If It’s Not a Hernia, Then What Is It? The True Source of Your Pain Might Surprise You.

By Dr. Christina Vivit, PT, DPT

There’s a reason we call ourselves pain detectives.

We have seen many patients, men and women, come through the clinic saying things like, “Yeah…I thought my pain was coming from a hernia but got checked and they said there was nothing there,” or, “I’ve been feeling this abdominal pain for a while and can’t quite figure out where it’s coming from.”

Well, fear not! At Sarton Physical Therapy, we love being body and movement detectives through identifying symptom contributors, discovering solutions, and empowering patients along their healing journeys.

From Isaacs RE, Fessler RG. Lumbar and sacral spine. In: Benzel EC, ed. Spine Surgery: Techniques, Complication Avoidance, and Management. 3rd ed. Philadelphia: Elsevier; 2012:359, Fig. 36.8. — From Isaacs RE, Fessler RG. Lumbar and sacral spine. In: Benzel EC, ed. *Spine Surgery: Techniques, Complication Avoidance, and Management*. 3rd ed. Philadelphia: Elsevier; 2012:359, Fig. 36.8.

Your lower back houses a group of nerves that start at the lumbar spine, wrap around and through abdominal and hip muscles, travel down into the pelvis, and supply the pelvic floor and surrounding musculature. These nerves not only provide your hip, abdominal, and pelvic muscles with the ability to move but also provide sensation to these areas.

Therefore, what you thought was coming from a hernia may be stemming from these nerves that exit out of your back and run to the lower abdomen and groin.

Some of the biggest culprits include:

the ilioinguinal nerve,
the genitofemoral nerve; and
the iliohypogastric nerve.

Not only can these nerves get “mad” when they exit from the upper lumbar spine (say from a facet joint that is inflamed), they can also get irritated from a psoas muscle that is too tight (or in spasm) exerting too much tension on them as they either pierce through this muscle or sit under it. If you have lower abdominal pain or groin pain, make sure your physical therapist is evaluating both your lumbar spine and you hip flexors, as well as your abdominal fascia and other associated abdominal muscles.

Spending prolonged time in one position (i.e. SITTING on a long flight, long car ride, sitting day in and out at work in 1 position) can contribute to “unhappy nerves,”

A couple of contributors to unhappy nerves include the following:

Spending prolonged time in one position (i.e. SITTING on a long flight, long car ride, sitting day in and out at work in 1 position)
Avoidance of certain movements or activities resulting in decreased mobility or guarded movement
Standing with chronic faulty posture
Significant scars after an abdominal surgery that can restrict these nerves as they run their course through the abdomen

Aha! So you’re saying what I thought was pain from a hernia may actually be stemming from an unhappy nerve from my lumbar spine and I can do something about it? You got it!

At Sarton Physical Therapy, we provide a comprehensive evaluation to help identify the causes driving your symptoms. We take an extensive medical history and physical exam to provide you with the most patient-centered, specialized care plan to reveal whether any of the previously mentioned contributors and more are part of your problem.

We are happy to serve you six days of the week as we are open Monday through Saturday. Call us with any questions and to set up an appointment!

We want to encourage you to get evaluated by one of our outstanding physical therapists, and regain control of your life. Pelvic pain, pelvic floor dysfunction, back pain, tailbone pain—you name it—these conditions do not have to control your life. There is hope. Call us today to book an appointment for 1 of our 3 Southern California locations, or inquire about a virtual, online treatment session.

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