I Have a Hernia! (NOW WHAT?)

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Hernias are one of the most common injuries suffered by men, with over 25% of all men likely to suffer one in their lifetime. That said, when you consider the increased risk in populations who lift weights, the numbers become even more staggering. The question is, what happens if you get a hernia? Are your days of lifting weights over? In this video, I’m going to answer the most common questions about hernias and tell you what to do to fix a hernia if you get one (if you even need to).

First, it helps to discuss a little bit about what a hernia even is. There are many different types of hernias but the one that is most commonly seen is called an inguinal hernia, which occurs in the inguinal canal or groin.

At birth, you are born with a weakened tissue in the lower abdominal wall due to the opening that never fully closes called the inguinal ring. When intra-abdominal pressure rises, such as though coughing, sneezing, or lifting heavy weights, the contents of the abdomen can be pressed against this hole causing it to gradually break down over time.

At the point that the hole is large enough, some of the internal structures, like the small intestine, can be pushed through the hole while still under the skin of course which can cause a dull or sharp ache in the groin area.

Anyone that suffers a hernia when lifting will likely see a visible bulge in the area just to the right or left of the pubic area. The question then becomes whether or not you should have hernia surgery to fix the problem.

If you were to opt for surgery there are two types of repairs that are performed. The first is one that isn’t often done anymore due to its increased failure rate. This is called a high tension repair. It involved sewing up the hole from the outside in. The sutures often break however as soon as IAP increases in the abdomen through any of the activities listed above.

On the other hand, the mesh surgery is something much more commonly done these days. It is called a low tension repair because the hole is never attempted to be closed and the tension on the tissues in the area remains low. Instead, a large piece of mesh is implanted on the inner abdomen that covers the hole and prevents the contents from pushing through the hole. Even if the hole becomes bigger over time, the mesh is large enough to cover the area and prevent aggravating the symptoms again.

I had two hernias in my life.

The first was repaired laparoscopically with a mesh and has been holding up well for the last 10 years.

The second occurred while demonstrating an exercise I was instructing you not to do, the one arm dumbbell row, back in 2013. I have lived with this hernia ever since and have opted to take a watch and wait approach. This is something that many choose to do as well but is it the right thing to do?

If you choose not to get surgery you have to understand the risks and what type of things you need to be on the lookout for. First, you should try and avoid exercises like the one armed dumbbell row. The offloaded arm combined with the position of the knee up on the bench and the back leg behind you creates increased tension in the area while allowing gravity a better opportunity to push the inner abdominal contents down.

A tripod stance on the exercise fixes many of the limitations that come with the performance of the exercise done this way.

The other thing to be mindful of is the use of exercises that greatly increase intraabdominal pressure (IAP) like the deadlift, squat or even leg press. I’m not saying that you have to forego these exercises if you have a hernia. Not at all. In fact, I think that would be a greater mistake in the long run if you did. You simply have to understand that these exercises require greater bracing which increases IAP and places more inner to outer pressure that can increase risk of further herniation.

Lowering the weight on the exercises a bit while wearing a belt can help to mitigate some of these stresses. The belt gives your abdomen something to press into while helping to keep the abdominal contents centralized. The lighter weights will decrease the increases in IAP that substantially heavy weights demand. You may explore alternative bracing techniques as well that decrease the need for IAP a bit by including a focus on isometric stabilization of the rectus abdominis and transverse abdominis.

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