After the news on Thursday that Columbus Crew SC playmaker Federico Higuain will miss six to eight weeks with a sports hernia, you might have some questions as to what that means. What happened to Pipa? What is he dealing with during his recovery? What happens if he comes back too soon? All of these are viable questions and I'll attempt to answer them below.
What is a sports hernia?
A sports hernia is a tear in the soft tissue in the groin or lower abdomen area. Also explained as a tear in any muscle, tendon, or ligament connecting the muscles and bone in the pelvic area. Ouch.
Typically in a sports hernia one of two areas are affected. The oblique muscles below the belly button can tear, or the thigh muscles can separate from the pelvic bone due to stretching or tearing of the tendon. Double ouch.
Image courtesy of pubs.rsna.org
How does it occur?
A sports hernia occurs when a player puts too much force in moving one part of the body, while leaving the other part stationary. For example, if a player plants his left foot and twists his hips to evade a defender. The planting of the left leg and the explosive twisting of the hips and pelvis can cause too much strain on the soft tissue and create a tear.
It is easy to see how this can happen in soccer. If a player is not sufficiently stretched and warmed up, his muscles can be stiffer than expected and not ready for the type of strain a soccer game puts on the body. Higuian is also at risk because of his age. As we get older, we lose elasticity and can take longer to recover from rigorous activity. Lack of rest combined with age and improper warm up can lead to muscles being asked to do things their not ready for, and thus causing a tear.
Image courtesty of epainassist.org
How much time can be expected to be missed?
Like most soft tissue injuries it is difficult to determine how long a specific athlete will need to remain sidelined for the injury to heal. The major factor is whether the tendon and muscles are stretched or torn. There are, however, two time ranges Higuain can expect: 4-6 weeks, or 6-12 weeks.
After the player is diagnosed with a sports hernia, he will need to rest for 7-10 days. This means no activity and as little movement of the affected area as possible. It's important for this initial rest period because the muscles and/or ligaments that have separated from the bone needs to reattach. This can only happen if the muscles are left alone to mend. Movement early in the injury can mean the muscles continue to separate and the body's natural healing elements never get the chance to take hold. We can assume Higuain took this time over the international break.
After the initial 7-10 days of inactivity physical therapy begins to strengthen and increase flexibility in the injured (and now somewhat atrophied) muscles. After the muscles reattach, scar tissue can form. This is harder and less flexible than the original muscle. Gradual stretches and non-impact activity can break down this scar tissue and allow the muscle and ligaments to retain their effectiveness. This process can take 4-6 weeks in order to get back to full strength.
Brace yourselves. The rest of this article gets ugly.
What makes this (any soft tissue injury) difficult is there is no conclusive test to determine if it is fully healed. The physical therapist and doctor will monitor for pain during rehab exercises, practice, and during a game. Typically the patient will if the patient continues to experience pain after this time, surgery is needed. Given the quick decision for surgery, it can be assumed that Higuain's injury was severe.
Image courtesy of sportshernia.com
Now Higuain will have surgery to reattach muscles or ligaments to his pelvic bone (because the tear was too severe for the body to attach them itself) he will miss 6-12 weeks after the surgery, which took place on Thursday.
Soft tissue injuries are extremely difficult to diagnose as healed and it is why we see such a high rate of injuries being "reaggravated" shortly after a player returns. The injury is not reinjured, but rather, it was never fully healed in the first place. No amount of therapy can simulate game activity. This makes it a nearly impossible task to determine if a soft tissue injury has healed until a player returns. Teams usually take a slow approach to reduce this risk, but muscles often heal even slower than any coach would like.
What level of performance can be expected once Higuian Returns?
Any time a player misses significant time due to injury there are two elements at play: the physical and mental. Will Higuain trust his newly rehabbed hip/groin/abs when it comes time to plant his leg, pivot his hips and swing his leg through the ball? If any amount of hesitation exists, he could tweak his mechanics and his trademark accuracy and curl will be thrown off.
A sports hernia is a complex injury affecting all the major muscle groups for a professional soccer player. Higuain may experience residual pain and subconsciously alter how he runs and kicks to compensate. This is a common occurrence for individuals who experience this type of injury. If Higuain does this, it won't effect much in the short term, but he will soon experience knee and ankle discomfort due to increased strain on these joints, which will lead to more missed time if he does not correct the problem.
If Higuian comes back after his hernia is fully healed and trusts his body, he should be able to return to the level of performance we have come to know and love from Columbus' No. 10
What I think will happen
Berhalter has shown a tendency to return players to action slowly. This is good considering in MLS, a team can stink until late August and still make the playoffs. There is really no need to rush Higuian back as long as other players are healthy.
I would guess that it will not take the full 12 weeks to recover (especially if Columbus is slipping out of the playoff race).
No matter the spin the club puts on it, this is an injury that will lead to Higuain missing a meaningful amount of games.