DEAR DR. DONOHUE: My son plays many sports, including soccer, basketball and baseball. Toward the end of the basketball season, he complained of pain in the left groin. He started the baseball season but had to stop because the pain increased.

I took him to our family doctor, who checked him for a hernia but found none. He suggested I take him to a sports-medicine doctor.

I did, and that doctor made a diagnosis of a sports hernia, something I had never heard of. Right now, the only treatment my son is getting is rest and Advil. My son says the pain is better but not gone. If the problem doesn’t resolve itself, the sports-medicine doctor will do surgery. What does that involve? — J.T.

ANSWER: Hernia, to most people, indicates a bulge in the groin area. That’s not the case with a sports hernia. It’s groin pain without any visible bulge.

Exactly what’s going on is a matter of debate. Some feel it comes from a weakness in the wall of the inguinal canal, the canal through which the testes passed into the scrotum from their in-utero position in the abdomen. The wall weakness gives rise to a bulge, unseen, that presses on a groin nerve and brings on pain. Others feel it’s a tear of the ligamentous attachment of the external oblique muscle, one of the abdominal muscles. The attachment inserts on the pelvic bone. The tear creates trouble for the same nerve mentioned above and causes the very same groin pain.

People describe the pain as sharp, burning or dull.

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Sports hernia arises in all sports, but is most common in hockey, soccer and football, sports in which there is a lot of twisting, turning and abrupt change of direction.

An ultrasound or MRI of the groin area shows the defect. As an aside, coughing produces the same kind of pain and is a good indication of this condition.

Rest and anti-inflammatory drugs like the one your son is taking constitute the only nonsurgical treatment.

Surgical repair brings relief from pain in 90 percent of patients. Recovery is fairly rapid. I read that in a European country, doctors allow their professional sports patients to return to play two weeks after surgery. That sounds a bit fast to me.

DEAR DR. DONOHUE: I am 46 (male) and active with yoga, running and tennis at least five times a week. My joints crack an inordinate amount, elbows, knees, ankles and shoulders. It subsides as the day goes on, except for my right elbow, which constantly cracks upon straightening it after it has been bent for even a short time.

There is no pain associated with these crackling sounds. Should I be concerned with all this popping? — E.H.

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ANSWER: The noises might be due to a snapping in and out of one bone with another. Or they might come from ligaments rubbing against the bone.

I have checked many reputable sources. They all say that if there is no joint pain or swelling and if the joint has full range of motion, nothing need be done.

DEAR DR. DONOHUE: A long time ago, I read what you had to say about stretching before playing golf. You said it doesn’t do much for golfers or their game. I still do it. Have you had a change of mind? — T.T.

ANSWER: I’ve had a little change of mind. The exercise entails putting a golf club behind the neck with the ends of the club resting on the shoulders. The golfer turns as far as possible to the left and holds that position for five seconds. Then he or she turns as far to the right as possible and holds the position for five seconds. A total of 15 repetitions are advised.

It’s said to give golfers greater flexibility. If you get some benefit from it, continue. I’m retreating a bit from my former position.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.


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