The inguinal ligament is a vital fibrous band of connective tissue structure present in the groin or pelvic region of the body. It plays an important role in preventing the intestines from projecting out from the groin area, offers support for the external oblique muscle in the abdomen and the soft groin tissues, as well as provides joints and bones with their range of motion and stability.
Athletes who sprint, run, or hurdle or engage in sports like ice hockey, soccer, or fencing are at greater risk to suffering from inguinal ligament sprains along with associated symptoms like unusual popping feelings in the pelvic area followed by intense pain. The groin and inside section of thigh may elicit chronic pain and tenderness. It may be painful to raise the knee or to bring the legs together.
Depending on the type and severity of inguinal ligament sprains and other problems, patients may be treated via medications, physical therapy and exercises, and surgery.
Inguinal ligament: Structure and Function
The inguinal ligament is a constricted band of thick normal fibrous connective tissue occurring in the pelvic area of the body. From the external abdominal oblique’s lower aponeurosis, arise its collagen fibers and obliquely pass across the groin. It attaches to the front section of the iliac spine of ilium on its lateral and superior end and then runs to the pubis bone’s pubic tubercle on its medial and inferior end.
A tiny opening, called the superficial inguinal ring, occurs in the connective tissues and muscles of the abdomen, just above the inguinal ligament. This opening constitutes a section of the inguinal canal which allows the uterus’ round ligament in females and males’ spermatic cord to exit the abdominal-pelvic cavity and cross via the external pelvic tissues. The inguinal ligament constitutes the inguinal canal’s floor and provides support to the passage of structures via the canal.
The inguinal ligament offers support to the muscles running inferiorly to the fibers of the ligament, including the hip’s pectineus and iliopsoas muscles. It also provides support to the femoral vein, artery, and nerve as well as other blood vessels and nerves of the lower limbs as they run across the pelvis. Such support is vital to maintenance of hip area flexibility, while simultaneously permitting essential nerve and blood supply to the lower limbs.
Inguinal ligament- Problems and complications
- When the abdominal muscles experience vigorous contraction, then the excess pressure exerted on the organs present in the abdominal-pelvic cavity can cause a section of the small intestines to get forced into the inguinal canal, thereby resulting in the formation of an inguinal hernia. The condition is considered as a complication of the canal’s unusual anatomical arrangement, particularly in males.
- A groin strain or pull occurs when excess stress is exerted on the thigh and groin muscles. Tensing of these muscles, suddenly or forcefully, can cause them to suffer from tears or over-stretching. Groin strains and pulls are common in individuals who engage in sports that need lots of jumping and running, especially sudden change of directions or jumping.
- Inguinal ligament pulls and strains are categorized into the below listed types:
- Grade I inguinal ligament or groin sprain: There is mild or minor pain but no motion or movement loss.
- Grade II inguinal ligament or groin sprain: There is moderate swelling, pain, and bruising. Jumping, running, and similar activities may be restricted till the torn muscle or ligament heals.
- Grade III inguinal ligament or groin sprain: It is caused due to severe injury to the muscles or ligament and is accompanied by severe pain. Patients may also experience muscle spasms, swelling, and bruising in addition to loss of function in the lower limbs till subsequent treatment and complete healing of the sprain.
Treatment of inguinal ligament problems
- Inguinal hernia is usually treated via surgery that may involve grafting the affected inguinal ligament with reinforcing mesh material to prevent/avoid further herniation.
- Treatment during the 1st 48 hours after an inguinal ligament strain or pull is vital to the healing process. This period may be marked by application of ice, every few hours, on the affected region to decrease pain and swelling. Painkillers and/or NSAIDs may be prescribe to alleviate pain.
- For Grade I inguinal ligament or muscle pull or strain, patients may be advised the use of a stationery cycle or walking exercises in addition to the above therapies. This will decrease stiffness and hasten healing.
- In case of Grade II sprains, icing may be replaced with moist heat therapy after 48 hours. Abduction and adduction, straight leg exercises, hip rotation and flexions and other such groin stretching exercises may be slowly added to the rehabilitation regimen. Use of compression wraps also helps enhance the range of motion and the healing process. Other inguinal ligament stretching exercises include knee stretches, pillow squeezes, hamstring stretches, board slides, and hip rolls. Consult a doctor before performing these exercises.
- For Grade III inguinal ligament pulls and strains, doctors may advise surgery to repair severe tears, and/or if the above treatment options do not yield results.