abdominal strain
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Abdominal Strain* Home * Abdominal Injuries * Abdominal StrainAbdominal StrainSportsMD2015-02-19T02:59:43+00:00medical second opinion Abdominal StrainBy Terry Zeigler, EdD, ATC
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A abdominal strain is fairly common in athletes and active populationsbecause this group of muscles is constantly engaged to keep theathletes core tight so that the athlete can perform and execute skillsusing his/her extremities and/or total body. Strong and healthyabdominal muscles only enhance an athletes performance. However, injurethese muscles, and the athlete will have significant difficulty tryingto perform.The muscles of the abdomen are layered from deep to superficialincluding the transverse abdominis (fibers run across the abdomen),internal and external obliques (fibers run in opposite diagonaldirections), and rectus abdominis (fibers run up and down). Each has afunction linked to its structure.The deepest muscle, transverse abdominis constricts to hold theabdominal contents in place and to help with forced expiration,coughing, laughing, and sneezing. The internal and external obliquesdiagonal fibers are designed to assist in trunk rotation, lateralflexion (movement sideways), and when working as a pair, trunk flexion.The most superficial muscle group is the rectus abdominis. This is theset of muscles that fun up and down the abdomen and can be seen inathletes who have a low body fat (also known as the much sought aftersix pack). The muscle fibers can be seen just under the skin as theyrise and fall from their attached fascial sheath. The rectus abdominisis primarily responsible for trunk flexion, but can also assist in othertrunk movement.*What is a abdominal strain? *A strain is an injury to a muscle. A strain can vary in severity from amild stretch to a full rupture. In an abdominal muscle strain, any oneof the four muscles can be injured causing extreme discomfort with anytrunk movements as well as with coughing, laughing, deep breathing, orsneezing.*What are the classifications of abdominal strain? *A mild stretching of a muscle is diagnosed as a first degree abdominalstrain and can result in localized pain, mild swelling, and pain withmovement, coughing, laughing, deep breathing, or sneezing.A more severe injury of an abdominal muscle is a partial tear (second
degree). Depending on the amount of fibers torn, this type of injury maybe quite debilitating for the athlete. The athlete may experience suddenabdominal pain, marked tenderness, localized swelling, anddiscoloration. Any and all movements of the athlete may be painful withthe athlete guarded in his/her movements.A third degree muscle strain is the most severe injury and is diagnosedas a complete muscle rupture either at its insertion, origin, ormidsection. Along with the symptoms of a second degree muscle strain,the athlete may also experience the symptoms of shock including nausea,vomiting, pale skin, excess perspiration, difficulty breathing, and ashallow and rapid heart rate.Athletes suspected of a full rupture muscle tear should be immediatelyremoved from the activity and provided emergency medical care untilemergency services arrives. The athlete should be kept still while anice pack is applied to the injury. The athletes vital signs (pulse,respiration, blood pressure) should be monitored until help arrives.*How is an abdominal strain diagnosed? *An abdominal strain is easily diagnosed by a sports medicineprofessional with the use of a thorough medical history and completeclinical evaluation. Palpation of the injury site combined withabdominal muscle tests can provide enough information to determine theseverity of the muscle injury as well as the specific muscle injured.*Who gets a abdominal strain? *Athletes more susceptible to an abdominal strain are those in sportsthat require strong rotational movements or flexion/hyperextensionmovements. They are usually acute (traumatic) injuries seen in athletesin the sports of baseball, softball, basketball, gymnastics, and trackand field.*What causes abdominal strain? *The most common causes of abdominal strains are sudden twisting (i.e.,swinging a bat) or sudden hyperextension of the spine (i.e., as seenduring dynamic gymnastics movements) (Anderson, M.K., Hall, S.J., &Martin, M., 2005).If the force of the movement is stronger than the fibers of the musclescan withstand, the muscle will begin to stretch. If the force continues,the fibers may begin to tear. Continued force could cause a completerupture within the muscle or between the muscle and its fascial attachment.*What can I do to prevent a abdominal strain? *Athletes can prevent abdominal strains by maintaining the flexibility oftheir trunk and increasing the strength of their core muscles. The goodthing is that many sports programs already include core strengthtraining exercises as part of their conditioning program.If athletes are involved in programs that do not incorporate coretraining, a large variety of these types of exercises are used by
personal trainers, physical therapists, and certified athletic trainers.These professionals can be consulted for additional or advancedexercises to strengthen core muscles.One core exercise that can be done without equipment is the bridge. Itis easily performed and has a lot of variations that can be added toincrease the difficulty level of the specific exercise.The athlete starts in a position lying on the floor. The athlete bendshis/her knees so that his/her feet are on the floor. Then the athletepushes his/her pelvis up so that the knees, hips, and spine are in oneline. Initially, the athlete may want to place his/her hands and arms onthe ground to add stability. As the athlete gets stronger, the athletecan raise his/her arms off of the floor.As the athlete moves up into the bridge, the athlete should contract allof the muscles in and around the trunk and hold the bridge for 10seconds. This can be repeated for a total of three sets of ten repetitions.To increase the difficulty of this exercise, the athlete can extend oneknee by lifting his/her foot off of the ground while in the bridgeposition. They key is for the athlete to maintain a neutral pelvisposition with hips straight and not rotated throughout this exercise.The athlete can alternate legs or hold the extended leg for a count offive or ten before replacing his/her foot on the ground.Another good exercise to build core muscles is the plank or pronebridge. Traditionally, the plank is performed on the ground with theathlete on his/her forearms in a push-up position. If this is toodifficult, the athlete may start in the plank position on his/her knees.The goal for the athlete is to hold the plank position for as long aspossible keeping his/her spine, hips, knees, and feet in one straight line.To increase the difficulty of aa forearm position to a push-uparm and then the other and thenkeeping a steady rhythm. Again,shoulders stabilized during the
regular plank, the athlete can move fromposition by alternately pushing up onereversing back to the forearm positionthe goal is to keep the hips andup and down movement.
Another alternative to the regular plank is the side plank or sidebridge. The idea is the same but the athlete is in a side lyingposition. The athlete balances on one forearm while holding his/heropposite arm up in the air keeping the body straight with only the feettouching the ground.A more difficult variation of the side plank is to have the athlete lifthis/her top leg and hold it while maintaining a tight core in the plankposition. This can be done with multiple leg lifts or by just holdingthe leg lift for a number of seconds.*What is the treatment for a abdominal strain? *The immediate treatment of an abdominal strain involves about *using theP.R.I.C.E. principle* Protection, Rest, Icing, Compression, Elevation-beginning with the application of an ice pack for twenty minutes. Theice pack can be reapplied every two hours for the first two to threedays post-injury.Rest is another component of the P.R.I.C.E. principle, but is a little
more difficult with an abdominal strain. Injuries to the arms or legscan easily be protected and rested through the use of crutches, slings,or braces. However, splinting the trunk of the body is not such an easytask.To protect and rest the abdominal muscles, the athlete may need to limithis/her activities for a few days until the pain decreases. To assistthe athlete in supporting the injured area, the athlete may choose towear an ace bandage. The ace bandage also serves to add compression tothe area minimizing any swelling.After the pain begins to subside, the athlete can begin mild stretchingof the injured area along with isometric contractions to begin tostrengthen and heal the injured tissue. Stretching should proceed slowlyand be performed carefully so as not to cause any pain.Pain is an indicator that the athlete has exceeded the injured tissuescapability to lengthen. Stretching too early during the rehabilitationof a muscle strain can reinjure the damaged tissue and set the athletesprogress back. New collagen tissue can be torn from its attachment andrestart the bleeding and swelling process.Isometric muscle exercises can be safely performed early in therehabilitation process because they are designed to contract a musclewithout allowing any movement of the associated joints. One suchexercise is to have the athlete lie on his/her back and flex his/herknees placing his/her feet on the ground. The athlete then pusheshis/her lower back against the ground while contracting all of theabdominal muscles at the same time. The athlete can hold the contractionfor 10 seconds and repeat 10 times.As the muscle continues to heal and the athletes range-of-motionimproves, the athlete can progress to concentric muscle exercises forhis/her core. Concentric muscle exercises are exercises in which themuscle contracts causing a shortening of the muscle and movement of theadjacent joints.Movements to improve the strengths of all of the abdominal muscle groupsshould include the movements of trunk flexion, rotation, and lateralflexion (side bend). Each exercise should be done to target specificmuscle groups.Although once popular to strengthen the rectus abdominis, *sit-ups arenot the best exercise for strengthening the abdominals.* An effectiveexercise is a modified crunch. The athlete lies on the floor withhis/her knees bent and feet placed shoulder width apart. The athletecontracts his/her abdominals and then lifts his/her chin to the ceilingfocusing on moving the chest off of the floor. It is a lift rather thana curl.The internal and external obliques can be targeted by using the sameexercise as above, but by adding a rotational component with each lift.The athlete can alternate rotations to the left and to the right witheach modified crunch. This rotational component targets the diagonalfibers of the internal and external obliques.Traditional core exercises can also be performed to strengthen theabdominal muscles. If available, core exercises can also be performedusing a therapy ball or foam roll.
*Please consider getting a medical second opinion from a top sportsspecialized physician. Click on this link to learn more.**Recovery Getting back to Sport*Once the athlete has pain-free full range-of-motion of his/her trunk(flexion, extension, rotation, and lateral flexion) and good strength,the athlete is ready to progress to sport specific functionalexercises. These exercises should include on a gradual progression ofskills required in the athletes sport.For example, a softball player should include both offensive anddefensive skills specific to the athletes position. For example, acatcher should include drills specific to that position whereas anathlete who competes as a middle infielder should include drillsfielding balls directly at the athlete as well as to either side.Regardless of the defensive position, all ball players need to be ableto swing a bat. Those returning from an abdominal strain should takeextra care when beginning and progressing through hitting drills. Theathlete should begin swinging drills at about an intensity of 50% whileusing a lighter bat than usual.Once the athlete can perform bat swings at full speed without pain, theathlete can progress to hitting whiffle balls off of a tee or soft tossdrills. Once the athlete can perform these drills comfortably and withconfidence, the athlete can proceed to hit off of a machine.Only when the athlete can comfortably perform all the basic skills ofhis/her sport without pain can the athlete progress to scrimmagesituations. With time and confidence, the athlete will be ready toreturn to sports.*When Can I Return to Play? *The athlete can return to sports when he/she has been released byhis/her physician and is pain-free through all ranges-of-motion of thetrunk with full strength.*References** Anderson, M.K., Hall, S.J., & Martin, M. (2005). Foundations ofAthletic Training: Prevention, Assessment, and Management. (3rdEd.). Lippincott Williams & Wilkins: Philadelphia, PA.* Arnheim, D.D. & Prentice, W.E. (2000). Principles of AthleticTraining. (10th Ed.). McGraw Hill: Boston, MA.*Disclaimer:* SportsMD Media Inc. does NOT offer medical advice. Thecontent on this website is for informational purposes only. Do not relyor act upon information from www.sportsmd.com without seekingprofessional medical advice. Consultations on SportsMD.com are not asubstitute to physical consultation with a doctor or hospital services.The service should not to be used for medical emergencies. Do not delayseeing a doctor if you think you have a medical problem. In case of a
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