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GROIN & HERNIA SERVICES

 

The Gilmore Groin and Hernia Clinic specialises in the management of men and women with sports related groin and adductor injuries. The clinic is structured for the rapid assessment of Gilmore’s Groin Disruption Syndrome and Hernia of all types.

A Hernia is a protrusion of a viscus (an organ) beyond its normal limits and occurs in either the groin or the abdomen. Hernia repairs of all types, both primary and recurrent, including inguinal, femoral, umbilical, epigastric, spigelian and incisional are undertaken by out 108 surgeons. Open or laparoscopic operations are available as required or as requested.

Groin disruption (Gilmore’s Groin) is a severe musculo-tendinous injury of the groin, which can be successfully treated by the surgical restoration of normal anatomy. The success of surgery for Groin Disruption (Gilmore’s Groin) depends on accurate diagnosis, meticulous repair of each element of the disruption and intensive rehabilitation. Surgery is indicated in sportsmen, who are unable to play, or fail to respond to rehabilitation. 

Groin disruption is a clinical diagnosis based on history and examination. Inverting the scrotum and placing the examining little finger in each superficial inguinal ring in turn gives the diagnosis.

If the diagnosis is clear then further investigations may not be required. Both MRI and high frequency ultrasound scanning may be helpful in some patients with conflicting symptoms and physical signs.

40% of patients diagnosed with Gilmore’s Groin also have torn adductors. Minor and moderate tears usually respond to adductor exercises and physiotherapy. Patients with severe adductor (muscle) tears usually require adductor tenotomy (division of tendon) or release. 

The Surgical Treatment of Gilmore’s Groin consists of restoring normal anatomy with a six-layered structural repair of the inguinal region.  Adductor tenotomy is indicated in patients with persistent and troublesome adductor tears, which do not respond to conservative treatment.

The original Gilmore technique has been modified with the aim of reducing the recovery time, whilst maintaining the strengths of the full anatomical repair. The formal repair is now known as the Marsh Modification of the Gilmore Technique. 

There is an established rehabilitation programme for Gilmore’s Groin, which may be recommended as an alternative to surgery.  There is also a Post-Operative Rehabilitation Programme available for both Gilmore’s Groin and Hernia surgery.

Our Consultant Surgeons provide a second opinion service for patients who have been diagnosed elsewhere and want this to be reviewed and/or wish to discuss the treatment options already proposed.

Osteitis pubis is a term given to lower abdominal and / or pelvis pain that can occur in athletes. Typically in causes pain towards the middle of the pelvis, at the front.

In medicine a term ending in “itis” implies an inflammation, such as in appendicitis or tonsillitis. In these cases you can measure what are called “acute phase proteins” in the blood and these will be at higher levels then normal in the presence of inflammation. In osteitis pubis none of these inflammatory markers is raised; so it is not an inflammation at all. It is now more correctly known as “pubic bone stress injury”. The question then arises as to what is causing the “stress”.

Changes in the pubic symphysis can sometimes be seen on an ordinary x-ray, a CT scan or on an MRI scan. There can widening of the symphyseal space (as if the joint at the front of the pelvis is being pulled apart) or irregularity of the bony margins.

REHABILITATION PROGRAMME

 

When doing the exercises it is important to activate the “core stability” muscles.  These muscles consist of the stabilising abdominal muscles and some of the lower back muscles. The hospital physiotherapist will show you how to do this and the Practice Nurses are available for advice if you have any concerns. The rehabilitation is divided into four stages which can be completed at an individual’s own rate.

  GENERAL AIMS SPECIFIC EXERCISES
STAGE 1
  • Straight line activities, avoiding abdominal straining
  • Treadmill jogging/running
  • Front crawl swimming
  • Cross training
STAGE 2
  • Body weight movements
  • Lunges
  • Side lunges
  • Partial squats
  • Hip flexion and extension
  • Begin ball work
STAGE 3
  • Increase intensity of core stability work
  • Change of direction at speed
  • Box drills
  • Cutting drills
  • Figure of eight routines
STAGE 4
  • Sport specific training
 

 

Note:

  • While exercising, and afterwards, some discomfort will be experienced at the repair and adductor insertion site.
  • Provided you adhere to the programme and avoid sudden sharp movements, you will suffer no harm.
  • Stiffness and discomfort occur the day after vigorous exercises. For this reason, some form of exercise is advised 7 days a week.
  • Swelling at the operation site takes 8 to 12 weeks to clear completely.
  • Professional sportsmen may be playing again at 4 weeks, amateurs may take 6-8 weeks. 

The hospital physiotherapist will show you how to follow this programme and the practice nurses are available if you have any problems.

WEEK 1
  • 1st Day stand upright and walk for 10 minutes; thereafter, walk gently for 10 minutes 4 times a day
WEEK 2
  • Return to work if in a sedentary occupation;
  • Walk for 30 minutes twice a day for 4 days;
  • Thereafter walk briskly or jog;
  • Gentle sexual intercourse and
  • Driving are permitted
WEEK 3
  • Return to light work
  • Run in straight lines
  • Gentle sit-ups and press-ups
  • Moderate gentle lifting (10 kgs max)
WEEK 4
  • Return to work if in a heavy occupation
  • Swimming (crawl)
  • Cycling, running
  • Heavy lifting (15 kgs)
  • Must still avoid sudden movement
WEEK 5
  • All activities are allowed

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