Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Overuse Injury and Rupture of the Abdominal Muscle

In cases of ruptures and overuse injury of the abdominal muscles it is usually the rectus abdominis muscle that is damaged, but the oblique and transverse muscles of the abdomen can also be affected. The rectus abdominis arises from the sternum and the fifth, sixth and seventh costal cartilages, and inserts on the upper part of the pubic bone at the symphysis. Overuse injury and partial rupture of this muscle are usually located at its insertion to the pubic bone. Ruptures can also appear in the transverse (oblique) muscles towards the sides of the abdomen and can confuse the diagnosis if they are located over the appendix. Ruptures of the abdominal muscles occur in weightlifters, throwers, gymnasts, rowers, wrestlers, pole-vaulters and others. Inflammation is often triggered by exertion, such as strength training, sit-ups, shooting practice in soccer, and serving and smashing in tennis and badminton.

Symptoms and diagnosis

– On forceful use of the abdominal muscles a sudden stabbing pain may indicate that a rupture has occurred.
– There may be tenderness and/or inflammation over the area in which the rupture has occurred.
– There is impaired function affecting, for example, forceful forward thrust in walking and running.
– A rupture of the abdominal muscles can be difficult to distinguish from inflammation of the internal abdominal organs such as appendicitis. It is typical of a rupture that the tenderness and the pain are more pronounced when the abdominal muscles are contracted than when they are relaxed.
– Pain can be elicited if the injured athlete lies flat and lifts legs against resistance.
– In cases of overuse injury of the abdominal muscles there is often tenderness and pain over the insertion of the rectus abdominis muscle into the pubic bone. The symptoms are triggered by contraction of the
abdominal muscles.

Treatment

The athlete should:
– initially rest; gradually increase activity as tolerated;
– apply local heat and use a heat retainer.

The doctor may:
– prescribe anti-inflammatory medication;
– prescribe an exercise program;
– administer a local steroid injection followed by 2 weeks’ avoidance of strenuous and explosive activities when there are signs of inflammation of the tendon attachment;
– operate when there is prolonged pain.

Healing and complications

If the athlete rests immediately when there are signs of overuse of the abdominal muscles, healing takes only 1–2 weeks. In muscle ruptures the healing time varies according to the extent of the injury. The injured athlete should not return to training and competition until healing is complete, otherwise new ruptures may ensue and delay the healing process. Large muscle ruptures can lead to hernia formation in the abdominal wall.

Most athletes train their abdominal muscles by sit-ups. In order to protect the iliopsoas muscle during the rehabilitation period, the hip joint should be held bent so that this muscle does not contract. The best method of training the rectus abdominis muscle is half sit-ups, done slowly with bent knees.

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