Abdominal Muscle Strains

Ovid: 5-Minute Sports Medicine Consult, The

Abdominal Muscle Strains
Jonathan A. Becker
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.
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
Acute or chronic muscle-tendon injury of the abdominal wall musculature
  • 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
  • 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.


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
848.8 Other specified sites of sprains and strains

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