INDIANAPOLIS (AP) – When Indianapolis Colts coach Tony Dungy heard the diagnosis on linebacker Cato June, he cringed. It was another sports hernia.

Dungy, who has been coaching in the NFL since 1981, finds these injuries baffling. He doesn’t remember them from his playing days in the 1970s, and wasn’t even familiar with the term until about five years ago.

Today, the injury is as familiar in football terminology as high ankle sprains and turf toes, and Dungy wonders if teams should – or could – be taking precautions to reduce sports hernias.

“We’re seeing it all the time, at all positions,” Dungy said, shaking his head. “We’ve seen it in defensive linemen, quarterbacks, I don’t have an answer for what’s going on.”

It’s a troubling trend that has cut across the sports world, including Orlando Magic forward Grant Hill and Houston Astros pitcher Roy Oswalt and ranging from hockey players to bullriders.

But football appears to have been hit hardest.

Philadelphia Eagles quarterback Donovan McNabb has played most of this season with the injury. In a little more than a year, Minnesota Vikings center Matt Birk has had five operations in his pelvic area – three to repair sports hernias and two to fix tears in his hips that Birk believes were caused by sports hernias. Last month, Green Bay Packers center Mike Flanagan joined the list.

What is a sports hernia?

“Think of the pubic bone as a joint and certain muscles are attached to it and what happens is you rip one of those attachments,” said William Meyers, chairman of surgery and senior dean for clinical affairs at Drexel University in Philadelphia. Meyers has performed more than 3,300 operations for sports hernias, and has treated pro athletes ranging from McNabb and Hill to Cubs infielder Nomar Garciaparra.

Diagnosis sometimes can be tricky because, unlike more common hernias, there is not always a visible bulge in the leg or groin area. And with about 18 different variations, sports hernias can range from torn muscles to frayed muscles to a weakness in the abdominal wall.

Sometimes, the symptoms masquerade as a hip joint problem, a groin pull, a strained abdominal muscle or bursitis in the hip. Meyers says MRIs and other technological advances now make it possible in about half the cases to quickly make that distinction.

Sports hernias are most common among male athletes, particularly those involved in high-speed collision sports such as soccer, hockey and football. Non-athletes also develop the injury, but most of those Meyers has treated have occurred after violent collisions such as automobile accidents.

But they aren’t new. Meyers said the injury is most common among bullriders and believes athletes played through the symptoms for decades – paying a price when they couldn’t continue.

“They were labeled as malingerers,” he said. “So most people dropped out with injuries like this or retired.”

Back then, doctors relied on physical exams and had to rule out other diseases or injuries before calling it a sports hernia – if they were even aware of the condition.

Better technology and greater knowledge of the injury have led to a seemingly rapid rise of cases. An NFL spokesman said the league does not track data for sports hernia injuries.

“In the first 10 years or so, people were being sent to orthopedic surgeons, urologists and they wouldn’t know what it was,” Meyers said. “In latter years, people are getting much more attuned to it, and trainers are getting more attuned to it.”

Players say the excruciating pain is unmistakable. Birk once described the feeling as a serrated knife going through his pubic bone, though some athletes with a high pain tolerance can continue to play.

The severity varies widely.

Colts defensive tackle Josh Williams, one of three Indianapolis players diagnosed with the injury this season, has been on the physically unable to perform list since July. June has missed a few practices but no games, while McNabb has played with his injury since September.

Birk believes his decision to play through the injury last year created more problems.

“Last year the doctor told me four weeks (on the bench) for a sports hernia,” Birk said with a chuckle. “And I went and ripped them both open.”

Rest provides temporary relief, but surgery often is required. Meyers said he has a 96 percent success rate among athletes with such operations.

“What rest does is alleviates the pain for a certain amount of time and as soon as you stress that area again, you are going to get the pain again,” said Eagles trainer Rick Burkholder, who is helping McNabb deal with his injury.

Colts safety Joseph Jefferson, who has had two sports hernias and two torn groins, believes McNabb has survived because he can control the tempo of the game – by throwing the ball away, handing off and limiting his sprints and twists, McNabb can prevent some of the factors that exacerbate the injury.

“When I’m out on that field, adrenaline is moving to a point where I feel that I can do everything,” McNabb said. “If it’s making guys miss, if I can get out of the pocket, throw the ball 50, 60 yards downfield, whatever it may be, I feel I can do everything.”

The causes of sports hernias remain befuddling.

Kevin Gebke, an assistant professor at the Indiana University Center for Sports Medicine, said debate continues in the medical community. He believes something as common as weight training, or something as complex as heredity, could be to blame.

“I think it may be more linked to strength training, like squats or leg exercises – that’s something we need to look at,” Gebke said.

Meyers’ research also has shown that aggressive weight training can lead to injury. Or, he said, it could be related to the normal wear and tear of year-round training.

Dungy, a liaison to the NFL’s competition committee, also wonders if too much or too little stretching is to blame.

“That’s something that certainly you think about,” he said.

Meyers, who calls himself an anti-stretcher, credits the Colts with implementing some exercises he believes will help prevent sports hernias. But the team still has had nearly a half-dozen players diagnosed with the injury during the past three years.

Other possible causes include playing surfaces, such as Astroturf or the softer ice in some NHL arenas.

Whatever it is, Meyers believes the most substantial increases are occurring in football.

“Hockey used to be No. 1 until last year with the (lockout),” he said. “This year, football is probably going to overtake hockey because there are more football players than hockey players. Baseball and basketball lag pretty far behind.”

Dungy thinks that means teams need to re-evaluate how to reduce the risk of injury to today’s players.

“We must be doing something, because I can’t remember anybody having one when I was playing, and now we’re seeing a lot of them around the league,” he said. “It’s baffling to me.”

AP-ES-11-03-05 1610EST