Earlier this month, Houston Texans fans received a bit of a scare when star defender and No. 1 overall pick Jadeveon Clowney underwent sports hernia surgery. According to the Houston Chronicle's Brian T. Smith, original recovery time projections put Clowney back in action in time for the start of late July's training camp.
For now, it remains difficult to predict Clowney's exact return date, and while the above quote is unsettling, its significance is not clear. To better understand whether or not his health remains a bona fide concern heading into the more important parts of the 2014 offseason, let's take a look at what, exactly, a sports hernia is—or try to, at least.
Unfortunately, it's not exactly a simple task.
In a broad sense, a "hernia" is a medical condition where a collection of tissue pushes through a weak area in the abdominal wall. For example, an umbilical hernia often makes itself known as a small bulge near the belly button. An inguinal hernia does so near the groin.
That said, a "sports hernia" does not actually represent a true hernia. Rather than a bulge of tissue, a sports hernia—also known as "athletic pubalgia" or, even more recently and probably more accurately, "inguinal disruption"—describes any condition or injury that manifests itself as chronic groin pain in an athlete. Athletes who frequently start, stop, twist and cut—such as football and soccer players—are generally more susceptible.
The above definition is purposefully vague, as the condition remains an area of intense research. In fact—as detailed here by Dr. William Brown—it even occasionally lacked support as a "real" diagnosis, so to speak.
Then, in late 2013, Dr. A.J. Sheen and the rest of the British Hernia Society added further legitimacy to the diagnosis by proposing a standardized definition of inguinal disruption—as well as a recommended sequence of treatment options—based on expert interpretations of currently available knowledge.
According to the proposal, at least three of five diagnostic signs—such as pubic bone tenderness, diffuse groin pain and other related findings—must be present to make the diagnosis, but they may not always immediately point to one particular underlying cause. However, the panel agreed that abnormal tension in and around the inguinal ligament—a band of tissue connecting the bottom of the "wing" of the pelvis to the pubic bone—probably contributes to the pain in many cases.
As one case of inguinal disruption will vary from another, it's extremely difficult to speculate as to what Clowney's surgeon found and did. Furthermore, the role of his recent groin injury is also unclear. Inguinal disruption pain tends to come on both slowly and subtly.
Despite the above uncertainty, Clowney's procedure likely focused on releasing the aforementioned tension—as well as repairing any tissue or muscle defects it may have caused.
Following surgery, a recovery time of six to eight weeks is typical, but as above, no individual case is the same. In other words, successful surgery depends on not only repairing any tissue abnormalities in the groin, but also identifying the underlying abnormalities in the first place and hoping they, indeed, caused the pain.
If all goes well, Clowney can and will take the field long before the start of the 2014 regular season. Given the fact that his medical team surely consists of the best in the world, there is not yet reason to expect anything less.
Then again, until Clowney returns to full speed, fans should pay attention to his bursting and cutting abilities—the types of motions that bring about inguinal disruption groin pain, if it still exists. A relative lack of agility could mean Clowney is dealing with ongoing issues.
Such a scenario wouldn't necessarily spell doom, and further procedures—such as tendon or nerve dissections—could satisfactorily address the problem. Adrian Peterson underwent a second groin surgery after the 2013 season, one presumably related to his original sports hernia from 2012.
However, the need for more intervention will signify a more troublesome case of inguinal disruption—and thus cast at least a shade of doubt on the future of the otherwise-surefire No. 1 draft pick.
Dr. Dave Siebert is a resident physician at the University of Washington who plans to pursue fellowship training in Primary Care (non-operative) Sports Medicine.
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