Core muscle surgery addresses injuries affecting muscles and tendons in the abdominal and groin regions. It is often performed when non-surgical approaches have not provided lasting relief for persistent pain. The surgery targets soft tissue damage, aiming to restore the integrity and function of affected core structures.
Understanding Core Muscle Injuries
The term “core muscles” in this context refers to the lower abdominal muscles, the groin, and the adductor muscles of the inner thigh. These muscle groups and their associated tendons are important for stability and movement, particularly during athletic activities. Injuries in this area often involve tears or strains in soft tissues like muscles, tendons, or ligaments.
A common condition necessitating this surgery is athletic pubalgia, known as a “sports hernia,” though it is not a true hernia where an organ protrudes. Athletic pubalgia involves damage to the deep layers of the lower abdominal wall or the tendons connecting muscles to the pelvis. Injuries often affect the oblique muscles in the lower abdomen and their tendons attaching to the pubic bone. Adductor tendons, which link thigh muscles to the pubic bone, may also be stretched or torn.
These injuries commonly arise from repetitive and forceful movements that involve twisting, kicking, sudden changes in direction, or maximum exertion. Athletes participating in sports such as soccer, ice hockey, wrestling, and football are particularly susceptible due to the high demands placed on their core and groin areas. Symptoms typically include chronic pain in the groin, which often intensifies with physical activity like sprinting or sit-ups and tends to subside with rest. The pain can sometimes extend to the inner thigh or even the testicles.
How Core Muscle Surgery is Performed
Core muscle surgery repairs damaged soft tissues in the lower abdominal and groin areas. There are two primary surgical approaches: open repair and laparoscopic repair. Each method addresses torn or strained tissues, differing in how the surgeon accesses the injured site.
Open repair involves a single, longer incision, usually made in the groin area. Through this incision, the surgeon directly visualizes and repairs torn muscles and tendons, often by suturing affected muscles. This approach can also involve reattaching muscle groups to the pubic bone and adjacent ligaments to stabilize the pubic joint.
Laparoscopic repair, a minimally invasive technique, uses several small incisions. An endoscope, a slender tool with a tiny camera, is inserted through one incision, allowing the surgeon to view internal structures on a monitor. Other specialized instruments are then inserted through remaining small incisions to perform the repair. Both open and laparoscopic techniques mend laxity in the posterior abdominal wall or repair tears in the rectus abdominis, with similar overall success rates.
In some cases, an adductor tenotomy may be performed. This involves cutting the tendinous portion of the adductor longus muscle, which may alleviate persistent inner thigh pain or contribute to stability. Occasionally, a small nerve in the groin, the inguinal nerve, may be severed during surgery to reduce pain. Approximately 90% of both open and laparoscopic core muscle surgeries are considered successful.
Preparing for Core Muscle Surgery and Recovery
Preparing for core muscle surgery often involves pre-habilitation, where patients engage in physical therapy to improve their condition before the procedure. This conditioning optimizes recovery by enhancing strength and flexibility. Patients receive instructions regarding fasting and medication adjustments before surgery.
Immediately following surgery, patients are often discharged the same day. Pain, swelling, and numbness around the operated area are common and managed with prescribed medications. Early mobilization is encouraged, with many patients advised to begin walking within the first 24 hours. During initial recovery, activities that increase abdominal pressure, such as heavy lifting, should be avoided.
Rehabilitation is an important part of the recovery process and begins soon after surgery. Physical therapy focuses on regaining strength and flexibility in the abdominal and inner thigh muscles, and restoring full range of motion. The program progresses through various stages, starting with gentle exercises like Kegel exercises and light core activation. As healing advances, more challenging activities, including stretching for the lumbar region, adductors, and hip flexors, alongside light resistance training, are gradually introduced. Most individuals return to sports and normal activities within 6 to 12 weeks, though complete recovery varies based on injury severity and surgical repair.
Deciding on Core Muscle Surgery
The decision to undergo core muscle surgery is made after a diagnostic process. This begins with a physical examination, where a healthcare provider palpates for tenderness in the groin and lower abdominal regions. Specific physical tests, such as resisted sit-ups or flexing the trunk against resistance, are often performed to reproduce the patient’s pain and confirm the injury.
To assess the extent of damage and rule out other causes of groin pain, imaging tests are used. Magnetic Resonance Imaging (MRI) is effective for visualizing soft tissue injuries, including tears or strains in tendons and muscles. Other imaging modalities like X-rays or ultrasound may also be used.
Core muscle surgery is considered when conservative, non-surgical treatments have been ineffective. These initial treatments include rest, ice, anti-inflammatory medications, and physical therapy. If pain persists or returns after conservative management, surgical intervention may be recommended. For severe tears or injuries, surgery may be considered sooner to facilitate recovery.