Stretching mobilising and strengthening your abs to prevent inguinal hernia
Inguinal hernias are due to weak, thin lower tummy muscles & unaccustomed extra load. Controled abdominal strengthening and stretching & massage of abdominal tight bands & trigger points reduce risk.
While delivering a pilates mat class I mentioned that intense abdominal effort (such as when sailors had to haul in sails by hand) often caused hernias (or “ruptures” as they were known in those days). I then went on to demonstrate a couple of stretching and mobilising exercises that would help condition the abs, and also reduce tight bands in abdominal muscles/connective tissue that might contribute to tears that would weaken the lower tummy wall.
What is an inguinal hernia?
If you don’t know, then read the Cleveland Clinic topic on Hernias. (Cleveland Clinic provides a classy patient education service, and it’s free - I suggest you bookmark its Health Library now!)
Video
Which got me thinking!
What do hernia patients report as causing their problem?
What does the research say about prevention?
What does the research say about non-surgical treatment?
Here’s what I found:-
What the patients thought
A research team in Dublin stated: “…the true incidence of body wall hernia is unclear but older studies have suggested that up to 27% of males and 3% of females will develop a hernia during their lifetime” (1).
The researchers put the question: “What activity do you believe contributed to the development of your hernia?” to 277 of their pre-surgical patients. Here is a aummary of their answers:-
Heavy labourers on the whole thought it was lifting that did it.
Sedentary workers thought it was “gym going”, or ‘sports”, or “coughing”.
My take is that the heavy labourers had strong abdominals due to their regular heavy work, but didn’t know how to stretch, massage and maintain their abs to eliminate tight bands and trigger points (tight bands and trigger points may create irregular pulls across the hernia location, leading to tears and weakness in the tummy wall).
The sedentary workers, however, didn’t know how to gradually and safely strengthen their abdominal muscles before engaging in activities that put sudden, sharp, intense loads on their abs. It’s not surprising that tears to the tummy wall were the result!
What the physios thought
A 1998 report in the journal “The Physician and Sportsmedicine” highlighted that:-
“Athletes who participate in sports that require repetitive twisting and turning at speed, such as soccer or ice hockey, may be at risk of developing a 'sports hernia'-disruption of the inguinal canal without a clinically detectable hernia”.
So here we learn that for sports people, sharp and repetitive twisting at speed is a factor. What makes a sports hernia different? Answer: ”It’s only partial. The top layer muscle (the external oblique) is able to prevent the bulge from breaking all the way through.
AI’s answer to “how to prevent hernias (research findings)”
Google’s AI gave an internet based summary of things you can do to prevent hernias. Here it is:
To help prevent hernias, focus on maintaining a healthy weight, strengthening your core, and practicing proper lifting techniques. Additionally, avoid straining during bowel movements, manage chronic coughs, and consider supportive clothing if needed. Quitting smoking is also crucial, as it can weaken abdominal muscles. And, diabetes can affect wound healing, so it's important to manage it properly.
Did you notice that it missed the nuances of (i) sudden twisting, (ii) sudden excessive loads on poorly conditioned muscles, and (iii) tears resulting from lack of stretching and massage?
What does the research say about non-surgical treatment and prevention?
(Disclaimer: if you suspect you have a hernia, then don’t go it alone - see your doctor, and take their advice - if surgery is needed, it’s needed).
I found two items of research - one on sports hernia(2), which utilised sports physiotherapy, and another on yoga for reducible hernias (3). Both conditions were causing severe discomfort and loss of function. Both treatments were surprisingly effective
The physios’ sports hernia treatment protocol
The sports physios worked with 20 soccer players and provided strength and stability work for the hip joints and abdominal core. They also used “perturbation training” so that the core (aka hip joints and lower half of spine) learned to be strong and coordinated against large and sudden limb movements and spine twists (something that’s really important in soccer players). There was just one tummy (and groin) stretch in the form of a lunge workout, and - much to my surprise - this single stretch seemed to be all that was needed for removing the risk of lower abdominal tears due to tight bands in muscle and connective tissue.
The results were very good (and took just 3 sessions per week for a period of 2 months):-
Of the treatment group, 13 of 20 returned to sport pain-free
Of the control group, 3 of 20 returned to sport pain-free
That’s a big benefit! - The exercises are described here and here.
The Yoga hernia treatment (7 poses)
Yoga poses were prescribed as a treatment for inguinal hernias in middle-aged, middle-class Indian men in Gujarat (not sportspeople).
Participants performed the seven yoga poses under supervision once a week and were also required to do the exercises at home. A
After 3 months, the results were spectacular!- Here’s a summary:-
At the start, all 19 patients suffered aggravations from daily activities such as walking, toileting, lifting, coughs and sneezes. Three months later, all patients had markedly improved, with four of 19 being pain-free!
Their frequency of hernial bulge reduced from an average of 12 times over previous two weeks to an average of two times over the previous two weeks! (Wow - big difference in three months!)
Caution: the patients were under professional supervision and had competent advice.(Read the Cleveland Clinic notes on Hernias as to why may be important!)
The Seven Exercises selected by the Physiotherapist/Yoga Practitioners
I shall be developing a Pilates/Yoga version of these soon. In the meantime, enjoy exploring the poses that the Indian physiotherapists prescribed.
The researchers' reasons are included for each exercise so as to give you an idea of how a yoga-trained physio sees the problem - I found them instructive, I hope you will too.
(Picture acknowledgements: SANSKRUTI YOGA & MEDITATION)
Vajrasana (Thunderbolt Pose):
Compresses the inguinal canal, which will prevent protrusion of abdominal contents.
Ushtrasana
(And paschimottanasana…) …were included based on the principle of proprioceptive neuromuscular facilitation technique, namely repeated stretch[8], i.e. the stretch reflex elicited from muscles under the tension of elongation will facilitate muscles to contract.
Note: yoga style stretches selectively and safely overload problematic tight lines in muscles and connective tissues, giving these areas time to lengthen, align and reorganise so that they elngate to be equal in length and strength to the surrounding healthy tissues. When that happens, there is a more equal pull from the muscles and therefore less of risk of them tearing and more chance of healing
Further explantions of stretching here.
Paschimottanasana
Has a direct strengthening effect on abdominal muscles.
Pawanmuktasana (Wind-Relieving Pose):
Strengthens abdominal muscles, compresses inguinal canal and also reduces intra-abdominal pressure by releasing air from gastro intestinal tract
Utthanpadasana (Raised Leg Pose):
Has a direct strengthening effect on the abdominal muscles.
Matsyasana (Fish Pose):
Is included to neutralise the flexion force created over the normal neck
Sarvangasana (Shoulder Stand):
It is to move abdominal contents toward the thorax, thereby reducing abdominal pressure and to prevent protrusion of abdominal contents or to facilitate replacement of herniated contents.
