Abdominal Muscle Strains

Brittney M. Richardson, MD, CAQSM

BASICS

DESCRIPTION

Injury to the abdominal wall musculature, including the rectus abdominis, internal/external obliques, and transverse abdominis muscles:

Typically a noncontact injury but may be caused by trauma
Can be acute or subacute.
Acute injury typically is the result of an abrupt movement of the trunk.
Subacute injury caused by repetitive activity
A specific variant known as a side strain most commonly involves the internal oblique at or near the inferior rib attachments.

EPIDEMIOLOGY

Somewhat uncommon injuries, but specific sports have a higher prevalence:

Account for < 2% of athletic injuries (1)
Sports with repetitive trunk rotation have higher rates:
- Soccer, tennis, baseball, ice hockey, gymnastics, pole vault, cricket, bowling (2)
Seen in runners, because the abdominal muscles are used for pelvic stabilization
Attributed to weight training and abdominal workouts as well

ETIOLOGY AND PATHOPHYSIOLOGY

Acute or chronic muscle-tendon injury of the abdominal wall musculature from a sudden intrinsic eccentric contraction of the abdominal musculature (3)

RISK FACTORS

Poorly conditioned abdominal musculature or deficits in core strength
Previous abdominal wall muscle strain/tear
Poor weight training or conditioning techniques
Participation in activities that require abrupt and/or repetitive movements of the torso early in the sport season

DIAGNOSIS

HISTORY

Acute abdominal wall pain associated with stretching or twisting mechanism
Chronic pain due to repetitive activity of the trunk or torso
Direct trauma associated with a minority of these injuries
Pain usually focal and exacerbated by specific movements or positions
Pain with active contraction of affected muscle during sneezing or coughing
Symptoms generally subside in the absence of activity.
In throwing or overhead athletes typically on the side contralateral to the throwing arm, in baseball batters contralateral to the dominant batting side (4)