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Abdominal Strain
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* Abdominal Strain
Abdominal StrainSportsMD
<http://www.sportsmd.com/author/tomsportsmd-com/>2015-02-19T02:59:43+00:00
medical second opinion <http://sportsmd.com/second-opinion-services/>
Abdominal Strain
By Terry Zeigler, EdD, ATC
<http://sportsmd.com/about-us/terry-zeigler-edd-atc/>
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A abdominal strain is fairly common in athletes and active populations
because this group of muscles is constantly engaged to keep the
athletes core tight so that the athlete can perform and execute skills
using his/her extremities and/or total body. Strong and healthy
abdominal muscles only enhance an athletes performance. However, injure
these muscles, and the athlete will have significant difficulty trying
to perform.
The muscles of the abdomen are layered from deep to superficial
including the transverse abdominis (fibers run across the abdomen),
internal and external obliques (fibers run in opposite diagonal
directions), and rectus abdominis (fibers run up and down). Each has a
function linked to its structure.
The deepest muscle, transverse abdominis constricts to hold the
abdominal contents in place and to help with forced expiration,
coughing, laughing, and sneezing. The internal and external obliques
diagonal fibers are designed to assist in trunk rotation, lateral
flexion (movement sideways), and when working as a pair, trunk flexion.
The most superficial muscle group is the rectus abdominis. This is the
set of muscles that fun up and down the abdomen and can be seen in
athletes who have a low body fat (also known as the much sought after
six pack). The muscle fibers can be seen just under the skin as they
rise and fall from their attached fascial sheath. The rectus abdominis
is primarily responsible for trunk flexion, but can also assist in other
trunk movement.
*What is a abdominal strain? *
A strain is an injury to a muscle. A strain can vary in severity from a
mild stretch to a full rupture. In an abdominal muscle strain, any one
of the four muscles can be injured causing extreme discomfort with any
trunk movements as well as with coughing, laughing, deep breathing, or
sneezing.
*What are the classifications of abdominal strain? *
A mild stretching of a muscle is diagnosed as a first degree abdominal
strain and can result in localized pain, mild swelling, and pain with
movement, 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 may
be quite debilitating for the athlete. The athlete may experience sudden
abdominal pain, marked tenderness, localized swelling, and
discoloration. Any and all movements of the athlete may be painful with
the athlete guarded in his/her movements.
A third degree muscle strain is the most severe injury and is diagnosed
as a complete muscle rupture either at its insertion, origin, or
midsection. 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 a
shallow and rapid heart rate.
Athletes suspected of a full rupture muscle tear should be immediately
removed from the activity and provided emergency medical care until
emergency services arrives. The athlete should be kept still while an
ice 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 medicine
professional with the use of a thorough medical history and complete
clinical evaluation. Palpation of the injury site combined with
abdominal muscle tests can provide enough information to determine the
severity 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 sports
that require strong rotational movements or flexion/hyperextension
movements. They are usually acute (traumatic) injuries seen in athletes
in the sports of baseball, softball, basketball, gymnastics, and track
and 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 seen
during 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 muscles
can withstand, the muscle will begin to stretch. If the force continues,
the fibers may begin to tear. Continued force could cause a complete
rupture 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 of
their trunk and increasing the strength of their core muscles. The good
thing is that many sports programs already include core strength
training exercises as part of their conditioning program.
If athletes are involved in programs that do not incorporate core
training, 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 advanced
exercises to strengthen core muscles.
One core exercise that can be done without equipment is the bridge. It
is easily performed and has a lot of variations that can be added to
increase the difficulty level of the specific exercise.
The athlete starts in a position lying on the floor. The athlete bends
his/her knees so that his/her feet are on the floor. Then the athlete
pushes his/her pelvis up so that the knees, hips, and spine are in one
line. Initially, the athlete may want to place his/her hands and arms on
the ground to add stability. As the athlete gets stronger, the athlete
can raise his/her arms off of the floor.
As the athlete moves up into the bridge, the athlete should contract all
of the muscles in and around the trunk and hold the bridge for 10
seconds. This can be repeated for a total of three sets of ten repetitions.
To increase the difficulty of this exercise, the athlete can extend one
knee by lifting his/her foot off of the ground while in the bridge
position. They key is for the athlete to maintain a neutral pelvis
position with hips straight and not rotated throughout this exercise.
The athlete can alternate legs or hold the extended leg for a count of
five or ten before replacing his/her foot on the ground.
Another good exercise to build core muscles is the plank or prone
bridge. Traditionally, the plank is performed on the ground with the
athlete on his/her forearms in a push-up position. If this is too
difficult, 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 as
possible keeping his/her spine, hips, knees, and feet in one straight line.
To increase the difficulty of a
a forearm position to a push-up
arm and then the other and then
keeping a steady rhythm. Again,
shoulders stabilized during the

regular plank, the athlete can move from


position by alternately pushing up one
reversing back to the forearm position
the goal is to keep the hips and
up and down movement.

Another alternative to the regular plank is the side plank or side


bridge. The idea is the same but the athlete is in a side lying
position. The athlete balances on one forearm while holding his/her
opposite arm up in the air keeping the body straight with only the feet
touching the ground.
A more difficult variation of the side plank is to have the athlete lift
his/her top leg and hold it while maintaining a tight core in the plank
position. This can be done with multiple leg lifts or by just holding
the 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 the
P.R.I.C.E. principle* Protection, Rest, Icing, Compression, Elevation
-beginning with the application of an ice pack for twenty minutes. The
ice pack can be reapplied every two hours for the first two to three
days 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 legs


can easily be protected and rested through the use of crutches, slings,
or braces. However, splinting the trunk of the body is not such an easy
task.
To protect and rest the abdominal muscles, the athlete may need to limit
his/her activities for a few days until the pain decreases. To assist
the athlete in supporting the injured area, the athlete may choose to
wear an ace bandage. The ace bandage also serves to add compression to
the area minimizing any swelling.
After the pain begins to subside, the athlete can begin mild stretching
of the injured area along with isometric contractions to begin to
strengthen and heal the injured tissue. Stretching should proceed slowly
and be performed carefully so as not to cause any pain.
Pain is an indicator that the athlete has exceeded the injured tissues
capability to lengthen. Stretching too early during the rehabilitation
of a muscle strain can reinjure the damaged tissue and set the athletes
progress back. New collagen tissue can be torn from its attachment and
restart the bleeding and swelling process.
Isometric muscle exercises can be safely performed early in the
rehabilitation process because they are designed to contract a muscle
without allowing any movement of the associated joints. One such
exercise is to have the athlete lie on his/her back and flex his/her
knees placing his/her feet on the ground. The athlete then pushes
his/her lower back against the ground while contracting all of the
abdominal muscles at the same time. The athlete can hold the contraction
for 10 seconds and repeat 10 times.
As the muscle continues to heal and the athletes range-of-motion
improves, the athlete can progress to concentric muscle exercises for
his/her core. Concentric muscle exercises are exercises in which the
muscle contracts causing a shortening of the muscle and movement of the
adjacent joints.
Movements to improve the strengths of all of the abdominal muscle groups
should include the movements of trunk flexion, rotation, and lateral
flexion (side bend). Each exercise should be done to target specific
muscle groups.
Although once popular to strengthen the rectus abdominis, *sit-ups are
not the best exercise for strengthening the abdominals.* An effective
exercise is a modified crunch. The athlete lies on the floor with
his/her knees bent and feet placed shoulder width apart. The athlete
contracts his/her abdominals and then lifts his/her chin to the ceiling
focusing on moving the chest off of the floor. It is a lift rather than
a curl.
The internal and external obliques can be targeted by using the same
exercise as above, but by adding a rotational component with each lift.
The athlete can alternate rotations to the left and to the right with
each modified crunch. This rotational component targets the diagonal
fibers of the internal and external obliques.
Traditional core exercises can also be performed to strengthen the
abdominal muscles. If available, core exercises can also be performed
using a therapy ball or foam roll.

*Please consider getting a medical second opinion from a top sports


specialized physician. Click on this link to learn more.
<http://sportsmd.com/second-opinion-services/>*
*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 functional
exercises. These exercises should include on a gradual progression of
skills required in the athletes sport.
For example, a softball player should include both offensive and
defensive skills specific to the athletes position. For example, a
catcher should include drills specific to that position whereas an
athlete who competes as a middle infielder should include drills
fielding balls directly at the athlete as well as to either side.
Regardless of the defensive position, all ball players need to be able
to swing a bat. Those returning from an abdominal strain should take
extra care when beginning and progressing through hitting drills. The
athlete should begin swinging drills at about an intensity of 50% while
using a lighter bat than usual.
Once the athlete can perform bat swings at full speed without pain, the
athlete can progress to hitting whiffle balls off of a tee or soft toss
drills. Once the athlete can perform these drills comfortably and with
confidence, the athlete can proceed to hit off of a machine.
Only when the athlete can comfortably perform all the basic skills of
his/her sport without pain can the athlete progress to scrimmage
situations. With time and confidence, the athlete will be ready to
return to sports.
*When Can I Return to Play? *
The athlete can return to sports when he/she has been released by
his/her physician and is pain-free through all ranges-of-motion of the
trunk with full strength.
*References*
* Anderson, M.K., Hall, S.J., & Martin, M. (2005). Foundations of
Athletic Training: Prevention, Assessment, and Management. (3rd
Ed.). Lippincott Williams & Wilkins: Philadelphia, PA.
* Arnheim, D.D. & Prentice, W.E. (2000). Principles of Athletic
Training. (10th Ed.). McGraw Hill: Boston, MA.
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