When to run after hernia surgery. (The Clinic).

I have an inguinal hernia that is causing discomfort and need advice regarding treatment and how it will affect running and participating in other sports. If I have it repaired, when can I run again, and how should I progress?

Sam Mullens

Pittsburgh, PA

A hernia is the protrusion of any structure, usually the bowel, through a weak point in the abdominal wall. The most frequent mechanisms of injury are repetitive lifting activities, activities that increase intra-abdominal pressure (such as weightlifting) or a sudden blow to the lower abdomen such as the impact of handlebars from a bicycle). Most often there is a pre-existing condition such as abdominal muscle weakness or a congenital defect. Hernias are noticed when they cause symptoms of bulging and possibly pain. An inguinal hernia is the most common type that occurs in adults. They are classified as indirect, direct, or femoral.

Indirect inguinal hernias account for 50% to 70% of all hernias. They are considered "congenital." In over 80% of male newborns, the path the testis follows as it descends into the scrotum remains open. By the age of two, about half remain open, and by adulthood only 25% remain open. Clinical symptoms often do not appear until years later.

A direct hernia is acquired and is usually seen in males over 40 years old. This type of hernia occurs when increased intra-abdominal pressure causes a protrusion through the posterior abdominal wall of the inguinal canal as a result of weakened abdominal wall muscles. A femoral hernia is less common and typically occurs in females.

Most hernias can be diagnosed by a physical exam. Sometimes a special X-ray using a contrast dye is needed. The treatment for large or painful hernias is surgical repair. Surgery is necessary to prevent incarceration and strangulation of the herniated bowel, which can cause serious complications. You should not neglect it or delay a consultation with your doctor.

Here are the standard recommendations for returning to sports following a hernia operation:

* Avoid activities that stretch or pull the abdominal muscle for the two weeks following the operation.

* Progressive resistance exercises and conditioning can begin at two to three weeks.

* Abdominal strengthening can begin after the fourth week.

* For indirect hernia repairs, an athlete can return to non-contact sports at six to eight weeks and contact sports eight to ten weeks after surgery.

* For direct hernia repairs, an athlete can return to non-contact sports at eight to ten weeks and contact sports at 12 weeks after surgery.

If your surgery can be performed laparoscopically, your layoff will be much shorter than if your surgery is performed through an abdominal incision. For laparoscopic repairs you may be able to return to walking/light running, as you feel ready, probably within two to four weeks. For your return to your running program, start out slowly with walking, then alternately walking and jogging. As is always true whether you are a new runner or returning from a layoff, reconditioning should proceed gradually in order to avoid injury. Limit your increases in mileage and speed to 10%, as a rule of thumb. What that means is to make a gradual, gentle progression. Stop and rest if you feel discomfort. If it persists, contact your doctor.

Troy M. Smurawa, M.D.

Clermont, FL