be relating all the details back to a recent client of ours who we helped avoid a second hernia operation. We’ll call him Joel, because that’s his name, and I checked he didn’t mind being talked about! I’ll put those sections in italics.
What Is An Inguinal Hernia?
Let’s first start a bit further back. What is a hernia? The NHS website defines it as:
“A hernia occurs when an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall.”
And encouragingly goes on to say:
“In many cases, it causes no or very few symptoms.”
They are generally in and around the abdomen. The inguinal hernia is the most common. This post is all about inguinal hernias but the principles we discuss here work well on abdominal hernias too. We have even helped people with hiatus hernias, which are internal, by creating more space – the detail on that one is for another time.
So where is your inguinal? It’s in your groin. It is literally the fold between your pelvis and your leg. If you want to be absolutely sure you are checking the right bit firstly you have to take all of your clothes off! Look down in the region where your pelvis meets your leg. Now lift your leg up and it’s where a fold appears.
If your symptoms are in this region carry on reading…
The most commonly seen symptoms are:
- A bulge in the groin region
- A burning or aching sensation on the bulge
- Pain or discomfort in your groin, especially when bending or coughing
- A heavy or dragging sensation in your groin
- Weakness or pressure in your groin
- Men occasionally get pain and swelling around the testicle
On top of these issues we often find associated muscular pain from guarding against the hernia or fearing making it worse.
When Joel first came to see us he had confirmed by his doctor he had a recurrence of his hernia. He was able to feel the bulge popping out and it felt a bit painful when he pressed it. It was occasionally quite painful at random times and he was unable to play football or tennis due to this pain especially when twisting.
Why Do Hernias Occur?
Quite simply too much pressure. Or increased load. That’s why things like lifting heavy things, sneezing, coughing or sport can cause the pain. Pre-disposing factors can be non-optimal bio-mechanics (more on that later) and obesity.
In this article we’re focusing on inguinal hernias but all kinds of the hernias have a similar origin. You’re asking the tissues to do too much for a prolonged period and eventually something pops through a little weakness between your pelvis and your rib cage.
What Are The Potential Complications Of Inguinal Hernias?
Before we can even consider what we can do about your average hernias we just need to be respectful of the complications so these have been ruled out before we do such a thing.
The two most common complications of hernias are obstruction and strangulation. Neither of which sounds very nice! Quoting the NHS website:
Obstruction is where a section of the bowel becomes stuck in the inguinal canal, causing nausea, vomiting and stomach pain, as well as a painful lump in the groin
Strangulation – where a section of bowel becomes trapped and its blood supply is cut off
If you have either of these issues chances are you’re not reading this article for the answer!
What Can You Do About Inguinal Hernias?
Quite a lot as it happens. Many people fear, and conversely other people want, a surgical intervention. This can be the right thing to do but you need to way up exactly what this will mean to you.
The surgical procedure can open the area up or go in arthroscopically. The bulge is pushed back and held in place with either stitches or a mesh. The advent of this latter technique has lead to a dramatic reduction in recurrences.
Which all sounds very good. And for the large part it is. But clinically we have seen many cases over the years whereby clients have been left with long lasting residual pain from the operation or even left with similar symptoms.
This piece of research looks into the post-operative implications on long standing pain. 31% of people reporting pain of some kind after the operation, with 6% of people suffering with pain affecting daily activities.
So you can see it’s worth looking into alternative options.
Which is exactly what Joel did when we first spoke on the phone. He was interested in our approach and whether we would be able to help him avoid a second hernia operation.
We explained that our approach had helped people many times before get rid of their residual post-operative pain and in theory the same should be possible for him. After a bit more chat about how we would achieve this he was keen to give it a go and booked himself in.
No. Once the hole in the abdominal wall is there it’s there. But remember how did that hole get there in the first place? Increased load. So if we can reduce the load on the bit with the hole we should be able to reduce the pain.
Should You Always Operate On Inguinal Hernias?
With there being a risk of long term pain after surgery and our clinical experience we would say no. But then we would! So in the interest of balance we’ve had a look for some more unbiased research comparing surgical and non-surgical interventions on inguinal hernias.
This nice piece of research showed in follow up studies that there was no difference in outcomes from those who had surgery and those who didn’t! It’s very important here that we mention that this study was done on people who were minimally symptomatic.
We have helped many people with a high level of pain and dysfunction at the clinic but these have all been post-surgery. It would be fascinating to conduct a larger study on those like Joel, and also those in more pain. How far we can bring those with a confirmed hernia? Can we avoid surgery for those in significant pain? Any volunteers?!
What’s The Alternative To Inguinal Hernia Surgery?
There’s a few underlying principles we used to help Joel that hopefully can help you too. It won’t be quite the same as having it all worked out for you for you as an individual. I’m hoping this will give you inspiration to find something that will work for you.
Biomechanics and Alignment
When we first assessed Joel he looked wonky. We’re not talking Quasimodo here. But to the trained eye he wasn’t in alignment. This immediately got our attention and our brains whirring as to what muscles would be over working and tight and how those muscles would affect the load in the groin.
Then we went a step further back. Why were those muscles getting tight. In Joel’s case it was mostly the wonky relationship of his pelvis to his rib cage. Commonly this can be affected from as far afield as the head or feet. But in Joel’s case it was the more local tightness that was increasing the load on his hernia and led to it’s appearance in the first place.
This was confirmed by Joel who had mentioned in our initial chat that his symptoms were definitely aggravated by hoeing! That’s what we love about the work. There’s always new and unusual things to consider in every individual’s case.
How Sensitive Are You?
Our initial work took place in the first couple of months after the first lockdown from July 2020 when we were allowed to re-open. Joel like so many of us had been adversely affected by the lockdown. Stress levels were high. Simply put when we’re more stressed we’re more physically sensitive. We feel more of what’s going on.
Part of our work was to get Joel in a more relaxed place. Firstly, allaying his fears about having another hernia op. Secondly, helping improve his confidence and improve his mood as he saw our work taking effect. And thirdly asking him to take on a better wellbeing routine to calm his nervous system to help him feel less pain.
Please Release Me!
A large part of our work is to test our hair brain theories. If we tell you it’s your foot that’s causing your hernia you may understandably be sceptical. If we do something to your foot which makes your hernia feel better you’re more likely to listen to us.
We use this principle to determine which areas are going to give you the most bang for your buck in terms of treatment. This also informs us as to what you need to focus on in your own rehabilitation at home. It may well be the localised area. And it is important to assess and treat the localised area. But it is very rarely the sole cause of the issue.
What kind of release would we recommend? As a practice we like to use both fascial and muscular release. And throw in the some joint work just for good measure. Again, the truth is what works best for each person varies from case to case.
If you don’t know what fascia is – and you will be forgiven – here’s a link explaining more.
In Joel’s case it was a nice combination of fascial work to get his body lined up better and then some muscular work to reduce the load on the painful region in his groin. All of which would of course improved the function in his joints.
Stretches To Loosen Muscles That Affect Your Inguinal Hernia
Reading this right now you don’t have the luxury of our hands on treatment. So we’ll now consider what you can try to release yourself.
Due to the scope of this article we’ll only consider muscles that can have a direct bearing on the symptomatic area. Rather than looking at the full biomechanical picture. That’s just not possible when we’ve never met!
That said what we show here aren’t necessarily considered directly related by the medical world. These are the ones we consider to be directly related based on our experience and our opinion of what affects what.
DISCLAIMER: All of these stretches are for guidance only and inspiration to get yourself checked out by a professional. If you do choose to attempt these you do so at your own risk. We cannot be held liable.
Legal stuff done. You’d have to be doing something pretty stupid to make a mess of these! Particularly given my next bit of advice. DO NOT STRETCH TO PAIN.
Don’t get competitive with yourself or others when you’re stretching! We are all unique. Accept where you’re at. Stretching should be enjoyable, not tortuous. With all of these stretches just take them to the point where you start to feel a slight stretch.
We find a yoga approach to stretching most effective. That is breathe into the area you’re trying stretch and then relax the area you are stretching on the out breath. Then move to the next point where you start to feel the stretch again. If you don’t move and it’s still the same place. That’s fine. Be patient.
Start with 30 seconds for each stretch and increase the duration as you gain confidence that they are feeling good and you’re not taking them too far. You can build up to holding the stretches for 3-5 minutes in a yin yoga style.
These previous 3 stretches use an often neglected gem of biomechanical knowledge from Grey’s Anatomy. I’ve linked to it here. If you’re looking at the illustration you’ll see the lats and obliques merge into the ilioinguinal ligament. This is the most common site for inguinal hernias. Reduce tension on the lats and obliques, reduce the load on the hernia.
This last stretch here I’ve not done a video for yet, sorry! Simply pop your foot up on something approprtiate height for your level of flexibility. Turn the foot inwards so the inside of your foot is on the chair as shown here. And then slowly bend your other knee to bring on the desired level of stretch. The use of hands on knees shown here is for balance. Feel free to hold onto something to help you down.
These last two stretches use the same principle from the other side. These are muscles whose fascia is continuous with the other side of ilioinguinal ligament. Some of these will be more relevant than others. It’s up to you to work out which.
Avoid Core Exercises!
Yes, we said it! Regular readers will know we’ve said it a lot. We’re not quite as anti-core exercise as we were when we wrote the Is There Any Point To Core Exercise post. But this is one of those cases where we think it’s really important to go against the accepted norms.
In the physio and fitness worlds there is this obsession with strengthening things. Particularly core muscles. It stems from the desire to control. Remember what we said at the start of the article. We want to REDUCE the load on the hernia region. All of the ‘core’ muscles attach into the inguinal region. Do you think asking them to do more increases or decreases the load on them?
This is backed up by what we see clinically. We rarely dish out strengthening exercises. Most of our advice is stretching. If we see an improvement in your symptoms from some of our hands on release work we want you to keep it lose. We don’t want you to tighten it up again.
Ironically more flexible muscles are normally stronger. They are at their optimal length and so perform beautifully. Tighter muscles tend to be dysfunctional. There is a balance to be struck. But most of us, ourselves included, are too uptight. And so we need to work hard on keeping those muscles loose.
In a follow up email Joel, having been symptom free for a couple of months, asked if he was allowed to resume core training. We had previously talked around all of the above but we’d not put it quite so black and white. Instead of pandering to him by saying yes, or having a rant as above and saying no we instead asked why he felt the need to do core work.
What came back was the vanity admission we see so often. His need to do core was just to keep a flat tummy and not for any functional reason. Don’t be tempted. Two reasons.
One, it simply doesn’t work. You cannot lose fat locally by training the muscles that sits beneath it. You lose fat evenly throughout your body when you burn off more calories than you need. Even if you put on weight in certain places e.g. stomach, bum or thighs.
Two, as discussed previously, you’re asking overworked muscles to do more work. Why would you do that? In Joel’s case we’d improved his wonkiness and so we were tempted to say he could do some basic core exercises. But then if he’s symptom free and doing everything he wants to, why bother?
Postural Correction and Awareness
Another key area for Joel was to understand how he got so wonky in the first place. For the vast majority of people we see we’ll back ourselves to be able to release off what needs to be released to reduce your pain. But can you keep it that way?
With Joel our conversation led us to realise it was how he held himself at his work desk and also how he ‘relaxed’ on the sofa in the evening. This was driven by his body. Looking at it and asking ‘Joel when do you get into a position like this?’
Thankfully Joel was a diligent student and identified the causes quickly. Like all of us, he still has tendencies back to his naughty posture. But he’s quick to be aware of how he’s holding himself and correct it.
This is easier to do when we’re calmer. Which circles back round to looking after ourselves better. It always comes back to the whole person in our experience. When we address the person as a whole that’s when we see the most amazing changes.
The following video is an easy thing to have a look at to see how you should be sitting so you’re more likely to notice when you go off kilter.
Conclusion – What Should You Do About Your Hernia?
Are we suggesting you don’t need surgery. Perhaps. But first, if you haven’t already, get to your doc and ensure that the bulge can be pushed back in. This will rule out any serious complications from the inguinal hernia.
We then urge you to consider the following questions. How much pain are you in? What do you want to be able to do with your body? How good can you feel without surgery? How good can you feel with surgery? What can you do to reduce your risk of any chronic pain whether you have surgery or not?
From our biased standpoint we recommend seeking out some kind of physical therapy to see how good you can get it feeling. Whether that’s with ourselves or any other provider really doesn’t matter.
You could be like Joel, playing football and tennis and simply have no awareness of your hernia. Wouldn’t that be nice? Of course we can’t guarantee that will be you but we urge you to do all that you can to minimise your risk of long standing pain. Whether that is before or after surgery. Or indeed like in Joel’s case, both.
And what of Joel? 6 months in and he’s still pain free. Is he in perfect alignment, no. But he’s better than he was. We don’t need to aim for perfection. Just better than we were. And what does Joel feel about all this. Well here’s his thoughts from the Google Review he left for us:
“I came to Jamie and Brighton Sports Therapy after being told by my GP that I had suffered a recurrence of of a previous hernia and needed another hernia operation (3rd in 10 years!). Keen to explore an alternative route to more surgery, Jamie initially provided a thorough assessment and treatment along with recommended daily exercises which four months later has enabled me to continue playing football, tennis and other physical activity without any adverse impact on my hernia and will hopefully mean I can avoid the surgeon’s knife again! I would thoroughly recommend him for anyone who finds themselves in a similar situation”
If you’d like to ask us about your hernia or any other injury then we’d love to speak to you. If you live locally or for those far away too we can always start the process with a video consultation. Please press the Get In Touch Button below.
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This post first appeared on our Brighton site.