Editor’s note: Kansas City Chiefs safety Armani Watts underwent successful core muscle surgery last week and is now on the team’s injured reserve list. What does that mean, exactly? For that, we bring in our in-house injury expert, Aaron Borgmann.
We found out last week that a player for the Kansas City Chiefs had surgery to repair something known as a core muscle injury. Since that term is somewhat new in the sports injury world, let’s break it down a bit and describe the situation for those who may not know much about it.
When I first started my sports medicine career, this injury was known by the terms, “sports hernia,” “goalie groin,” and sometimes, “athletic pubalgia.”
These names have gone by the wayside due to their lack of specificity and inaccuracy. At its most basic explanation, this condition is defined by tearing or multiple small tears of structures that attach to your pubic bone. Think of a suspension bridge – the bones are the steel or concrete girders and the muscles are the tension cables. If one cable is fraying, the whole system is going to not support correctly.
It is important to note that due to the various structures that attach here (groin muscles from below, as well as abdominal muscles from above) that symptoms for this condition as well as onset can vary quite a bit. It can be chronic or acute, sharp or dull, debilitating or something people can play through. It really does all depend on the amount of damage that the athlete has sustained. Since there are over a dozen variants of how this condition may present itself, accurate diagnosis of what structures need to be repaired is key. Specific MRI images or “cuts” can assist with this.
It should also be noted that some athletes discover that they have this condition and elect not to have surgery and instead rehab through it. There are many successful cases of this as well. As with anything else, this is very athlete and specific condition dependent.
Due to the fact that we were told this athlete suffered from the groin variant we can break that down a bit and tease out what the most likely intervention was. With the groin (adductor) muscles being involved the most likely intervention was either an adductor release (where the muscle is completely cut and allowed to scar down on its own) or a full-on repair (where it is sutured together). The release of a muscle sounds like it would be a bad thing, but there are enough other supporting structures to help pick up the slack and return to function and pain relief are the goals here.
Rehab here is interesting and unique. Many surgeries call for a rest period, but not here. Within the first couple of days, post operation, the first thing you do is walk a mile on the treadmill. Doesn’t matter how long it takes or how fast you go, you walk a mile. Sounds crazy, but this is done to help the repair scar in. I have seen it take 80 minutes, I have seen people do it in 25 (again, this is very dependent upon the patient what structures had to be repaired).
Specific soft tissue work over the repaired structures and a lot of ice assists in pain relief early on. Rehab continues with a lot of specific sequential muscle firing and how to learn to use your true core muscles (things like multifidus and transverse abdominus – NOT ABS) to help support your pelvis. There is additional work done including lots of resistance in key positions to stress the supporting structures is beneficial here. Think of lunges and squats with rubber-band resistance while firing your pelvic floor muscles. It’s not easy!
Athletes generally feel pretty good within a matter of weeks and some surgeons will tell you that they can return to play at this point. This has not been my experience and have always thought to avoid re-injury here that it was better to give the athlete more time and truly get the rehab portion of this injury correct.
No matter the variance, these repairs all have good outcomes in my experience. The surgery is quick, as well as minimally invasive. The rehab generally goes smoothly. No matter when this athlete returns you can probably assume that he will be 100 percent when back on the field.
Aaron Borgmann is the founder of Borgmann Rehab Solutions. He spent 12 years in the NFL as an assistant athletic trainer and physical therapist before joining Arrowhead Pride.