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!

Friday, 2 November 2012

A Quick Post

In less then 3 days I should of had the operation that has stopped me doing what I love doing again - Running!
This blog has died of death this last year but I'm hopeful it will spring back to life soon.Its been over 12 months since I have done a race and 16 months since I got injured.
During that time I have enjoyed taking photos and less enjoyed riding my road bike - over 3500 miles of getting seriously pissed off!!
I would like to say a big thank you to Nick Ham who sent me emails offering advice and encouragement - a true gent!
I would also like thanks Tom Paget who stumbled accross this blog and sent a couple of wonderful emails just last week. Tom has had the very same operation that I am having and has really settled my mind and given me a much needed boost.
I'm going to post some photos that I have taken this year but before I do must mention that Steve B is still falling on his arse every time he steps foot on the fells and Steve Angus will be forever known as the most ugliest bloke that has ever won Lakeland 50!
At the very bottom of this post I have added a link of some of the things I have done on my bike this year - courtesy of me old running mucker Nick Ray.

link to my bike skills below