Inguinal Hernia: Physiotherapy Exercises

When it comes to an inguinal hernia, exercises can help manage or even prevent the onset. Classified as a protrusion through the abdominal wall near the inguinal canal, or groin, an inguinal hernia is the most common. Affecting just over 60% of people, symptoms include pain and discomfort at the hernia site with bending, lifting, and coughing. In this article we break down the best exercises (recommended by physical therapists) to strengthen muscles that will help decrease and prevent symptoms.

Inguinal Hernia

Types of Exercises to Perform

An exercise program for an inguinal hernia will focus on two primary goals:

• adequate trunk flexibility
• good core strength

When the core is strong and can properly coordinate daily activities, it will minimize strain on surrounding tissues, like the groin. Unfortunately, poor trunk flexibility and weak abdominal muscles are common with an inactive lifestyle and being overweight; which often lead to the need for hernia surgery if not properly addressed.

6 Best Stretches & Exercises

Below are six of the best stretches and exercises for both managing and preventing an inguinal hernia which focus on flexibility, core strength, and stability. 

1. Hamstring Stretch

The hamstrings attach to the bottom of the pelvis. This commonly tight muscle group can throw off the mechanics in the entire core and put excessive strain on the pelvis, low back, and groin. Thus, a simple hamstring stretch can go a long way.

• Grab a stretch strap or towel and lie on your back
• Start with both knees bent and wrap the band around the mid foot of the leg you wish to stretch 
• Then, extend the knee until straight, if tolerated
• Finally, to deepen the stretch bring the entire leg up toward your chest
• Hold for 30+ seconds for 2-3 sets on each leg

2. Side Lunge Groin Stretch

This exercise is a great strengthening and stretching combo for the groin. Start cautiously with a small range of motion to ensure your groin can tolerate this move before progressing.

• In standing, bring the leg you want to stretch straight out to the side while keeping the knee straight 
• As you do this, you will shift most of your weight into the opposite leg - with the knee and hip bent - how deep you can go will depend in your strength, flexibility and comfort
• Ensure your form is optimized with your butt back and get into a full sideways lunge position
• Hold for 1-3 seconds
• Then, move with care as you bring the straight leg back up to the starting position
• Repeat on one side for 10-15 repetitions for 2-3 sets on each leg

If you're struggling with this stretch, you can also try a frog stretch (see the next exercise in the video) or a seated butterfly stretch as well.

3. Button Pull or TA activation

The transverse abdominis (TA) muscle, or lower abdominal muscle, is essentially your body’s own built in corset. Strengthening this muscle can help protect the groin and lower abdomen by providing great innate stability. This muscle commonly gets weak with inactivity, low back pain, and being overweight.

• Lie on your back with both knees bent and feet flat on the floor
• Place your hands inside your hip bones to monitor your muscle activation
• Practice drawing the belly button toward your spine - you should feel your ab muscles tightening under your fingers and belly flatten
• Start by holding the tightened muscles for 3-5 seconds while focusing on keeping the upper body relaxed and breathing normally (note: this is easier said than done)
• Try 10-15 repetitions for 2-3 sets
• Progress how long you can hold with time and then build to more dynamic moves- this is the most important stepping stone to other core strengthening exercises with proper form

4. Pillow Squeeze

This exercise works the hip adductors, the inner thigh muscles that attach directly to the groin. Thus, it’s important to always start gently.

• Grab a pillow, large towel, or even a small ball that you can comfortably squeeze between your legs
• Lie on your back with the knees bent and feet flat on the floor
• Place the pillow between the knees
• Engage the core first (as discussed in the TA exercise above)
• Then, press the knees together as you squeeze the pillow, taking care not to strain other areas of your body
• Hold for 5-10 seconds for 10-15 repetitions for 2-3 sets total
• Don’t forget to breathe!
• Progress your hold time and intensity of the squeeze as tolerated

5. Bridge

This exercise is excellent for working the glutes, hamstrings and core all at once. Focus on keeping good form to boost your body’s overall core stability.

• Lie on your back with the knees bent and feet flat on the floor
• The heels should be 6-12 inches from the butt and directly under the knees- not too close or far away
• Keep your weight balanced through your feet as you tighten the abs and lift your butt off the ground 
• Lift as high as you can without pain, strain, or arching of the low back
• Hold for 3-5 seconds and then return to the starting position
• Repeat for 10-15 repetitions for 2-3 sets total
• To progress, increase the hold time or try a single leg bridge

6. Bent Knee Fallout

This is an exercise progression for the TA activation we went through above. The goal is to learn to coordinate using the core with more dynamic moves of the arms and legs, just like you would with normal daily activities.

• Start in the same position on your back 
• Find a neutral spine (like explained above) and tighten the lower abs
• Let one leg (not both) fall out to the side as you externally rotate the hip and you come onto the outside edge of your foot
• Go as far as you can while you are still able to keep the spine in neutral without rotation
• If you are having trouble with wobbling, then keep the motion smaller
• Alternate between the legs until you have completed 10 repetitions on each side
• Repeat for 2-3 sets total

Benefits of Exercises

Practicing safe stretching and strengthening for an inguinal hernia leads to a handful of benefits; including:

• Better core coordination to minimize unnecessary strain
• A great way to reduce the risk of a hernia (aka hernia prevention)
• Increased blood flow to the groin area to help reduce swelling, redness and pain - this can be further addressed with other hernia treatment options
• Reduced risk of a hernia progression or strangulated hernia
• Lower chance of needing a surgical hernia repair

More Ways to Relieve Hernia Pain

What Makes a Hernia Worse?

Excess stress on the abdominal cavity and groin can make your hernia much worse and exacerbate symptoms. If you’re not sure what you should be doing or voiding, it is always best to check in with your physical therapist for more personalized recommendations for core exercises. In general, here is what to avoid:

• Situps or crunches
• Heavy lifting
• Valsalva maneuver (holding your breath and bearing down with a bowel movement or lifting) - due to the extra intra-abdominal pressure it creates
• Straining with a bowel movement, particularly with constipation
• Core focused moves with pilates and yoga (until ready)
• High impact sports or other straining physical activity

Moving Smart

Managing and preventing an inguinal hernia all begins with a better understanding of the underlying cause. Plus, learning how to minimize strain to the groin with an exercise routine and proper lifestyle choices. These exercises are a great addition to any home program and can yield great benefits for feeling your best without risking complications from your hernia. If you notice the bulge getting larger, you feel ill (fever or chills), or symptoms get progressively worse, make sure to get in touch with your doctor immediately for medical advice.