Friday, 16 November 2012

Gilmore Groin


This post is more for myself and anybody else trawling the net trying to find out about Gilmore groin/sports hernia/inguinal hernia repair.


My History
At the end of 2010 I was probably the fittest I had ever been. In May I successfully completed the Bob Graham Round and in the autumn I set a few Pb's on the roads. In January 2011 I developed a stress fracture in the ankle and got laid up for 6 weeks. When it healed I started doing faster running reps to try and improve some of my times for later on in the year.
When fit I like to try and do a fell race every other week and from April on-wards I competed in Loughrigg, coledale horseshoe, TWA, lords seat, 3 peaks, Helvellyn, Blencathra, Tebay, and Wasdale - slowly getting fitter and improving. I had entered Snowdon fell race in July and in the week before I was doing 400 reps on grass and near the end of the session I felt a sharp burning pain in my lower abdomen. I stopped straight away and after a few minutes rest it eased off. I tried jogging home but the pain was too much, my groin was hurting too. I wasn't too concerned - I've had groin trouble since and on my BGR (I had to walk/shuffle from Pilar onwards - such was the pain) and thought it would pass with a day or two rest. This is when it all started for me....

My Symptoms
That night when I went to bed I was in a good bit of pain and I convinced myself it was a stomach tear.
When awoke in the morning I tried to sit up but the pain in my lower abdomen  was tremendous and it took me 20 minutes to get up. I walked very gingerly to work and as the day went on the pain eased off a bit. I made a doctors appointment and he told me I had probably torn a muscle - rest til better was his advice.
As the week went on my pain eased of almost completely and I decided to travel down to Snowdon.
The first time I had ran since my injury was the warm up prior to the race and I decided if I didn't push too hard I should be OK.
I loved the race - right up my street with plenty of good running - and felt OK til the last mile when I felt mild pain again in the lower abdomen.
Over the next few weeks I eased back on the running and did more road cycling. I was still doing a bit of fell running but only at a plodding pace, anything harder hurt specifically on the descents.
By the end of September I ran at the Orton fell race, which is more like a XC race and ran OK but the last mile pain began to form in the abdomen and groin area again.
It was beginning to hurt if I coughed or sneezed now and getting in and out of bed was sometimes awkward.
I was finding I could run a few miles before the abdomen pain kicked in and if it did it would recover in a few days again.
I started stretching more and visited a few physios. Physio didn't work out for me so I went to a very good remedial masseurs in Dave Stones/Ray Pescod who thought my problems stem from my back being so stiff.

I managed to compete in the IHMR and British Fell Relays but realised things were NOT getting any better.
I started googling my pains up and this is when I first came across Gilmore groin - the symptoms were exactly like mine.I felt a slight relief!
I went back to the doctor and asked if I could have a scan and mentioned Gilmore groin to him.He had never heard of it but said he would send me for a ultrasound scan. I knew this was pointless because if it was Gilmores it does not show up on ultrasound scans, but I went on the off chance.
The result came back - I did not have a hernia - I KNEW THAT.
I had packed in running now. The last run I did had seen me walking back the 7 miles to my car in pain.
The pain is hard to describe. The abdomen pain is like a tear and the pain goes down the inside of your leg.
I was desperate now and started looking at going Private, but the cost (£3000-£5000) was far more then I could afford.
I kept on going back to the doctors and two GP's told me stop running if it hurt.
Another one suggested I stop for a year to give things a chance to repair/improve. This was good advice but if it was Gilmore groin it does not mend itself.
After 4 months of not running and still getting pain if I coughed/sneezed and getting in and out of cars, I returned to the doctors. I seen a different GP this time and he sent me to see a general surgeon in Hexham who might be able to help.
The General Surgeon had a junior DR with him and it was the junior doctor who examined me first. He mentioned Gilmores Groin to me and I felt such relief. The General Surgeon then came into the room and the junior DR told him about the possibility of Gilmore Groin. He examined me and said I did not have a hernia and he was very sceptical that Gilmores Groin even existed!!
I went home really confused and depressed.
I then got an appointment to go for a MRI scan. Again this did not show any sign of a hernia.

A bit of Good Luck
I got a letter of the junior doctor who had examined me, saying that he had taken an interest in my case and had made an appointment for me to go and see a Groin Specialist at Gateshead.
In September this year I traveled over and within 2 minutes of being examined was told I had Gilmore groin on both sides and would need operated on. The relief was immense and I came home with a date to be operated on- 6 weeks time - November 5th  2012. Seventeen months after getting injured.

What is Gilmore Groin

This condition is named after Jerry Gilmore, the London surgeon who first recognised this syndrome in 1980. The condition is also known as a Sports hernia, but Gilmore's Groin is a more apt title because, strictly speaking, there is no true herniation.

Gilmore's Groin is characterised by damage to the tissue that surrounds the Inguinal canal. Specifically, there is a tear to the aponeurosis (a sheet like tendon) of the External Oblique muscle and/or a tear to the tendon of the Internal Oblique muscle.


The symptoms of Gilmore's Groin are characterised by pain during sports movements, particularly twisting and turning. This pain usually radiates to the Adductor muscle region and even the Testicles, although it is often difficult for the patient to pin-point.
Following sporting activity the person with Gilmore's Groin will be stiff and sore. The day after sports activity, getting out of bed or a car will be difficult. Any exertion that increases intra-abdominal pressure, such as coughing, sneezing or sporting activity can cause pain. In the early stages, the person may be able to continue playing their sport, but the problem usually gets progressively worse.
Pain in the groin and pelvis can be referred from a number of problems, including injuries to the lumbar spine, the hip joint, the sacro-iliac joint, the abdomen and the genito-urinary system, so diagnosis of Gilmore's Groin requires skilful differentiation.
The diagnosis of Gilmore's Groin is based on the patient's history and clinical signs. The most notable clinical sign is widening of the superficial Inguinal ring on the affected side, which can be palpated during the physical examination when the scrotum is inverted with the doctor's finger. Typically, there is specific pain on coughing and sneezing, as well as sitting up and squeezing the legs together.


The Operation
I had to have a bilateral (both sides) Inguinal repair operation.
Inguinal hernia is when when you HAVE a hernia and can be seen - don't get confused!
My operation meant I was to have a two cuts in the lower abdomen about 3" long and mesh placed inside to strengthen the walls of my abdomen.
I was to be allowed out on the same day and recovery would begin the next day walking for 15 minutes building it up to 4 x 30 minutes after 7 days.
I was warned that I would be in some pain for the first week or two and just grit your teeth.
The staff at the Queen Elizabeth Hospital and surgeon (Dr Kevin Clark) was first class and I cannot praise them enough.

However......anyone who should Stumble Upon this blog whilst looking for advice  info on Gilmore Groin/Sports Hernia I've added the healing part of which nothing can prepare you for....

Grit Your Teeth
OK I maybe a wuss but if I can help prepare one person of what to expect I shall feel my life fulfilled!

When I came around in hospital (very surreal) I was giving toast and water and told to dress myself when I felt I could. The toast was much needed - I had not eating owt all day and it was 5.30pm now- and I soon scoffed it down. I got dressed fairly quickly (I was still numb and had no pain......yet).
I was told when I could pass water I was allowed to leave. My brother was waiting to drive me back the 80 odd miles home.
A couple of nurses had stressed concern about me going home and wanted me to stop in for the night - they did not know I lived so far away but I convinced them I felt fine. I did.....
...until I went all faint and they had to put a oxygen mask on me. I must of got up too fast!!

Eventually Im heading back home along the A69 and the journey passes ok.
Getting out of the car the other end though proved to be a bit more awkward but I soon find myself back in my favorite chair being fussed on (this did not last long).
Getting into bed was about the hardest thing I have ever done and I am more proud of this feat then anything else I have achieved! (obs the birth of my kids don't count....or getting married)
It was AGONY. And when I did get laid down I lay there like a plank. I could not move up, down or side to side.
My stomach had swollen up like a hot air balloon and I was up to the loo about 4 times during the night passing urine!
Each time getting in and out of bed was shear torture.The incisions are right on the part of your body where everything goes through you to make your lump of a body move!!
Morning came and the wife was fed up of me now!!
At dinnertime we had a 15 minute walk ,as ordered. I was like an old women, barley able to put one foot in front of the other but I achieved it and was soon back home in my chair.
Top Tip-keep moving about every hour or so - no matter how much it hurts getting up and down - it's better then stiffening up.
This went on for 3-4 days. My walks got further and and I a littlt faster.
All was going well. It still hurt to get in and out of bed and I could slowly inch down if I was too high.
But then I sneezed!

Christ that was pain ! (worse then childbirth.......I imagine)

My right side was healing nicely but my left was still very painful, especially in the incision. I was convinced something had not worked. For one side was pain free and the other total agony.
If I turned sharply, coughed or sneezed it was like a red hot poker going down your groin. I learnt to hold my bad side if I was going to cough - this helped, just apply gentle pressure.
On day eight I was walking up to 2 miles. The right side was fine, no pain whatsoever. Job done.
The left side was not going so well..
It really hurt to laugh and after a visit from Steve A and Steve B there was no danger of getting pain from laughing - boring sods ( only joking fellas. your visits were very much appreciated)
I'm writing this 11 days after my operation. The left hand side is beginning to catch the right side up. Still mega sore to cough but I'm walking about nearly normal now.
I phoned the surgeons secretary up and asked her about the pain in the right side, she said the surgeon had probably gone deeper into that side and it's normal. She said it will take up to 6 weeks to recover and I was only in day 9!!
She probably wanted to say that I was a pain in the right side but good manners prevented her!!

The Conclusion
Diagnosing a sports hernia can be difficult unless the doctor has a wealth of experience treating athletes who have groin pain. Sports hernia is the most unique and misunderstood cause of groin pain, and not all doctors recognise sports hernia symptoms.
Physical exam focusing on the groin area, upper leg, and lower abdomen. Ordering appropriate x ray studies to rule out courses of groin pain and other sports hernia.

On a personal note I hope to start light running again after Xmas and have got a weeks physio booked for the second week In January. I go back to see the surgeon on the 7th Jan to make sure all is well.
Fingers crossed.

Thanks you to everybody who has left messages via this blog, text , twitter, blipfoto and email. All very much appreciated.

The photo Bit
As you can imagine I haven't been out and about much lately but the night before mt operation I had a wander up Hallin Fell









The disclaimer

Did I say that!



23 comments:

DaveT said...

I'm right there with you.
When you recover from this kind of ordeal, you'll be mentally tougher and appreciate every running step you take.

ultra collie said...

fingers crossed it all goes to plan stu
amazing universe pics mind :)

Seb Fox said...

I know where you're coming from Stu. I've had problems with Gilmore's groin for years. Took a few years to even get an accurate diagnosis from the NHS. Four years after the original injury I was diagnosed with a sportsman's hernia and referred for hernia repair surgery. Had a laparascopic op, but the hernia specialist said he couldn't find a hernia. After the op it took a few months before I could return to any kind of training, at which point I started a physio rehab programme. 6 months after the op I returned to football, but still had some pain and discomfort in the groin area. I just tried to play through it, as I thought it's either that, or retire from football, and if it turns into a full hernia at least the doctors will be able to do something about it. With the right level of physio, gym and football training the problem gradually got better, but it's still not 100%. One thing that helped a lot to reduce groin pain and injuries was compression shorts, I now wear these all the time for training and matches. I've just bought a pair of these http://www.gilmoresupportshorts.co.uk , not tried them out yet, but they look better than others that I've seen.

Will Jones said...

It was great to see such a detailed post on going through this experience. As you rightly pointed out from your experience, it is incredibly hard to differentiate between hernia or groin strain and not every GP might be able to tell hernia symptoms from a groin strain rightly. But I'm glad it worked out well and to see you have recovered.

Nick said...

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Nick said...

Hi, just come across your blog, my symptons very similar to yours, but only had them 3 weeks, but after googling found out about Gilmore's groin and am going to Mr Gilmores clininc in Harley st in a couple of days. Just a quick point, in my research over last few days, I came across a video of Mr Simon Marsh from the Gilmore clinc, where he deatils diagnosis and treatment but says specifically, that they DO NOT treat it with mesh as it just covers up the area of injury rather than repairs it! Just wondering how you are getting on now and whether it had totally cleared up?
Good blog.

Paul Jones said...

This is correct. I have have been operated on a few times at the Harley street clinic. Simon Marsh is now the lead surgeon after jerry retired. The recoveries from my surgery have been brilliant and have been running in no time. The thing that most people forget to do is to keep up their core strength exercises. Not doing this coupled with a weak groin area will cause the problem to happen again. Also I am pretty sure a inguinal hernia repair isn't the same a Gilmore's groin because they have different surgery codes.

Stu Stod said...

Hi Nick & Paul
I had the symptoms for 18 months before I got operated on.
I couldn't afford the private treatment and had no other choice then NHS.
The surgeon said it was Gilmores Groin and putting a mesh in would almost certainly fix me. I was sceptical but also very desperate!
The morning of the operation he said it was a Inguinal repair operation.
He did stress how important that core strength exercises are to help heal.
It is coming 10 months since the op and Im still in pain on the left side - still hurts if I cough or sneeze - but I'm running. Not super fast- I don't think I could run a great distance any more but up 10 -15 miles I can just about manage.
If your asking me if the op has been a success I would say NO.
I managed a fell race 3 wks ago - loved it - but the next day the old pain is still there.
Private is without doubt the way to go - if you can afford it.

JAX said...

I've just had bilateral groin strain repair for my Gilmore groin/sportsman hernia from Mr Kevin Clark a few days ago.

Stu Stod said...

Hi JAX -
I hope everything went OK? let me know how your recovery goes.
Stu.

Anonymous said...

Great blog..i think i have it, scan due any day now, i wonder if these ever heal up on their own?

Sam said...

Hi,

I am supposed to have this op done by Kevin Clarke tomorrow on my private insurance, I was wondering if it's any good? I think if it's just a mesh it will not work as I have just watched the simon Marsh video, I hope that Kevin Clarke has learnt how to do it now. Jax how are you doing now?

Stu Stod said...

Hi Sam
Its worked in the sense I'm running 40 plus miles PW again but mostly on the road. I still get pain if I descend fast on the fells. I also still get a sharp pain if I sneeze or cough unexpectedly but at least I'm running again. I ran Haweswater half in March in 1-23 and I couldn't of done that before the op.
I def recommend physio asap after the op - I had to wait a few weeks cos I was still in loads of pain. Also take loose joggers to travel back home in - I had to travel back home 70 odd miles in my jeans and I dint think that did me any favors. Good Luck and let me know how you come on.
Dr Clarke is very nice but he does seem to rush you a bit so take your time and ask him everything that concerns you. Once again good luck.

Stu

Sam said...

Thanks Stu,

I live 15 minutes away from the hospital, I'm going to ask him if there's more into it than fixing a mesh and I will let you know. I think they have to fit a mesh in the end anyway to strengthen the tendons but they have to rearrange the muscles and the tendons first and then. My case now is very mild I am feeling a constant pain in my groin as if something is pushing towards it all the time. I don't get any pain with sneezing or coughing as I stopped any sort of excercise since last October but I do get pain in the right testicle which he said it will def go after he re-attaches the tendons.

Anonymous said...

It will not heal on it's own. I've had mine for over 5 years in which time the nhs kept denying it was a hernia, they were right, but they didn't know about this condition. Anyway getting surgery next week on it (private) hopefully putting an end to this ordeal.

Sam said...

Hi all,

It's been a month now since I had the procedure. My recovery has been quick although the the third and the fourth days were really rough.
I have started physio now and already feeling much better but there is still some discomfort under the stitches, it looks like a lump which still hurts when you press on it, I will start jogging next week and will let you know how it goes.

Anonymous said...

Hi, I had surgey with mr Clark last december. Things have improved but still get the old ache feeling on the left side if I push myself hard in the gym or sometimes if I just sit for long periods. I'm concerned that as its nearly 8 months since the op it's never going to fully get better. Anyone been in the same boat and found a way to improve their condition? Don't fancy going through surgery again!

Paul said...

Hi,
I've just had Bilateral gilmores groin repair 3 weeks ago and surgery was performed by Kevin Clark (who has been great).Im not sure if it was ignorance on my behalf but I never thought the pain/discomfort would have been like this post-op.
I work in a manual environment and was wondering how long its taken others who've had the the Op to get back to work ??
Any advice on post-op and recovery would be appreciated also as I'm a cyclist will things be the same when I recover??
Thanks
Paul

Oz said...

Really good blog, in fact it's the only info I have been able to find about what to expect post op and it's nice to know others are in the same boat!

I had abdominal pain for over 6 months, not enough to stop exercising but quite painful when sneezing and sometimes after exercise, and then one day it just went! Gilmore's really is the ticking time bomb of sports injuries!

People should know the symptoms because it seems in most cases surgery is inevitable-wish someone had told me! Anyway I had the surgery a week ago, hard to walk for the first couple of days but after day 3 was walking 20-30 minutes, not up to 40 minutes. Had a bit of a setback today and couldn't walk after 15 minutes but I may have been pushing a little bit too hard too soon. If anyone is in the same position and wants to know if what they are going through pain/activity wise is normal then post back! God knows that this is not a very well known condition- even in orthopaedic surgeons and physios so we need all the help we can get!

Ian Pyne said...

I have surgery scheduled for this on 5th November. It has taken me many doctors and appointments to get firstly a diagnosis, and secondly a surgeon who knows how to repair a sports hernia. Fingers crossed for the 5th.

Anonymous said...

I had my procedure 2 days ago and the recovery is going well. The service by Kevin Clark was exemplary and the recovery will only be as good as the physio service you pay for. I was referred to Kevin Bell Physiotherapy who does a lot of work with footballers etc and his efforts have been great. The NHS are utterly clueless when it comes to diagnosing this condition so a GP or ultrasound won't serve any purpose. Signed up for Saltwell 10K in December with a few half marathons then the Paris Marathon in April next year. Fingers crossed all goes well with recovery.

Steven Garland said...

After 15 months of pain and frustration, I was finally diagnosed with bilateral Gilmore Groin and had surgery 3 weeks ago. After 2 weeks of strong painkillers, I have stopped using them and am slowly getting back to normal. I'll stress its a slow, methodical recovery with gentle physio after 2 weeks, plenty of warming up in the morning! The pain is still there but is reducing in severity and duration. Hopefully the surgery has worked, Mr Clark at Gateshead QE was the surgeon and came highly recommended (it's not my local hospital). Surgery and recovery isn't pleasant but is miles better than putting up with the injury. I realise I'm not alone in it taking ages to diagnose, GP's just don't want to know about sporting injuries.

Gary Wilkinson said...

Thanks for this Blog. It's both comforting to know others have expereinced this condition, but also galling to hear about the generally long and painful post op recovery. Still, Man up Gary! I've struggled with a progessively higher level of pain for over 2 years now. The epicenter of pain being where the tendon joins the pelvis under my left testicle, down the inside of the leg and deep in my abdomen.
I have managed a few Marathons since this problem began, but at 9/10 miles the pain becomes quite intense, and it's a case of slowing down to not accelerrate the pain, which is of course very frustrating.
A physio (probably my 10th in the past 2 years) proded and poked around last wqeek, and gave it the name of Gilmours Groin - somehow better when it has a name!? He said no amount of physio was going to mend the problem, and surgery is the only option.
I have a Marathon next weekend. I am going to give it the best i can, as i suspect it may be the last race i participate in for some time, given the comments on this blog!Thanks for setting expectation!
Gary Wilkinson