Having a hernia can significantly disrupt your workout routine, even if it isn't painful. Before you continue running with a hernia, consult your doctor. The complications that can occur far outweigh the benefits you're getting from the exercise.
Running with a hernia might or might not be OK, depending on the severity of your injury and the intensity of your workouts. Consult you doctor before exercising with a hernia to help prevent potentially life-threatening complications.
Read more: Exercising With a Hernia
Is It a Hernia?
If you suspect you might have a hernia, see your doctor for an evaluation. Hernias occur when the intestines push through a weakened area in the abdominal wall, most commonly near the belly button or the groin in the lower abdomen.
Sometimes, these injuries aren't too serious. You might notice a bulge only during activities that increase pressure in your abdomen — coughing, jumping or when you initially stand up. If your hernia isn't painful, your doctor might just monitor it.
If you're able to run without pain, you might be able to continue this activity, with your doctor's permission. However, the intensity of your workouts matter — strenuous exercise can make a hernia worse.
Hernias often need surgical repair. Leaving a hernia untreated can lead to strangulation — your intestines can become trapped, cutting off the blood flow to the tissue. This can be a life-threatening situation.
According to Mayo Clinic, signs and symptoms of a strangulated hernia can include:
- sudden, rapidly increasing pain
- trapped gas
- skin darkening (red or purple)
Exercise and Running with Hernia
Any type of exercise that increases pressure on your abdominal muscles can make a hernia worse. At first glance, it might be difficult to make the connection between running and your abdominal muscles. However, these muscles play an important role in running.
A small March 2018 study of 28 individuals, published by PLOS One, examined the effects of 12 weeks of Pilates training — core strengthening — on 5K running performance. The study showed activation of the abdominal muscles, particularly the obliques, during running. In addition, core muscle activation increased as running speed increased. Because running increases abdominal muscle contraction, running with a hernia can potentially make your condition worse.
Exercise can be beneficial in the treatment of a hernia, particularly if it is small. A case study published in February 2012 by International Journal of Sports Physical Therapy describes the successful rehabilitation of a professional hockey player who sustained a sports hernia injury during a game. Treatment occurred in three phases:
- Phase 1: Pain management and introductory core stabilization exercises
- Phase 2: Progressive stabilization and strengthening exercises
- Phase 3: Functional training and return to the game
Consider Conservative Treatment
If your doctor determines that your hernia can be treated without surgery, consider physical therapy for your abdominal hernia. A physical therapist can prescribe an individualized exercise program for abdominal strengthening to help prevent worsening of your symptoms. Exercises focus on core strengthening, without overtaxing the damaged abdominal muscles.
Core strengthening for a hernia begins with learning how to contract the transverse abdominis — an abdominal muscle that helps support your low back and internal organs, according to ExRx.net. One you've mastered this movement, called the abdominal draw-in, incorporate this maneuver into the other core strengthening exercises, described by Princeton University Athletic Medicine. Perform each exercise 10 times, working up to three sets in a row. Stop immediately if you have pain.
Read more: The 41 Hardest Ab Exercises
Move 1: Abdominal Draw-In
- Lie on your back with your knees bent and feet on the floor.
- Put your hand on your hip bones, spreading your fingers over the muscles on each side of your lower abdomen.
- Tighten your abs as if you are "drawing-in" your belly button to bring it closer to your spine. Breathe throughout this movement.
- Hold for two to three seconds, then relax.
Move 2: Knee to Chest
- Perform an abdominal draw-in.
- Slowly lift one foot off the ground, bringing your knee in toward your chest.
- Lower back down and repeat on the opposite side.
Move 3: Heel Slide
- Perform an abdominal draw-in.
- Slide your right heel along the ground, straightening your knee.
- Slowly slide your heel back up toward your buttock.
- Repeat on the opposite side.
Move 4: Double Knee to Chest
- Perform an abdominal draw-in.
- Lift both feet off the ground at the same time.
- Bring your knees in toward your chest, keeping your low back pressed against the ground.
- Slowly lower back down.
Move 5: Bridge on Ball
- Lie on your back with your knees bent.
- Place your feet on a firm medicine ball.
- Perform an abdominal draw-in and maintain this throughout the exercise.
- Push down through your feet and lift your hips off the ground, no higher than three inches.
- Hold for two to three seconds, then lower back down.
If your hips rock side to side or if your legs start to waver, you're lifting your hips up too high.
Exercise After Hernia Surgery
If you have a hernia, there's a good chance you'll eventually need surgery — especially if you want to maintain an active lifestyle. According to the National Institutes of Health, 800,000 hernia repairs are performed each year in the U.S., making them one of the most common reasons people have surgery.
Exercise after hernia surgery follows a specific protocol, which is usually overseen by a doctor or physical therapist. Core muscle injury recovery time usually requires 12 weeks for full return to sports or exercise activities. Follow your surgeon's instructions after hernia repair to help prevent complications. Exercises, such as the ones below, are typically progressed every two to four weeks after hernia repair, as described by Massachusetts General Hospital Orthopaedics:
Post-Op Phase (0-2 weeks):
- walking for 15 minutes, twice per day
- gentle lower extremity stretches
Intermediate Phase (2-4 weeks):
- walking for 30 continuous minutes, once per day
- stationary biking for 15 minutes, progressing to 30 minutes
- swimming at a leisurely pace (after incisions are healed)
- gentle core strengthening begins (abdominal draw-in and progressions)
- ball squats
- balance training (ball toss on an uneven surface)
Strengthening Phase (weeks 4 to 8):
- stationary biking (progress resistance and time)
- elliptical training
- swimming at higher intensities
- walk/jog program with progression to jogging (at 6 weeks)
- progressive core and lower extremity strengthening
Advanced Strengthening and Agility Training (weeks 8 to 10):
- interval training with cardio equipment
- progress jogging to running (avoid start/stops)
- lateral shuffles
- jumping activities
- agility ladder
Return to Sports Activities (weeks 10-12):
- sports-specific drills
- running while incorporating starts/stops and changes in direction
Return to Recreational Running
If you don't participate in formal sports activities but want to start running again after hernia surgery, do so gradually. For the best results, follow a return to running program, such as the 4-phased program presented by the head trainer at the College of William and Mary, Steve Cole, ATC, CSCS.
Phase 1: Prior to attempting to run, work up to walking at 4.2 to 5.2 miles per hour — without pain — on a treadmill.
Although running might not seem like a high-intensity exercise, as Cole points out, a one-mile run consists of 1,500 foot falls — 750 on each foot. Be patient and build your endurance slowly to help avoid post-operative complications.
Phase 2: Perform a plyometric training program to get your body ready for high-impact running activities. Rest 90 seconds between each set and three minutes between each exercise.
- Hop in place on two feet — 3 sets of 30 reps
- Hop forward/backward on two feet — 3 sets of 30 reps
- Hop side to side on two feet — 3 sets of 30 reps
- One-legged hops in place— 2 sets of 20 reps on each side
- Forward/backward hops on one leg — 2 sets of 20 reps on each side
- Side to side hops on one leg — 2 sets of 20 reps on each side
- Single leg broad jump — 4 sets of 5 reps on each side
Phase 3: Begin the walk/jog progression part of this program once you have successfully completed phases 1 and 2. You should be able to complete all daily activities without pain and be able to touch your abdomen without experiencing tenderness.
Progress your walking/jogging in 5 stages. Stay in each stage until you can perform the prescribed activity without pain, and have no pain the following day. Run on a flat, forgiving surface — such as a racing track — as you begin to run again.
- Stage 1: walk 5 minutes, jog 1 minute; repeat 5 times
- Stage 2: walk 4 minutes, jog 2 minutes; repeat 5 times
- Stage 3: walk 3 minutes, jog 3 minutes; repeat 5 times
- Stage 4: walk 2 minutes, jog 4 minutes; repeat 5 times
- Stage 5: jog every other day, working up to 30 consecutive minutes of jogging; begin with 5 minutes of walking to warm up, and finish with 5 minutes of walking to cool down at the end of your workout
Phase 4: Progress your running program based on your personal goals. Try running every other day for eight weeks. As your running frequency increases, consider shortening your workouts to help your body adjust. Incorporate rest days or cross training on your non-running days.
As you work on your running speed and overall running distance, don't increase both at the same time. This can lead to injury. According to Cole, you should increase the intensity (how hard or fast you run) before you increase the length of your runs. As you increase your intensity, consider reducing the length of your runs to allow your body to adjust.
If your goal is to progress your running distance, increase total running mileage no more than 10 percent each week to help prevent injury.
- Massachusetts General Hospital: Orthopaedics: "Post-Operative Rehabilitation Guidelines Following Bilateral Sports Hernia Repair and Adductor Release"
- Mayo Clinic: "Inguinal Hernia - Symptoms & Causes"
- National Institutes of Health: "Battling a Bulging Hernia"
- PLOS One: "Pilates Training Improves 5-km Run Performance by Changing Metabolic Cost and Muscle Activity in Trained Runners"
- Oxford University Hospitals: "Physiotherapy Advice After Abdominal Surgery"
- Princeton University Athletic Medicine: "Lumbar/Core Strength and Stability Exercises"
- College of William and Mary: "Return to Running Program"
- ExRx.net: "Transverse Abdominis"