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Other Soft Tissue Conditions

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Injury Information

Trocanteric Bursitis

This condition is highly prevalent in long distance runners. Pain in caused by inflammation of either of the two fluid filled sacs or ‘bursae’ that sit between upper part of the femur and the muscles that pull the thigh backward or outward. Pain is usually localized on the upper outside part of the thigh but may extend down the outside of the thigh during the night. Pain will tend to be aggravated by running or walking.

Hernia

Hernias can be present at birth or occur over time due to stress and strain on the abdominal wall. Most hernias become apparent later in life because it takes time for the hernial sac to enlarge enough for tissue to fall into it. A hernia is the protrusion of an organ or tissue through an abnormal opening. As the hernia enlarges it forms a sac. Internal organs such as the intestines can push into this sac creating one of the major hernia symptoms – a bulge.

Hernias develop at certain sites that have a natural tendency to be weak; the groin, the umbilicus (belly button) and previous surgical incisions

A hernia induced bulge is most often visible when standing. Lying down allows the tissue in the sac to return to its proper position and the bulge temporarily disappears. While hernias occur throughout the body, 95% are in the groin area.

Inguinal Hernia

Inguinal hernias are protrusions of soft tissue such as a portion of the intestine through a weak spot in a muscle, usually in the abdominal wall. Inguinal hernias occur where the abdomen meets the thigh in the groin region.

Over time, hernias often get worse due to physical stress or aging. Children’s hernias usually are congenital and are present from the time they are born.

Hernias produce different symptoms or feelings. Sometimes you will notice a protrusion in your groin area between the pubis bone and the top of the leg or feel pain when you strain during urination or a bowel movement, or when lifting a heavy object. The pain can be sharp and immediate. Other times you will just feel a dull aching sensation, a vague feeling of fullness, nausea or constipation; these feelings typically get worse toward the end of the day or, as previously discussed, after standing for long periods of time and may disappear when you lie down.

If the hernia can be pushed back onto the abdominal cavity, it is referred to as a ‘reducible hernia’. While it is not an immediate health threat, will require surgery to disappear. If it cannot be pushed back it is ‘non-reducible’. This is a condition that may lead to dangerous complications such as the obstruction of the flow of the intestinal contents or intestinal blood supply (strangulation), leading to tissue death, intestinal obstruction produces nausea, vomiting, loss of appetite and abdominal pain and usually requires immediate surgery. A strangulated hernia is very painful and requires immediate surgery.

Specific inguinal hernia symptoms may include:

Treatment Options – Hernia

Wearing a support that places pressure over the hernia may temporarily decrease symptoms but will not cure the hernia. Only surgery corrects the defect in the muscle wall.

Surgical repair techniques involve pulling together muscles and ligaments for reinforcement. Since muscles are soft and movable, the repair can separate over time causing hernia recurrence. Unfortunately, approximately 10% of hernias do recur.

The standard method of hernia repair involves making an incision in the abdominal wall around the area of weakness. This area, including the hernia, is then repaired with stitches. Usually a prosthetic material such as nylon is used to reinforce and subsequently strengthen the area of weakness. (A nylon mesh patch or plug). Finally the skin and other healthy tissues that were cut at the beginning are stitched back together to complete the repair.

Early Injury Management

For approximately the first 72 hours following an injury, the RICE regime should be followed to ensure control of inflammation and pain relief.

R - Rest

I – Ice

C - Compression

E – Elevation

Rest from aggravating activity.

Ice should be applied in the first 72 hours or when inflammation persists. Ice should be applied for 15 to 20 minutes at a time. Ice should not be applied directly to the skin, but through a wet towel or cloth.

Compression can be achieved with an elastic bandage.

Elevation is used to help swelling to return to the heart through the blood stream.