Ok, now they are saying its a hernia...questions

[raymond3]

Wow, some doctors amaze me. I go last week and a doctor (not my usual one, but same office) checks me for a hernia because thats what I was thinking it was from the get go. He's says no and prescribes me an anti-biotic for a possible infection. A little over a week later, it still hurts so I go and see my normal doc today. He feels around and says he believes I have a small inguinal hernia and has me going to see a surgeon.

I feel the pain/discomfort in my left testicle, my inguinal crease and in my lower ab region on my left side...is this the usual signs of this particular hernia? Also, is this the type of hernia caused from lifting? I was going to ask the doctor this, but he never came back in..usual doctor bs- wait 1 1/2 hours to see him and he is in and out within 5 minutes.

Also, Im assuming I should refrain from lifting...does this include all lifting and cardio? Thanks in advance.

[bryanc]

To answer your specific questions:

1) Is this caused by lifting? That's quite unlikely, as many people develop hernias who don't do any lifting at all. Guys inherently have a weak spot in their abdominal wall where the spermatic cord comes through the peritoneal wall. Some people are genetically predisposed to weaker abdominal walls (nothing to do with muscles). Put the two factors together and you get a higher risk of hernia that has nothing to do with whether you lift or not.

2) Does your activity restriction include all lifting and cardio? Yes, it includes all lifting unfortunately, since the reason why your hernia needs to be repaired is that a portion of your intestine is slipping in and out of that hole in your abdominal wall and could become stuck, or strangulated. And increasing intra-abdominal pressure while lifting increases the chance that you little bit of intestine will slip out through the hole. The more times it slips through the hole, the more chance that it will become strangulated. Strangulation of a hernia means that the blood supply to that part of your bowel could get cut off and that part of the bowel will die--which then becomes a life-threatening emergency. Cardio is probably okay, provided it is light cardio (sorry, no HITT for you), but you should check with your surgeon.

[raymond3]

Ok cool, thanks bryanc. Im going to go within the next week or so to take care of the issue. I dont believe it was from doing any squats or deads, but if anything irritated it, I think it was from doing planks, or hanging leg raises from the straps. I would raise my legs all the way up and this is when I noticed the issue (and what bothers it). So light cardio is okay? Like jogging moderately on the treadmill or using the eliptical machine? Also, once repaired, does it mean I shouldnt do ab work or how long before I can lift again? Thanks again for the advice.

[bryanc]

Once repaired, you should get a 'return to activity' protocol that outlines when you can ease back into your normal activities. This is, of course, assuming that what you have is indeed a hernia. Generally speaking, the lifting restriction applies for about 4-6 weeks post-surgery. You probably won't feel the greatest after surgery anyways in terms of working out. Sounds like an opportunity to tune up your diet as the primary method of 'weight control'

[UConnJulie]

Also be sure to let your surgeon know exactly what kind of activity that you want to return to so that he can give you a more specific timetable based on what he finds when he's "in there".

[raymond3]

Update: I went to a specialist/surgeon yesterday. He felt around, etc and said he could barely feel something and thought it could be a small hernia, but nothing to worry about (said unless its golf size or something, shouldnt be an issue). It has been getting better and Im starting to wonder if I had a abdominal strain/pull (because it only bothers me when doing ab work, especially leg lifts)...it doesnt bother me at all when doing squats or deads, or anything else. I asked him if I could go back to lifting and he said yes, no problem. He said some people just carry small hernias and there isnt much you can do...told me to come back and see him if it happens to get worse. So I guess Im okay to workout again. Does this sound straight? I know some docs are full of it, but this was with an actual surgeon and he said I could work out right away.

[russ]

Originally Posted by raymond3

Does this sound straight? I know some docs are full of it, but this was with an actual surgeon and he said I could work out right away.

Most surgeons would take a 'better safe than sorry' approach to answering your question about lifting, so if your surgeon isn't too concerned, then you should be good to go.

[raymond3]

Cool thanks, I appreciate it.

[Kaiser]

Originally Posted by bryanc

1) Is this caused by lifting? That's quite unlikely, as many people develop hernias who don't do any lifting at all. Guys inherently have a weak spot in their abdominal wall where the spermatic cord comes through the peritoneal wall. Some people are genetically predisposed to weaker abdominal walls (nothing to do with muscles). Put the two factors together and you get a higher risk of hernia that has nothing to do with whether you lift or not.

Question: if you are genetically predisposed to it, won't lifting heavy in squats and DLs potentially be the catalyst that causes the inguinal hernia?

[bryanc]

You'd think so, eh?

Lifting has not been established as an independent risk factor for development of hernia (inguinal or otherwise). There are two case reports of hernias in powerlifters, one of which was a 42 year old former record holder powerlifter who developed an umbilical hernia when lifting without his weight belt, and then subsequently developed bilateral inguinal hernias when he lifted WITH his belt. There are also two small studies looking at a possible increased incidence of HIATAL hernias in elite powerlifters (which is a category that only a very very very very small number of forumites could likely be considered to aspire to). In all of these studies and case reports, self-reported steroid use is also possible confounder.

It's possible that heavy lifting could precipitate a hernia event in someone who is already predisposed, but considering that it takes study of a population that lives in the extreme tails of the normal distribution (i.e. elite athletes) who subject their abdominal contents to elite-level loads to actually detect a measurable proportion of "increased prevalence" (and in a hernia category that isn't even inguinal), I'd say that the risk for a non-elite lifter would be on the theoretical level (i.e. it's like when they say your risk of being killed by a falling airplane part on your way to Little Rock to the next Fitness Summit _does_ exist).

[Kaiser]

Originally Posted by bryanc

It's possible that heavy lifting could precipitate a hernia event in someone who is already predisposed, but considering that it takes study of a population that lives in the extreme tails of the normal distribution (i.e. elite athletes) who subject their abdominal contents to elite-level loads to actually detect a measurable proportion of "increased prevalence" (and in a hernia category that isn't even inguinal), I'd say that the risk for a non-elite lifter would be on the theoretical level (i.e. it's like when they say your risk of being killed by a falling airplane part on your way to Little Rock to the next Fitness Summit _does_ exist).

Help me understand here, please, because I am not asking for pedagogical purposes, but rather because of my own personal situation. After having an inguinal hernia repaired (I noticed it had occured after a coughing bout, not lifting), my surgeon told me not to lift heavy again. Of course, I ignored him, but while deadlifting heavy (for me), I could feel the strain in the repaired hernia and the other side felt like it was going to go as well. Since then, I've avoided very heavy DL and squats.

[raymond3]

Just to give an update on my situation- when the doc/surgeron felt for the hernia, he said he could feel something very small, but nothing to worry about. He said some people just carry them around for awhile, or possibly forever. I asked when I could return to lifting heavy and squats/deads, etc. He said I could right away, which surprised me. Since, Ive started lifting and have had no issues. I can still feel something when I move certain ways, but its getting less and less and barely noticible now.

Im beginning to wonder if I just had an abdominal strain or something. One, because I never had a big lump or anything and it didnt bother me when doing any squats or deads, just when do ab exercises (which I still havent done any and plan on waiting a few more weeks).

Kaiser- I would get a 2nd opinion on it (by a specialist or surgeon). Ive heard of people having full blown inguinal hernias and once repaired were told they could lift again within weeks. Might be worth getting another opinion.

[bryanc]

Originally Posted by Kaiser

Help me understand here, please, because I am not asking for pedagogical purposes, but rather because of my own personal situation. After having an inguinal hernia repaired (I noticed it had occured after a coughing bout, not lifting), my surgeon told me not to lift heavy again. Of course, I ignored him, but while deadlifting heavy (for me), I could feel the strain in the repaired hernia and the other side felt like it was going to go as well. Since then, I've avoided very heavy DL and squats.

I'm on call right now, but I will get to this question eventually.

Recurrent hernias (post-repair or otherwise) are a bit of a different story.

[Kaiser]

Originally Posted by raymond3

Kaiser- I would get a 2nd opinion on it (by a specialist or surgeon). Ive heard of people having full blown inguinal hernias and once repaired were told they could lift again within weeks. Might be worth getting another opinion.

I had it checked this summer during my physical, and there is no herniation again. Still, when the intraabdominal pressure goes up with heavy weights, I don't feel quite right. Not like I have a hernia, but like I am going to get one. Perhaps it is all in my head, but I recall reading that there is a higher percentage chance of getting an inguinal hernia on the opposite side of where you alrady had one once you have had the first. AND... my surgeon did tell me that despite the repair, which makes you stronger than even naturally, he wouldn't recommend very heavy lifting again. Of course, that could just be him telling me to be cautious.

Honestly, I'm guessing most people don't lift like we do - especially squats and deads which would put a lot of pressure on the area we are discussing. I mean, how many people at your gym do you even see doing those lifts? There are over 12,000 people at my gym, and yet the three squat cages are always open.

Bryan, I am eagerly awaiting your reply. Thanks.

[bryanc]

As with any injury, we have to consider modifiable and non-modifiable risk factors. In the case of hernia, the modifiables are things like smoking, and...well, smoking. Unmodifiables are things like your developed internal anatomy, your personal expression of the your genetic subtypes of the collagen subtypes, your age, and your gender.

Previous hernia isn't really a true risk factor (just as previous injury isn't a true risk factor for subsequent injury), but rather, a proxy for the unmodifiables. The fact that you have sustained a hernia in the past, means (until our knowledge changes, if it does) that you have a collection of unmodifiable risk factors that eventually manifested as a hernia. So, if you had a patent processus vaginalis (which you have or you don't as part of your embryological development; and is one of the postulated normal anatomical variations that causes hernias) on your right side, it's far more likely that you have one on your left side.

The mechanism by which inguinal hernias are thought to happen have to do with abdominal muscle activation and the inherent strength of the transverse fascialis (under transverse abdominus). Under lifting or coughing situations (and coughing produces a very large intra-abdominal pressure as well, just more transient than lifting), the abdominal muscles tighten and reinforce the fascialis. But under situations where loading of the abdominal wall is more gradual (including during some lifting), the fascialis doesn't get the reinforcement from the abominal muscles. And you have an inherently "weaker" fascialis, or a patient processus vaginalis, the "passive" barrier may give way to cause a hernia.

There have not been any studies to see whether training the abdominal muscles can be helpful in preventing recurrent or contralateral hernias, so whether this is one strategy that can be used, while theoretically a valid one, is still up in the air.

As with any collagenous structure (including bone), remodelling is possible through progressive stress. Just as your tendons get stronger over time, it is theoretically possible to strengthen your transverse fascialis. However, collagen remodelling takes far longer than muscle remodelling (not to mention the "neural remodelling" component of strength gain), so, subjecting the transverse fascialis to increasing abdominal pressures in an effort to get it to strengthen (if you don't have a patent processus vaginalis) is likely to be MUCH slower than the rate of strength gain one would achieve with a strength training program.

So, based on all of this, I think there are a couple of soft recommendations for you, Kaiser:

1) You probably already have a strong core, but some transverse abdominus training can't hurt.

2) You can try to keep your intra-abdominal pressure down during a lift, by not Valsalva'ing during your lifts (i.e. no breath holding, no bearing down). Try actively breathing out during both eccentric and concentric phases.

3) Let the giving sensation be your guide with respect to your loading progression. In time, you may find that you are able to lift a heavier load without the sensation on a consistent basis.

4) Pay attention to any giving sensations during other times of increased abdominal pressure such as coughing, sneezing, bearing down.

[Kaiser]

Bryan,

Thank you! Thank you! I especially appreciate the recommendations. Going to make a few changes to my lifting routine immediately based on these.