Bones, cartilage, ligaments and tendons are vital structures of the human musculoskeletal system. While the skeleton that is made up of bones and cartilage provides a structural framework for the body, ligaments and tendons perform the important function of supporting the bones. Ligaments and tendons are bands of fibrous tissue. While a ligament connects bones in our body and may provide support to organs or muscles, a tendon connects a muscle to a bone. Muscles, on the other hand, are contractile tissues that facilitate the movement of joints. These ligaments, tendons and muscles work in tandem so as to help us move and carry out various physical activities.
If ligaments or tendons in any part of the body are stressed beyond a tolerable limit, one is most likely to experience pain. For instance, excessive strain on the inguinal ligament, which is the ligament that provides support to the sensitive groin region, is most likely to cause pain in the groin region. This ligament connects the anterior superior iliac spine with the pubic tubercle. It is formed by the lower edge of the aponeurosis, which is the fibrous membrane or fascia of the external oblique muscle that extends from the anterior superior iliac spine of the ileum to the pubic tubercle. The incidence of inguinal ligament injuries is definitely high in case of people who participate in sports.
Causes of Pain in the Inguinal Region
Inguinal, pectineal and lacunar ligament are ligaments that are located in the groin region. The anterior abdominal wall comprises the external oblique aponeurosis and the internal oblique muscles. The transversus abdominus muscle is placed beneath the internal oblique muscle. These abdominal muscles converge at the aponeurosis to form the inguinal ligament. The inguinal canal is a passage in the anterior abdominal wall. It is located just above this ligament.
Gilmore's groin, which is also referred to as groin disruption or sports hernia, is a medical condition which occurs when the tissues that surround the inguinal canal get damaged. Those who play football, hockey, rugby, soccer or tennis are susceptible to groin disruption. Participation in sports that involve repeated sprinting, turning, twisting and kicking movements can cause stress on the posterior wall of the inguinal canal. This could lead to development of tears in the oblique muscles or the conjoined tendons. This could cause the muscles to pull away from this ligament. As a result, one may experience pain in the groin region. Pain may sometimes be localized to the inguinal canal, but it could also radiate to adductor muscles. Though this condition is referred to as sports hernia, there is no actual herniation. So, groin disruption is an accurate medical term for this condition.
At times, repeated twisting and turning movements that may lead to the development of tears in these muscles can further cause the archway in the external oblique muscle to dilate. This triangular opening or archway is called superficial inguinal ring. It consists of certain nerves and is the exit of the inguinal canal. At times, a part of the intestine may protrude through the dilated ring towards the muscles of the groin. Under such circumstances, one is diagnosed with inguinal hernia. The inguinal canal is one of the most common sites that is affected by hernia.
The round ligament of the uterus, which is a band of tissue that supports the uterus during pregnancy, passes through the inguinal canal. When the uterus expands during pregnancy, it may put pressure on the round ligament. This could give rise to ligament pain during pregnancy. Tearing of the ligament owing to strain during childbirth could also cause inguinal ligament pain. Multiple pregnancies can also lead to the development of weak spots around the inguinal canal, thereby putting such women at an increased risk of developing inguinal hernia.
Treatment of Pain in the Inguinal Region
As mentioned earlier, weightlifters, sprinters or those who play high speed contact sports are definitely more susceptible to developing ligament tears. If the intensity of pain increases while playing sports, one must get a thorough medical checkup done. If the damage is severe, one may also experience pain while coughing or sneezing. If diagnostic tests and imaging procedures reveal torn aponeurosis of the external oblique muscle or torn tendon of the internal oblique muscle, one must take rest and should refrain from indulging in strenuous physical activities that may put strain on the groin region.
In case of a ligament injury or strain, the RICE (rest, ice, compression and elevation) principle is usually incorporated in the treatment. If the muscles, tendons or ligaments are strained, one needs to take rest. After all, you need to allow the tissues to heal. Application of ice packs may help in reducing the swelling and will also reduce the intensity of pain. One can also use thigh supports or compression wraps in order to support the injured ligament. Elevating the legs on stacked pillows will also help in reducing the swelling. Doctors may also prescribe pain medication and anti-inflammatory drugs. If the injury is severe, and doctors believe that the conservative treatment would not suffice, then doctors may consider prolotherapy or surgery.
Prolotherapy, which is also referred to as non-surgical ligament reconstruction, is another treatment option wherein dextrose solution is injected at the affected area to induce localized inflammation. The body responds to inflammation by increasing the flow of blood. The increased supply of oxygen-rich blood to the affected area helps in repairing the damaged tissues, thereby speeding up the healing process. In severe cases, doctors may recommend surgery for repairing the damaged ligament. If ligament pain is caused due to sports hernia, surgery would be required for pushing back the herniated section into its place.
Patients would have to be careful post surgery, and will need to take rest. They will also need to comply to other guidelines given by the surgeon. Once the incision has healed, and there is considerable improvement, they can go for physiotherapy sessions. Performing certain exercises will help in strengthening the ligament, and would help to improve one's flexibility. If pregnant women develop ligament pain due to the strain placed on the ligament by the growing fetus, taking rest will help in resolving the pain. If pain persists, consult a doctor immediately.
Unlike muscles which heal at a faster rate due to the rich blood supply, ligaments take much longer to heal due to the limited supply of blood. Moreover, groin region is a very sensitive area. One must therefore take special care and refrain from indulging in activities that can cause damage to the ligaments.
Disclaimer: This HealthHearty article is for informative purposes only, and should not be used as a replacement for expert medical advice.