You Can Injure Abdominal Muscles Too

We’ve been seeing more abdominal injuries over the past 10 years. The term that came out of them—sports hernia—really doesn’t tell us much, if anything, about the injuries. That’s because the injury isn’t a hernia but a tear, or overstretch, of the rectus abdominis muscle.
The injury started to be recognized in the late 1980s and only recently is being readily acknowledged. The two sports with the most prevalent ab tears are hockey and soccer, even though they’re seen in football and basketball, and I’ve seen cases in weightlifting and marathon running. The reason I decided to address it is a recent case of a weight trainee who has been dealing with the symptoms for three years.
The trainee stated he felt the pain shortly after performing crunches. He said he was performing three sets of 70. That certainly didn’t seem to be enough to cause the injury. Still, he became unable to run due to his abdominal pain.
As it turned out, the trainee had suffered a right shoulder injury, which prevented him from performing much of his upper-body training. So he’d been concentrating his time and energy on ab training. He was performing flat crunches, crunches across a Swiss ball, side crunches and several other exercises. He’d suddenly increased his volume of ab training, added new exercises and wasn’t getting much recovery. The result was that he tore his rectus abdominis.
The tears usually occur low in the abdomen and can be adjacent to the pubic bones—where the rectus abdominis inserts, or attaches—or they can be slightly higher. They’re often near an area where common hernias occur. Many patients think they have strained a deep hip flexor muscle, the psoas major, or health care providers have told them that they’ve strained it.
The injury can come from several actions. One is the forceful lengthening of the ab muscles while they are trying to contract—that is, eccentric action, or “negatives.” For example, if you perform a dumbbell curl, the biceps works and shortens as you raise the dumbbell in a concentric action, or “positive.” When you lower the dumbbell, the muscle is still working but lengthening in an eccentric action—most muscle strains occur during such moves. The negative in abs can occur when two players collide, as in hockey, football or soccer. It can occur with overuse, which leads to a severe strain or tear. The muscle can also be so overstretched that the local area loses its ability to contract. The ab muscle functionally behaves as if it is torn.
You can’t necessarily pinpoint the pain. Rather, the entire lower quadrant of the abdomen may feel sore and usually feels painful during activities such as abdominal training or quick or explosive movements in sports; for example, direction change, starting a sprint or jumping. I recall watching one NBA player who had torn or overstretched his rectus abdominis. When he’d jump and dunk the ball, he’d land, bend forward, place his hand on his lower abdomen and wince.
Unlike a simple muscular strain, which heals in weeks, the ab tear can last for years. It may last until it is repaired. I have seen patients lose a season because the team physicians did not recognize the injury. One first-round draft choice lost the first three years of his professional career. Once he had the problem repaired, he returned to play. Those cases occurred in the 1990s. It’s less likely to take so long today for a professional athlete to be diagnosed with this injury. The term “sports hernia” has circulated enough for most doctors who work in sportsmedicine to recognize it.
If you have similar symptoms but haven’t had a proper diagnosis, you may not have access to doctors who are familiar with the problem. You may be dealing with the injury and can’t find an answer, as happened to a recent patient who’s an avid weight trainee. If that’s your situation, perhaps you can find a hockey or soccer team doctor who may be able to help you diagnose the injury. The tear, or overstretch, of the rectus abdominus usually requires repair. There are now two main repair methods, and the doctor you see will choose which to use.by Joseph M. Horrigan, D.C