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.Risk: 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. 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
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
| 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
| 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
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 | |
| Physical Therapist | | Up to 6 visits within 3 weeks | |
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| 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
| Third-degree abdominal muscle strains may result in herniation of the intestines through the muscle defect. |
Source: Medical Disability Advisor
| 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
| 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?
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Were other causes of abdominal pain and/or swelling ruled out?
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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?
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Has heat in some form been added to the treatment regimen?
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Has individual been instructed to avoid excessive lifting, bending, or twisting, as well as sudden stretching?
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Was surgery performed to repair torn muscle or related hernia?
Regarding prognosis:
- Does excessive soreness persist despite treatment?
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Has individual resumed activity too soon?
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Is he or she prone to repeated injury? If so, was individual instructed in safe body mechanics?
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Source: Medical Disability Advisor
| CitedArmfield, D. R., et al. "Sports-related Muscle Injury in the Lower Extremity." Clinics in Sports Medicine 25 4 (2008): 803-842.Cabaltica, Rex B. G. "Muscle Strain Injuries: Research Findings and Clinical Applicability." Medscape General Medicine 1 2 (1999): |
| RehabilitationJarvinen, 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. |
| GeneralDeLee, 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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