title: Inguinal hernias associated with a single strenuous event.
abstract: There is debate regarding the role of physical activity and, in particular, a single strenuous event (SSE) in the development of inguinal hernia. This study aims to identify the incidence and associated features of hernias perceived to be due to a single strenuous event and to compare their features with published guidelines.
  
  
  
  All consecutive patients surgically treated for primary inguinal hernia at a single NHS trust between April 2010 and April 2011 were identified and contacted to participate in a questionnaire. Clinical details from operative records and case notes were compared with patients' responses to identify features of their presentation attributable to a single strenuous event according to previously published guidelines.
  
  
  
  Three hundred and thirty five eligible patients were contacted with a response rate of 292 (87 %). 41/292 (14 %) of patients reported an SSE associated with the onset of their hernia. Only 2 of 41 (5 %) patients reporting a hernia associated with SSE met published criteria for association of the hernia with SSE, and this represented less than 1 % of all patients treated for inguinal hernia at a single centre in a 1-year period.
  
  
  
  The relationship between physical activity and development of inguinal hernia is under debate; however, we find that inguinal hernia that can be attributed to SSE is a rare event, despite the fact that many patients present with acute symptoms. Updated guidelines for the assessment of 'cause' in industrial claims for the association of hernia with workplace activity are required.
authors.affiliation: Royal Gwent Hospital, Newport, NP20 2UB, UK. jswilliamson@doctors.org.uk.
authors.forename: J S
authors.initials: JS
authors.lastname: Williamson
authors.affiliation: Royal Gwent Hospital, Newport, NP20 2UB, UK.
authors.forename: H G
authors.initials: HG
authors.lastname: Jones
authors.affiliation: Royal Gwent Hospital, Newport, NP20 2UB, UK.
authors.forename: R R
authors.initials: RR
authors.lastname: Radwan
authors.affiliation: Royal Gwent Hospital, Newport, NP20 2UB, UK.
authors.forename: A
authors.initials: A
authors.lastname: Rasheed
mesh_terms: D015444:Exercise; D005260:Female; D006552:Hernia, Inguinal / Q000209:etiology* / Q000601:surgery; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013314:Stress, Mechanical; D013312:Stress, Physiological; D011795:Surveys and Questionnaires
keywords: Hernia; Inguinal; Strain