There are many things to think about when it comes to dealing with a hernia. First off, there are many kinds: hiatal, epigastric, spigelian, inguinal femoral, and inguinal scrotal. Secondly, most MD’s will hold your balls, make you cough and then diagnose you with a “hernia.” They will not tell you what kind, how bad it is and most will tell you that day that you will need or need surgery. Thirdly, a hernia means that there is a window of weakness in the specific area, tissue, organ system or muscular systems. Below are some recommendations that you need to know of prior to agreeing on whether or not to have surgery, to know if you are working with someone to repair your hernia and if you have one, what you should know prior to even working with someone in order to make sure you working with the right individual.
1. ALWAYS request an image from your MD or health care practitioner. One major reason for the image request is to see what type of hernia you have, which will dictate your course of rehabilitation. As each hernia is treated completely differently. In the states today it is very common to see a tear in the abdominal wall and call it a “sports hernia” and off to surgery you go.
1. The fascia iliaca (the fascia in the pelvic and lower torso area) is in contact with every major organ/organ system in the pelvic region. When you have any type of hernia, it is important to realize that there will be some level of scarring in the different layers of the fascia. This is in result to tissues having to adapt to compensate for the lack of movement between the layers, as well as for too much movement in the layer that the hernia is in. The body is always trying to adapt and reinforce areas of weakness.
As a result, a lot of times you will see problems with digestion and elimination as the ascending and descending colons are either side of the body. The Restricted tissues will affect motility of the track and if there is a component of mechanical torsion resulting from the tear (the body always moving away from pain), be it before the injury or after the procedure, certain structures and their tissues may have changed for the worse.
2. Structurally: From my experience focusing on nutrition and lifestyle principles (refer to the many articles on our website www.eastwesthealing.com to learn more about nutrition or give us a call to set up your FREE consultation) is the key to the healing of any type of hernia. As I have said before, “you can’t make chicken salad out of chicken shit!” The body requires quality protein, fats and carbs in order to make your cells, make your hormones, bones, teeth, all tissues in your body, etc. As well as in order to heal and regenerate. When your body is in a healing state, whatever you eat, you remake the tissues out of. In my opinion, this is why we are seeing so many hernias in men these days. Guys are walking around with huge guts, which compresses the organs, alters the biomechanics of respiration, alters the motility of the organs, stretches out and inhibits the inner unit (core muscles) and much much more. Their nutrition and lifestyle sets them up for any one of the above hernias.
I have also found that most with inguinal hernias typically have an increased pelvic inlet, SIJ blocked in nutation, which creates UE and LE dysfunctions, which are too many to name. All of this creates altered thoracic and abdominal pressures while breathing, SIJ strain, as well as visceroptosis (organs hanging down). The main cause from my experience is altered breathing mechanics secondary to the excess weight. If they don’t have excess weight, then the altered respiratory is typically the issue a long with visceroptosis. So, to keep it simple, every time the client breathes, their is an anterio-inferior pressure towards the inguinal canal (typically see DJD or DDD in the spine as well with hypomobility at L2 and L3 and hypermobility above and below), instead of an A-P, lateral and sup-inf movement. So every time this client breathes, he exacerbates the inguinal or any other type of hernia.
I typically use my infant development assessment from CHEK IV and others I learned in my DNS course by Kolar (based of Voijtr’s, Yanda’s and Lewitt’s work). But as I said, you typically see altered breathing mechanics, that leads to altered intrinsic stabilization, inhibition of the pelvic floor and sometimes these clients even have a diastasis.
One more important thing, which is based off of the work of Guy Voyer, be sure to clear yourself or client of any ankle problems; check past medical history; it is quite possible that unresolved ankle problems and/improper mechanics at the sub-talar joint set this person up for an abdominal tear. If there was ankle injury and it does affect the mechanics of the pelvis this need to be addressed at some point. “As above, so below and as below so above!”
3. Pelvic biomechanics: According to Guy Voyer, D.O., there are 23 axis of rotation in the pelvis. So when you have any type of hernia, which affects the fascia iliaca or an unresolved ankle issue, you will see problems arise in the mechanics of the sacrum and pelvis. Typically you will see a torsion in the pelvis thus creating an outflare of the one of the hips, a false long leg, and a lesion along one of the oblique axis. This needs to be corrected but it will not hold unless the inner unit/core are properly rehabilitated. As Paul Chek states, this client will need lots of work re-programming these all of the abdomen-neurologically, segmentally and dynamically. This goes back to my reasoning for requesting images… you can see exactly where the tear is and then prescribe the proper abdominal exercises. For now, just know that if the lesion was in the inguinal region, all the lower abdominal muscles-I/O, E/O, and rectus sub-umbilicus, will need to be rehabilitated. In fact this person will most likely need regular reinforcement of the abs 2-3 times a week. But, keep in mind, rehabilitation and nutritional recommendations are all person specific.
Further, a lesion in the region of the inguinal ligament will affect the mechanics of the pubis symphysis thus affecting one or both iliums, the sacrum-L5 segment and L3; beyond. Additionally, depending on how supple this person is you might find problems in the coxo-femoral joint.
4. Another common issue you will see is a C0-C1-C2 dysfunction that the therapist or NUCCA are having trouble fixing. This is because it is being driven from below. You will commonly see lesions in the T-spine and C-spine to counter the torsion created from the tear in the inguinal region… maybe even a reoccurring problem in C0-1-2 and perhaps shoulder, TMJ, vision and hearing/equilibrium issues in the from of chronic tightness.
5. It is important that this client understand the importance of quality tissue work done on all the obvious regions and those structures that many might not consider. The key here is not just quality tissue work, but to the right structure and most of the time require asymmetrical work. So make sure when finding someone, you seek out a professional that knows exactly what they are dealing with.
6. Exercise: As infant, we develop muscle chains in the sagital plane first, then frontal and then transverse. When someone has transverse plane instability, it is much safer to train that person initially in flexion/extension, which is the sagital plane. Then in later phases of training, you can add in frontal and then transverse movements. I would limit rotation or twisting for period of time. With this type of injury the body will not rotate equally on both sides thus exposing the spine to increased risk of damage.
7. Myofascial stretching will be needed on all the muscles of the pelvis: psoas, adductors, all, ilio-pectineal band, rect-fem., obterator I, glutes-all, secondary to their attachments on the pelvis, correlation with the inner unit and relationship with the fascia iliaca.
8. There is an exercise system for creating space and restoring biomechanics in the joints; it is called ELDOA (based off of the work of Guy Voyer, D.O.). The ELDOA for the pubis symphysis will be very helpful.
9. Last, depending on the type of activities done prior to and since the original procedure it is highly possible that the pelvic floor will need treatment and re-training. Be sure that fascia leading to the genitals and prostate are in good condition now. This client may not have a problem now but they could in ten years if left untreated and this was in fact, an actual inguinal tear.
What about the inguinal scrotal hernia? Can you provide us with more information about that kind of hernia, the surgery and the prior treatment and the approximate time to heal completely and go back to the normal activities of the patient?