Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Abdominal Muscle Strain


Related Terms

  • Abdominal Strain
  • Abdominal-Wall Strain
  • Pulled Abdominal Muscle
  • Strained Abdominal Muscle

Differential Diagnosis

Specialists

  • General Surgeon
  • Orthopedic (Orthopaedic) Surgeon
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Physical Therapist
  • Sports Medicine Physician

Comorbid Conditions

Factors Influencing Duration

Length of disability depends on which abdominal muscles are injured, the severity of the strain, the presence of a hernia, and physical demands of the individual's work. Disability duration will be increased if a hernia is present, or if the individual does not comply with activity restrictions during the healing process. If surgery is required, additional postoperative recovery will be necessary.

Medical Codes

ICD-9-CM:
848.8 - Sprains and Strains, Other and Ill-defined, Specified Sites

Overview

Abdominal muscle strain occurs when muscles of the abdominal wall are stretched or torn as a result of forceful activity. Abdominal wall muscles include the rectus abdominis, external and internal obliques, and the transversus abdominis. Most abdominal strains affect the rectus abdominis muscle that runs down the middle of the abdomen from the ribs to the pelvis.

Muscle strains are classified as first-, second-, or third-degree (mild, moderate, or severe, respectively). In a first-degree strain, the muscle is stretched but not torn. A second-degree strain is a partial muscle tear resulting from more forceful stretching. In third-degree strains, a complete tear or rupture of the muscle has occurred, often at the muscle-tendon junction (musculotendinous or myotendinous junction). A tear through the muscle and the abdominal wall covering (fascia) may result in protrusion of the intestines and connective tissue through the tear (hernia). Bleeding may occur within the site of muscle injury.

In the workplace, abdominal muscle strains are most often the result of heavy lifting or sudden twisting. However, any sudden and forceful activity can stretch abdominal muscles, including vigorous or prolonged coughing or sneezing. Abdominal muscles may be stretched or torn when an overweight or deconditioned individual exercises too forcefully. Athletic activities such as weightlifting, pole-vaulting, sit-ups, skating, hockey, and breaststroke swimming are common causes of abdominal strain.

Incidence and Prevalence: Thirty percent of all injuries seen in physicians’ offices and emergency rooms are strains; however, less than 3 percent are diagnosed as abdominal muscle strains. Most reported strain injuries are sports related (Armfield; Kirkendall).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Individuals at highest risk of abdominal muscle strain are workers and athletes engaged in physical activity such as lifting, carrying, pushing or pulling heavy objects.

Individuals who are overweight or with poor muscle-tone are at risk of abdominal muscle strain if they engage in strenuous activity. All individuals who engage in physical activity should do appropriate "warm-up" exercises.

Source: Medical Disability Advisor



Diagnosis

History: The individual complains of abdominal pain that becomes worse with muscle contraction and decreases with muscle relaxation. Spasms may also occur, particularly during movement. Individuals usually report participation in some type of vigorous activity prior to the onset of abdominal pain.

Physical exam: Local tenderness, swelling (edema), muscle guarding, and some loss of strength may be present. With a third-degree tear (complete muscle rupture), a defect or void may be felt (palpated) in the muscle immediately after injury. Within several hours, however, bleeding (hemorrhage) and edema may make the defect in the muscle tissue less obvious.

Tests: X-rays have little role in the evaluation of abdominal strains. They are helpful in diagnosing rib or pelvic fractures. Other imaging studies such as ultrasound, CT or MRI allow visualization of the muscle tissue and may be helpful in determining the presence of an umbilical or ventral hernia (hernia that protrudes through the abdominal wall).

Source: Medical Disability Advisor



Treatment

The goal of treatment is to reduce pain, inflammation, and bleeding. Treatment of first- to second-degree abdominal strains consists of ice application and rest to provide pain relief. Pain can usually be controlled by taking a nonsteroidal anti-inflammatory drug (NSAID) for the first 36 to 48 hours. However, if there is hematoma formation or significant bleeding, aspirin and other NSAIDs may be avoided because of their anticoagulant effects. If stronger pain relief is needed, an oral narcotic or injection of a long-acting local anesthetic may be appropriate. After 48 hours, moist heat may be applied to the area. Ice and heat help manage pain. Between treatments, a loosely wrapped elastic bandage or abdominal corset may be worn for compression and restriction of movement. Any activity involving lifting, twisting, or sudden stretching should be avoided as it may increase pain and prolong healing. A gradual increase in activity is encouraged as pain decreases. In some cases, third-degree strains may require surgical repair or reconstruction of the torn abdominal wall muscle. Indications for surgery include presence of a hernia with protrusion of the intestines through the muscle tear, or special needs of high performance athletes.

Source: Medical Disability Advisor



Prognosis

For first and second-degree strains, complete recovery is expected. In most cases, conservative treatment with ice, rest, and pain medication results in recovery of function and resolution of pain. For third degree strains, surgical repair or reconstruction generally restores function. Compliance with the physician's instructions, particularly activity restrictions, is important to avoid prolongation of the healing time. The individual may be prone to repeated injury of the same muscle unit.

Source: Medical Disability Advisor



Rehabilitation

The goal of the rehabilitation of an abdominal muscle strain is to decrease pain, to restore function of the abdominal wall, and to instruct the individual in methods for avoiding re-injury. Based on clinical manifestations and their severity, muscle strains are divided into three different categories. First-degree strains are of mild severity and represent muscle stretching, or tears of only a few muscle fibers. Moderate or second-degree strains are of greater damage to the muscle with a clear loss of strength. Third-degree strains are severe tears across the whole muscle belly, resulting in a total loss of muscle function.

The immediate goal of the rehabilitation of all abdominal muscle strains is to decrease pain and swelling. Application of ice can reduce formation of a hematoma and control pain. Duration of treatment depends upon the severity of the strain (Noonan).

First- and Second-Degree: Physical activities should be terminated immediately after the injury to avoid further damage. As pain and swelling decrease, early stretching exercises within the pain limit helps to minimize the negative effects of scar tissue formation. Individuals may progress to flexibility and strengthening activities as tolerated using pain as a guide, depending on the severity of the injury (Jarvinen).

Third-Degree: Third-degree strains of the abdominal wall are rare. The immediate rehabilitation is the same as for first- and second-degree strains. If pain and functional limitations persist, the injury needs to be re-evaluated. Besides clinical evaluation, sonography or an MRI may help to detect the extent of the injury. Depending on the severity of the muscle strain a surgical intervention might be necessary.

FREQUENCY OF REHABILITATION VISITS
Nonsurgical
SpecialistAbdominal Muscle Strain
Physical TherapistUp to 6 visits within 3 weeks
The table above represents a range of the usual acceptable number of visits for uncomplicated cases. It provides a framework based on the duration of tissue healing time and standard clinical practice.

Source: Medical Disability Advisor



Complications

Third-degree abdominal muscle strains may result in herniation of the intestines through the muscle defect.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Because strenuous activity may increase pain and prolong healing, temporary reassignment to duties that do not involve lifting, bending, twisting, or prolonged standing may be necessary until the injury heals. For example, a childcare employee who often lifts or carries toddlers might be reassigned to work with older children who do not require such care. Delivery drivers, warehouse workers, and others whose jobs involve repetitive lifting may need to be assigned to modified duty until the strain heals.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Was diagnosis of muscle strain confirmed?
  • Were other causes of abdominal pain and/or swelling ruled out?
  • Were x-rays performed to rule out additional injuries such as fractures (especially rib fractures)?

Regarding treatment:

  • Have rest, ice, and nonsteroidal anti-inflammatory drugs relieved symptoms?
  • Has heat in some form been added to the treatment regimen?
  • Has individual been instructed to avoid excessive lifting, bending, or twisting, as well as sudden stretching?
  • Was surgery performed to repair torn muscle or related hernia?

Regarding prognosis:

  • Does excessive soreness persist despite treatment?
  • Has individual resumed activity too soon?
  • Is he or she prone to repeated injury? If so, was individual instructed in safe body mechanics?

Source: Medical Disability Advisor



References

Cited

"Muscle Strain Injuries: Research Findings and Clinical Applicability." Medscape. WebMD, LLC. 27 Feb. 2014 <http://www.medscape.com/viewarticle/715533>.

Armfield, D. R., et al. "Sports-related Muscle Injury in the Lower Extremity." Clinics in Sports Medicine 25 4 (2008): 803-842.

Jarvinen, T., et al. "Muscle Strain Injuries." Current Opinion in Rheumatology 2 12 (2000): 155-161.

Noonan, T.J., and W. E. Garrett. "Muscle Strain Injury: Diagnosis and Treatment." Journal American Academy Orthopedic Surgery 7 4 (1999): 262-269.

General

DeLee, Jesse, and David Drez, eds. "Muscle, Tendon, and Ligament Injuries." DeLee and Drez's Orthopaedic Sports Medicine. 2nd ed. 2 vols. Philadelphia: W.B. Saunders, 2003. 790-796.

Source: Medical Disability Advisor






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