Hernias occur when a part of the body (usually an organ or part of) protrudes through a weakness in the surrounding wall of muscle. The most common type of hernia is an inguinal (groin) hernia. This is when a portion of the small intestine ‘pokes’ through a weakness in the abdominal wall. 98% of hernias occur in men, with 70,000 surgical operations a year required to fix them. The older you get, the more likely you are to experience a hernia.
Symptoms
The tell-tale sign of an inguinal hernia is a lump or swelling in the groin area which is often painless. This can sometimes be pushed back into place (reducible hernia). However ones that cannot be pushed back into place (irreducible hernia) often required further treatment as they can lead to bowel problems. Many other problems can cause groin pain and full assessment by a Chartered Physiotherapist is certainly recommended.
Playing sports, bending, lifting, coughing and having sexual intercourse can all exacerbate the symptoms of a hernia. In men, the hernia can often descend into the testicles, causing more intense pain.
Treatment
Depending on the severity of the hernia, physiotherapy can be beneficial with no surgery. Our physiotherapists can prescribe a set of exercises to strengthen the surrounding abdominal, hip and groin muscles to reduce the symptoms, and work with you to adjust your lifestyle so as not to aggravate symptoms.
Surgery is usually needed to repair a hernia. During surgery, the surgeon will place the protruding intestine or tissue back into the abdominal wall. The muscles of the abdominal wall will then be strengthened by fixing a synthetic mesh to the muscles.
There are two ways that a hernia repair can be carried out:
- open surgery – where the surgeon will make a large incision in your abdomen, and
- laparoscopic (keyhole) surgery – where the surgeon will only make a very small incision in your abdomen, before using a specially designed camera and instruments to perform the surgery. This approach is now mostly used.
Specific post-op rehabilitation is required to ensure best recovery in the safest time possible, we slant recovery towards your specific sport/lifestyle and work in conjunction with your surgeon to get optimal results.
Bursitis
Bursitis is the inflammation of one or more bursae (small sacs) of synovial fluid in the body. The bursae rest at the points such as muscles and tendons, slide across bone. Healthy bursae create a smooth, almost frictionless functional gliding surface making normal movement painless. When bursitis occurs, however, movement relying upon the inflamed bursa becomes difficult and painful. Moreover, movement of tendons and muscles over the inflamed bursa aggravates its inflammation, perpetuating the problem.
Symptoms
Bursitis is commonly caused by repetitive movement and excessive pressure. Bursitis symptoms vary from local joint pain and stiffness, to burning pain that surrounds the joint around the inflamed bursa. In this condition, the pain usually is worse during and after activity, and then the bursa and the surrounding joint become stiff the next day in the morning.
Common examples of bursitis are
- Prepatellar Bursitis – “housemaid’s knee”
- Infrapatellar Bursitis – “clergyman’s knee”
- Trochanteric Bursitis – giving hip pain
- Olecranon Bursitis – characterised by pain and swelling in the elbow
- Subacromial Bursitis – which gives shoulder pain
- Retro-calcaneal Bursitis- giving heel pain
Treatment
Bursitis that is not infected can be treated with rest, ice, elevation, anti-inflammatory drugs and pain medication. Since bursitis is caused by increased friction from the adjacent structures, compression bandages should be avoided because compression would create more friction on movement (passive and active). Our Physiotherapists will often apply advanced massage therapy techniques to help with the inflammatory process of bursitis. Electrotherapy, such as Ultrasound or Shortwave Diathermy can also help greatly. In some cases steroid injections can be used to provide immediate pain relief and graduated lessening of symptoms.
Bursitis that is infected requires further investigation and antibiotic therapy. In cases when all conservative treatment fails, surgical therapy may be necessary. In a bursectomy the bursa is removed with either keyhole or open surgery. The bursa grows back in place after a couple of weeks but without any inflammatory component.
