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ABDOMINAL-WALL STRAIN
ABDOMINAL-WALL STRAIN
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GENERAL INFORMATION
DEFINITION--Injury to the muscles or tendons of the abdominal wall, or injury to the places where muscles or tendons attach to pelvic bones. Tendons, muscles and bones comprise units. These units stabilize the pelvis and rib cage and allow their motion. A strain occurs at the weakest part of a unit. Strains are of 3 types:
Mild (Grade I)--Slightly pulled muscle without tearing of muscle or tendon fibers. There is no loss of strength.
Moderate (Grade II)--Tearing of fibers in a muscle, tendon or at the attachment to bone. Strength is diminished.
Severe (Grade III)--Rupture of the muscle-tendon-bone attachment with separation of fibers. Severe strain requires surgical repair. Chronic strains are caused by overuse. Acute strains are caused by direct injury or overstress.
BODY PARTS INVOLVED--------------------
Abdominal muscles and tendons.
Bones in the abdominal area (ribs, pubic bone and iliac-crest bone).
Soft tissue surrounding the strain, including nerves, periosteum (covering to bone), blood vessels and lymph vessels.
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SIGNS & SYMPTOMS--------------------
Pain when moving or stretching abdominal muscles.
Muscle spasm, especially with hard breathing or twisting.
Swelling in the abdominal area.
Loss of strength (moderate or severe strain).
Crepitation ("crackling") feeling and sound when the injured area is pressed with fingers.
Calcification of the muscle or its tendon (visible with X-ray).
Inflammation of the tendon sheath.
CAUSES--------------------
Prolonged overuse of muscle-tendon units in the abdominal wall.
Single violent injury or force applied to the muscle-tendon units in the abdominal wall.
RISK INCREASES WITH--------------------
Stretching exercises.
Pole vaulting, high jumping and hurdling.
Contact sports.
Any cardiovascular medical problem that results in decreased circulation.
Medical history of any bleeding disorder.
Obesity.
Poor nutrition.
Previous abdominal-wall strain.
Poor muscle conditioning.
HOW TO PREVENT--------------------
Participate in a strengthening and conditioning program appropriate for your sport.
Warm up before practice or competition.
WHAT TO EXPECT========================================
APPROPRIATE HEALTH CARE
Doctor's diagnosis.
Self-care during rehabilitation.
Physical therapy (moderate or severe strain).
Surgery (severe strain).
DIAGNOSTIC MEASURES--------------------
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of injured areas to rule out fractures.
POSSIBLE COMPLICATIONS--------------------
Prolonged healing time, if activity is resumed too soon.
Proneness to repeated injury.
Inflammation at attachment to bone (periostitis).
Prolonged disability (sometimes).
PROBABLE OUTCOMEIf this is a first-time injury, proper care and sufficient healing time before resuming activity should prevent permanent disability. Torn ligaments and tendons require as long to heal as fractured bones. Average healing times are:
Mild strain--2 to 10 days.
Moderate strain--10 days to 6 weeks.
Severe strain--6 to 10 weeks. If this is a repeat injury, complications listed above are more likely to occur.
HOW TO TREAT========================================
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AIDFollow instructions for R.I.C.E., the first letters of REST, ICE, COMPRESSION and ELEVATION (if possible). See Appendix 1 for details.
CONTINUING CARE--------------------
Use ice massage 3 or 4 times a day for 15 minutes at a time. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a softball.
After the first 24 hours, apply heat instead of ice, if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments and ointments.
Take whirlpool treatments, if available.
Wrap the injured abdominal-wall muscles loosely with an elasticized bandage or wear a corset between treatments.
Massage gently and often to provide comfort and decrease swelling.
MEDICATION--------------------
For minor discomfort, you may use:
Aspirin, acetaminophen or ibuprofen.
Topical liniments and ointments.
Your doctor may prescribe:r Stronger pain relievers.
Injection of a long-acting local anesthetic to reduce pain.
Injection of a corticosteroid, such as triamcinolone, to reduce inflammation.
ACTIVITYResume your normal activities gradually after pain subsides.
DIETEat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
REHABILITATIONBegin a supervised weight-lifting program when supportive wrapping is no longer needed. Use ice massage for 10 minutes prior to exercise.
CALL YOUR DOCTOR IF========================================
You have symptoms of a moderate or severe abdominal-wall strain, or a mild strain persists longer than 10 days.
Pain or swelling worsens despite treatment.
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From Complete Guide to Sports Injuries by H. Winter Griffith, M.D. Copyright by Putnam Publishing
Group. Electronic rights by Medical Data Exchange.
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