Abdominal Muscle Strains

By admin Last updated Dec 18, 2023

Ovid: 5-Minute Sports Medicine Consult, The

Jonathan A. Becker

Basics

Description

Injury to the abdominal wall musculature:

Typically a noncontact injury, but may be caused by trauma
Acute or subacute injury
Acute injury result of an abrupt movement of the trunk
Subacute injury caused by repetitive activity
The abdominal wall musculature includes rectus abdominus, internal/external obliques, and transverse abdominus.

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, ice hockey, gymnastics, pole vault
Seen in runners, as the abdominal muscles are used for pelvic stabilization
Attributed to weight training and abdominal workouts as well

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

General Prevention

Appropriate weight training and conditioning techniques with attention to core strength

Etiology

Acute or chronic muscle-tendon injury of the abdominal wall musculature

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.

Physical Exam

Appearance is typically normal with swelling and evidence of contusion rare in the absence of preceding trauma.
Splinting may be noted if pain is severe.
Tenderness of the abdominal wall is usually focal and discrete, but may be more diffuse in overuse type injury.
Muscle defect may be notable if an associated tear or herniation is present.
Peritoneal signs are absent.
Symptoms are reproduced by contraction of the affected muscle.

Diagnostic Tests & Interpretation

Imaging

Plain films, CT scan indicated if there is concern for rib fracture or intra-abdominal process
MRI can be utilized to assess for muscle tear or to assess the extent of injury:
- Reserved for more severe injuries
Musculoskeletal US may prove to be the diagnostic procedure of choice.

P.3

Differential Diagnosis

Abdominal wall contusion
Abdominal wall hematoma:
- Swelling, periumbilical contusion, and a mass with rigidity and/or guarding are signs of a rectus sheath hematoma
Abdominal wall hernia (umbilical, Spigelian)
Intra-abdominal injury (contusion, laceration, perforation)
Intra-abdominal process (eg, infection, mass, etc.)
Iliac apophysitis
Osteitis pubis

Treatment

Acute treatment:

Remove the athlete from the offending activity.
Ice
Compressive wrap
NSAIDs or acetaminophen
Once pain subsides, a rehabilitation program may be initiated (1,2)[C].

Medication

First Line

NSAIDs or acetaminophen:

Avoid NSAIDs if there is concern for bleeding or hematoma.

Second Line

Narcotics or muscle relaxants may be utilized for more severe injuries, but are rarely needed.

Additional Treatment

General Measures

Rehabilitation:

Assess abdominal muscle strength and core strength/stability.
Initiate a rehab program once pain has subsided:
- Start with passive stretching.
- Advance to strengthening activities.
- Progress to sport-specific activities (1,2)[C].

Additional Therapies

Modalities such as US or muscle stimulation may help alleviate symptoms.
Corticosteroid injection at the site of muscle tear/strain may be considered for acute pain relief or refractory cases.

Surgery/Other Procedures

Surgery may be necessary in cases of rectus sheath hematoma, hernia, or intra-abdominal process.

Ongoing Care

Follow-Up Recommendations

The athlete may return to activity once pain subsides and they can engage in sport-specific activity.

Prognosis

Overall prognosis for recovery is excellent:

Duration of symptoms is variable and may persist for months.
Recurrence rates are high (>20%).

References

1. Johnson R. Abdominal wall injuries: rectus abdominis strains, oblique strains, rectus sheath hematoma. Curr Sports Med Rep. 2006;5:99–103.

2. Maquirriain J, Ghisi JP, Kokalj AM. Rectus abdominis muscle strains in tennis players. Br J Sports Med. 2007;41:842–848.

Codes

ICD9

848.8 Other specified sites of sprains and strains