Maybe, maybe and maybe. 🙂 Ok, let’s dive a bit deeper into each of those maybes so you can hopefully pull out some more useful information than a bunch of maybes.
First, what is a hernia?
A hernia is a weak spot in your muscle or connective tissue where organs or tissue can squeeze through.
If we know a hernia is a weak spot, could that spot be prevented, or was it always set up to give from the time you were born?
What amount of pressure is needed on that spot to make it finally give?
If you’re aware of a weak spot, could you in theory prevent the hernia from ever happening?
What types of activities can cause too much pressure out on that weak spot? In essence, what should you do with caution or perhaps avoid completely?
Can you prevent a hernia?
Hernias are generally the result of poor pressure management. Meaning, you put too much pressure on the potential hernia area, often without realizing it, and the fascia eventually gives. This can be pressure over time, way too much pressure all at once, or a combo.
Pressure is force. Think about those plastic stress toys. When you squeeze, places bulge. So when we look at pressure management in the human body, you can think of your torso as that stress toy. If you put too much pressure or force into a weak spot, it just might give and bulge out. This is called a hernia.
With practice, you can learn to feel and manage pressure to keep it from overloading any one vulnerable spot.
How much pressure an area can sustain is often due to genetics. Some people can get away with a significant amount, while others not so much. That’s what makes hernias so hard to prevent. You don’t know what your system can handle because there is no set standard or easy way to measure the amount of pressure you’re generating against a given area.
Working with people who are trying to either prevent hernia surgery or gain back their strength post-hernia surgery has taught me a few things.
The biggest takeaway is that they tend to load the most into their most vulnerable spot. (Load means increase pressure through things like exercise or lifting. Basically, how someone is handling force.)
When I have them show me the ab routine they were doing pre-hernia, I often see lots of bulging and doming or pressure out at their hernia repair location. The repair reinforced the tissue, but it didn’t change their movement pattern. A little education goes a long way for how to move without stressing the hernia area. If you change your patterns, you can change the amount of pressure placed on the area— even during the same exercises that used to place excessive pressure!
So what happens if someone has learned how to move without putting pressure into vulnerable areas or potential hernia sites? Well, in theory you could prevent hernias. The issue here is you don’t know that you need this re-education until you know you need it, and most of us think it won’t happen to us (me included) until it happens to you. Prevention takes a lot of effort! And frankly, hindsight is often the best teacher for truly being able to understand something. Effort can be hard to come by when you don’t know whether or not you’ll need it, with life pulling us in so many different directions already.
How might you know you need preventative work?
Talk to your family. Do you have a family history of hernias? You may find your grandma had a hysterectomy and your mom had hernia surgery, Oh, and most of your aunts and uncles as well, when you start asking around. If your family history sounds like mine, then there really should be some light bulbs going off. If no one in your family has had any pressure fascial issues, like a hernia or prolapse, then you might be able to get away with more.
It’s a continuation risk line. The better your genetics, the harder you can load pressure into the fascia before it gives.
Learning your family history can help you guess where you’ll fall on that spectrum. My entire family is literally filled with people having hernia issues. That’s a huge red flag that I should be a little extra careful, and I need to educate my kids on how to load properly so hopefully they don’t ever have to deal with it. I just wish I’d asked my mom about my family history before it was hindsight for me. LOL!
What if you have a hernia? Can you “just watch it” and potentially keep it from getting worse while continuing to do what you want to do? Maybe!
Some hernias will need surgery right away. The risk of strangulation or obstruction is not one to take lightly. But some hernias are small enough that they can be safely watched and don’t require immediate surgery. Talk to your doctor about this.
In the group that doesn’t need immediate surgery, some of these hernias will heal with conservative treatment, others will simply not get worse. Fascia does turn over, but at a much, much, much slower rate than other tissue in the body. You’re going to need a lot of patience loading correctly over an extended period of time. And, you guessed it, that too can depend on your genetics. Some people just have better genes for fascial turnover and recovery than others, but I don’t think it’s all in the genes. I think there is a big environmental stimulus as well.
There was a study from Sweden looking at 2,299 men and 157 women a few years after their hernia repair. Of these patients, thirty-one percent reported pain, years post surgery. That’s a pretty high percentage! It’s high enough for me to want to use a little hesitation and caution before diving into a surgery. I’ve had experience with postsurgical patients who were actually in worse shape after the surgery due to botched surgery, scar tissue formation and nerve entrapment. So if you’re opting for surgery, please do spend some time researching the best surgeon in your area. (Just to be clear, I’m not talking about surgeries that are needed. I’m talking about the ones where the surgeon says, “we can wait and watch if you like, or operate at any time.”) Sometimes surgery really is the absolute best option and exactly what should be chosen, and finding the best surgeon is a good idea!
Just because you’ve fixed the hernia doesn’t mean you’ve fixed the cause of the hernia. Have you heard the old saying - things go wrong in 3s. I’ve known lots of people who have had multiple hernia surgeries. It’s worth taking the time to understand pressure management and learn great lifting technique when it comes to breathing and bracing.
On the positive side for those who fall into the conservative category of “learn how to move so you don’t make it worse,” imaging has shown that hernia dimensions can improve for some of these people. As they wait and watch, some will actually see healing. (Which I think is pretty amazing!) I have no idea what that percentage is, there are just too many factors and I haven’t been working in this area specifically enough to gather data. But I do love sharing a success story when I can! Read more of Gina’s story here. She’s a #momfithero from our program who had great conservative hernia recovery success!
So, for hernias, sometimes surgery is the best option. But even if you do have surgery, I’d still work diligently on pressure management (loading and bracing strategies), because you now know this may help prevent further hernias. The last thing to keep in mind is hormone changes can cause changes in tissues. Our hormones change, especially in the postpartum and menopause time periods. These might be times you should be particularly mindful of movement patterns and your pressure strategies.
-Ulf Fra¨nneby and Gabriel Sandblom. Risk Factors for Long-term Pain After Hernia Surgery Ann Surg. 2006 Aug; 244(2): 212–219.
-Rodrigues Junior, Aldo Junqueira, Rodrigues, Consuelo Junqueira, Cunha, Ana Claudia Pereira da, & Jin, Yoo. (2002). Quantitative analysis of collagen and elastic fibers in the transversalis fascia in direct and indirect inguinal hernia. Revista do Hospital das Clínicas, 57(6), 265-270.
-Robert Schleip. Fascia in sport and movement. Publisher: Edinburgh: Handspring Publishing, 2015.
-Erik A.Yuill and Jason A. Conservative care of sports hernias within soccer players: A case series. Journal of Bodywork and Movement Therapies. Volume 16, Issue 4, October 2012. 540-548
-Woodward JS, Parker A, Macdonald RM. Non-surgical treatment of a professional hockey player with the signs and symptoms of sports hernia: a case report. Int J Sports Phys Ther. 2012;7(1):85-100.
-Garvey, J.F.W., Hazard, H. Sports hernia or groin disruption injury? Chronic athletic groin pain: a retrospective study of 100 patients with long-term follow-up. Hernia 18, 815–823 (2014).