Abdominal Strain Injury AKA: Stomach Strain

Explained

Abdominal pain may be due to a Stomach muscle strain sustained during sport.
Alternatively it is not uncommon to sustain an Abdominal strain during stomach
exercises. A muscle strain refers to a tear within the muscle. Usually the muscle is
forcibly stretched beyond its limits and the muscle tissue becomes torn. Depending
upon its severity it is classified as a first, second or third degree strain:

• a first degree strain is damage to a few muscle fibres

• a second degree strain is damage to a more extensive number of muscle fibres
• a third degree strain is a complete rupture of the muscle itself

The immediate treatment of any muscle injury consists of rest, ice and compression
(never apply ice directly to the skin). The rest period is usually between 2 and 4 weeks,
although depending on the severity of the strain it can require up to 3 months of
rehabilitation.

Common Abdominal Strain signs & symptoms:

• Abdominal pain when attempting a sit up.

• Abdominal pain when bending back and stretching the abdominal muscles.
Abdominal Strain Signs & Symptoms
With a grade one Abdominal muscle strain the signs of injury may not be present until
after the activity is over. There may be a sensation of cramp or tightness and a slight
feeling of pain when the muscles are stretched or contracted.

With a grade two Abdominal muscle strain there is immediate pain which is more severe
than the pain of a grade one injury. It is confirmed by pain on stretch and contraction of
the muscle. A grade two Abdominal strain is usually sore to touch.

With a grade three Abdominal strain there is an immediate burning or stabbing pain and
the athlete is unable to move without pain. The muscle is completely torn and there may
be a bulge of soft tissue through the muscle layer - this is known as a hernia. In the case
of grade two and three injuries, a bruise may appear after a few days below the injury,
caused by bleeding within the tissues.

Abdominal Strain Treatment

What you can do

The immediate treatment for any muscle injury consists of rest, ice and compression. Ice
packs can be applied for periods of twenty minutes every couple of hours (never apply
ice directly to the skin as it can cause an ice burn). The ice packs relieve pain and reduce
bleeding in the damaged tissue.

Resting may be the common sense approach, but it is one that is often ignored by
competitive athletes. This is unwise, since it does not take much to turn a grade one strain
into a grade two, or a grade two strain into a grade three. As a general rule, grade one
injuries should be rested from sporting activity for about 3 weeks and grade two injuries
for about 4 to 6 weeks. In the case of a complete rupture, the muscle may have to be
repaired surgically and the rehabilitation afterwards will take about 3 months.
 What you can do

Abdominal Strain Prevention

What you can do

The following measures may have the effect of reducing the chances of sustaining a
muscle strain:

• Warm up prior to matches and training is thought to decrease muscle stretch

injuries because the muscle is more extensible when the tissue temperature has
been increased by one or two degrees. A good warm up should last at least 20
minutes - starting gently and finishing at full pace activity. Practising sport
specific activities helps tune coordination and prepare mentally for competition.

• Recovery after training sessions and matches can be enhanced by performing a

cool down. Ideally the cool down session should take place the day after the
activity. This is thought to help muscles get rid of waste products. This is also the
ideal time to do stretching exercises.

• Maintaining good muscle strength and flexibility may help prevent muscle strains.
Muscle strength allows a player to carry out match activities in a controlled
manner and decreases the uncoordinated movements which can lead to injury.
Core strength exercises using a Swiss Ball are ideal. Tight muscles are
associated with strains and stretching on a mat should also be practised to
maintain muscle length and prevent injury.

Core Strengthening Programme

What is the Core Strengthening Programme?
The Core Strengthening Programme is an exercise programme that aims to improve
stabilisation and support to the spine. This is achieved by re-training specific trunk
muscles, which may be under used.

Once these stabilising muscles have been re-trained the muscles of the arms and legs will
have a more stable base to work from. This allows you to carry out arm and leg
movements with more control and is thought to improve the quality of your movement.
How will it help during sport?
• It will provide more support for your back and may reduce the risk of back
injuries.
• It will provide a more stable base for arm and leg movements, improving the
control and quality of your movements.
• It will improve your muscular co-ordination during movement.
• As the stabilising muscles gain more endurance you will be able to perform
movements without your technique deteriorating excessively, due to fatigue.
• Your ability to hold off opponents in contact sports should improve.

Programme Overview
The programme is broken down into stages and must be completed step by step. You
should not progress to the next stage until you have mastered the exercises of the
previous stage.

The stages are:

• Stage 1
Learn to contract the deep muscles which stabilise the spine. At first this takes
quite a bit of concentration. Each individual will master this at their own pace.
There is no set time, but perseverance is the key.

There are two main deep stabilising muscles that support your lower back: the Multifidus
muscle and the Transversus abdominis muscle.

In order to
practice getting Transversus and Multifidus muscles to contract, it is easiest to get on all
fours. Without moving your back, or pelvis, draw your stomach up gently - try to bring
your belly button up towards your back. This is a very subtle movement so it is best to
get your technique checked by a physiotherapist .
Important notes:

• This movement should not be confused with breathing in - it is important to

breathe normally while activating the stabilising muscles.
• Do not use the muscles at the front of the stomach - using your 'six pack' is not the
correct technique.

• Stage 2
Increase the endurance capacity of the deep stabilising muscles of the spine, by
practicing to contract them in different situations for as long as you can. This will
become easier with practice.

Practicing to Activate the Deep Stabilisers and Improve their Endurance

Using the same techniques described in Stage 1, you should eventually aim to hold the
contraction for as long as is possible. You will find that once you have activated the
muscles to this level it will become second nature to you.

To progress from Stage 1, simply increase the duration of the contraction to ten seconds,
then twenty, while continuing to practice in sets of ten. Then progress the contraction to
as long as possible, aiming for five minutes, then longer.

At this point, progress to contracting the deep stabilisers in different positions such as
sitting and standing. Practice while you are doing everyday activities, such as sitting at
the computer, watching TV or on an exercise bike.

Once you have mastered this you will be ready to progress to stage 3.

• Stage 3
Begin arm and leg movements whilst contracting the deep stabilising muscles of
the spine.

The whole point of the Core Strenthening Programme is to increase the support for your
back and trunk in order to provide a more stable base for arm and leg movement. The
best position to start these exercises is on all fours.
Commence by contracting the deep stabilisers (as described in Stage 1) and hold this
contraction. Then raise your right arm straight out to the horizontal. Perform the
movement slowly and in a controlled fashion - there should be no wobbling or unwanted
movement of the trunk. Hold the arm up for four seconds and then slowly lower.

Repeat for the left arm.

Next, whilst maintaining the same position, contract the deep stabilisers and then slowly
lift your right leg up straight to the horizontal. Hold it there for four seconds and then
slowly lower. The movement should be controlled and there should not be unwanted
movement of the trunk or pelvis.

Repeat for the left leg.

Once you have mastered these exercises, whilst maintaining a contraction of the deep
stabiliser muscles, you can start doing the core strengthening gym exercises.

• Stage 4
Progress to the core strengthening exercises, while contracting the deep stabilising
muscles.

What You'll Need

Essential kit that you'll need for these exercises are:

• A Swiss Ball
• An Exercise Mat
• A Medicine Ball

Progression of the Core Strengthening Exercises

The core strengthening exercises featured in this guide are suitable for most levels of
fitness, but for best results it is always beneficial to do them under the supervision of a
chartered physiotherapist. The physiotherapist will be able to monitor your technique and
suggest appropriate modifications where necessary.

As a rough guide to the progression of the programme, the timescales below may be
helpful. However, for exact sets, repetitions and their progression it is best to consult a
healthcare professional or certified conditioning coach.

Beginner

It's best to aim to do two different circuits (trunk, arm, leg, back and gluteal) per week,
with three days between each circuit. Rotate through all the different circuits to make
sure all areas of the body are worked over the course of a few weeks. If you are
unaccustomed to this type of exercise then you can expect some general muscle soreness
for a couple of days after exercise when you are starting out.

As an example,the following progression may be appropriate to do every Monday and

Thursday:
 Circuit
Week Exercise Repititions
Sets
1 1 4
2 1 4
3 1 6
4 1 8
5 1 10
6 2 6
7 2 6

Intermediate

After becoming familiar with the exercises, the feeling of muscle soreness after exercise
should go away. Usually, it is then possible to do the exercises every other day by
rotating the circuits to work on different areas of the body.

For example, this progression may be appropriate to do Monday, Wednesday, Friday:

Circuit
Week Exercise Repititions
Sets
8 2 6
9 2 6
10 2 8
11 2 8
12 3 6
13 2 10
14 3 8

Advanced

By doing the exercises regularly over a period of months, it is possible to do more work
with less rest time. However, remember to rotate the circuits to make sure all areas of the
body are worked.

For example, it may be possible to do these exercises five days of the week:
 Circuit
Week Exercise Repititions
Sets
15 3 8
16 3 8
17 3 10
18 3 10
19 4 8
20 4 10
21 5 8

Shoulder, Trunk and Adductor Exercise

Position your shins on the top of the Swiss Ball with your hands on the floor. Slowly roll
the ball round to your right, then over to the left.

Hamstring Exercises
Lie on your back with your heels on top of the Swiss Ball. Dig your heels into the ball
and lift your pelvis up. Hold for 4 seconds.
Hip Flexor, Hamstring and Gluteal Exercise
Lie on your back with your heels on the Swiss Ball. Arms across chest. Lift up your
pelvis and hold. Lift up alternate legs and hold for 4 seconds.

Hamstring and Gluteal Exercise

With your knees and ankles 15cm apart, balance with your back on the Swiss Ball. Your
knees should be at 90 degrees. Tighten your bottom and push your pelvis up. Raise your
alternate legs to horizontal and hold for 4 seconds.
Sit Ups
Sit with the small of your back on the Swiss Ball and with a medicine ball between your
knees. Fold your arms across your chest and slowly sit up.

Trunk and Gluteal Exercise

Balance with your back on the Swiss Ball, your pelvis pushed up and your knees at 90
degrees. Hold the medicine ball out with your arms straight above you. Keep your pelvis
pushed up and rotate the medicine ball slowly to the left then to the right. Keep your arms
straight.

Trunk Exercise
Sit on the Swiss Ball and balance with your feet off the ground. How long can you
balance before touching the ground?
 Exercises for Strengthening the Arm Muscles
Press Ups
Balance your knees on the Swiss Ball and hands on the floor. Slowly lower your chest to
the floor then raise up.

Pelvic Lifts
Sit on the floor with your hands behind your shoulders and your heels on top of the Swiss
Ball. Lift your pelvis up and hold for 6 seconds.
Shoulder, Trunk and Adductor Exercise
Position your shins on the top of the Swiss Ball with your hands on the floor. Slowly roll
the ball round to your right, then over to the left.

Arm, Trunk and Abductor Exercise

Lay on your side on an exercise mat. Keep your legs and trunk straight. Push up on your
forearm and hold. Steady yourself and raise your top leg up and hold for 4 seconds.

Trunk and Pelvis Exercise

Keep your body and legs straight. Push up on your forearm. Hold for 6 seconds. Roll
over and work other side.
Exercises for Strengthening the Leg Muscles
Lunges
Standing feet 20cm apart. Lunge forward, alternate left and right.

Abductor Exercise
Lie on an exercise mat and k eep your toes pointing to the floor. Raise your ‘top' leg and
hold for 2 seconds. After each set roll over and do the other leg.
Adductor Exercise
Raise your ‘bottom' leg and hold up for 2 seconds. After each set roll over and do the
other leg.

Quadriceps Exercise
Rest your back against the Swiss Ballwith your knees bent. Push back and straighten your
knees.
Hamstring Exercises
Lie on your back with your heels on top of the Swiss Ball. Dig your heels into the ball
and lift your pelvis up. Hold for 4 seconds.

Hip Flexor, Hamstring and Gluteal Exercise

Lie on your back with your heels on the Swiss Ball. Arms across chest. Lift up your
pelvis and hold. Lift up alternate legs and hold for 4 seconds.

Hamstring and Gluteal Exercise

With your knees and ankles 15cm apart, balance with your back on the Swiss Ball. Your
knees should be at 90 degrees. Tighten your bottom and push your pelvis up. Raise your
alternate legs to horizontal and hold for 4 seconds.
Trunk and Pelvis Exercise
Lay on your side on an exercise mat. Keep your body and legs straight. Push up on your
forearm. Hold for 6 seconds. Roll over and work the other side.
Back Extensor Exercise
Slowly lift you head and shoulders up off the floor. Hold for 6 seconds.

Back Extensor and Gluteal Exercise

Keep your knee straight and slowly lift your leg up. Hold for 6 seconds then relax. Repeat
with opposite leg.

Back Extensor and Gluteal Exercise

Slowly lift your opposite arm and leg. Hold for 6 seconds. Repeat on other side.
Arm, Trunk and Abductor Exercise
Keep your legs and trunk straight. Push up on your forearm and hold. Steady yourself and
raise your top leg up and hold for 4 seconds.

Press Ups
Balance your knees on the Swiss Ball and hands on the floor. Slowly lower your chest to
the floor then raise up.
Pelvic Lifts
Sit on the floor with your hands behind your shoulders and your heels on top of the Swiss
Balll. Lift your pelvis up and hold for 6 seconds.

Exercises for Strengthening the Back Muscles

Trunk and Pelvis Exercise
Lay on your side on an exercise mat. Keep your body and legs straight. Push up on your
forearm. Hold for 6 seconds. Roll over and work the other side.
Back Extensor Exercise
Slowly lift you head and shoulders up off the floor. Hold for 6 seconds.

Back Extensor and Gluteal Exercise

Keep your knee straight and slowly lift your leg up. Hold for 6 seconds then relax. Repeat
with opposite leg.
Back Extensor and Gluteal Exercise
Slowly lift your opposite arm and leg. Hold for 6 seconds. Repeat on other side.

Arm, Trunk and Abductor Exercise

Keep your legs and trunk straight. Push up on your forearm and hold. Steady yourself and
raise your top leg up and hold for 4 seconds.
Press Ups
Balance your knees on the Swiss Ball and hands on the floor. Slowly lower your chest to
the floor then raise up.

Pelvic Lifts
Sit on the floor with your hands behind your shoulders and your heels on top of the Swiss
Balll. Lift your pelvis up and hold for 6 seconds.

Exercises for Strengthening the Gluteal (Buttocks)

Muscles

Trunk and Pelvis Exercise

Lay on your side on an exercise mat. Keep your body and legs straight. Push up on your
forearm. Hold for 6 seconds. Roll over and work the other side.
Back Extensor Exercise
Slowly lift you head and shoulders up off the floor. Hold for 6 seconds.

Back Extensor and Gluteal Exercise

Keep your knee straight and slowly lift your leg up. Hold for 6 seconds then relax. Repeat
with the opposite leg.
Back Extensor and Gluteal Exercise
Slowly lift your opposite arm and leg. Hold for 6 seconds. Repeat on the other side.

Arm, Trunk and Abductor Exercise

Keep your legs and trunk straight. Push up on your forearm and hold. Steady yourself and
raise your top leg up and hold for 4 seconds.
Groin Strain Injury
A Groin Strain is one of the most common injuries in sports, especially football. The term
describes a strain of the Adductor muscles that are located on the inside of the thigh. The
injury usually occurs when the muscle is forcibly stretched beyond its limits and the
muscle tissue tears. A tear in a muscle is referred to as a strain and, depending on its
severity, is classified as a first, second or third degree strain.

The immediate treatment for any muscle injury consists of the RICE protocol - rest, ice,
compression and elevation (never apply ice directly to the skin). As a general rule, grade
one Groin Strains should be rested from sporting activity for about 3 weeks, and grade
two injuries for about 4 to 6 weeks. In the case of a complete rupture, the muscle may
have to be repaired surgically and the rehabilitation afterwards will take at least 3
months.

Common Groin Strain signs & symptoms:

• A sensation of pain, tightness or cramp in the inner thigh.

• Groin pain when turning and kicking a football.
• Sharp pain when walking in severe cases.

Groin Strain Injury Explained

A Groin Strain is one of the most common injuries in sports, especially football. The term
describes a strain of the Adductor muscles that are located on the inside of the thigh. The
Adductor muscle group is made up of five muscles:

• Adductor Brevis
• Adductor Longus
• Adductor Magnus
• Gracilis
• Pectineus
The injury usually occurs when the muscle is forcibly stretched beyond its limits and the
muscle tissue tears. A tear in a muscle is referred to as a strain and, depending on its
severity, is classified as a first, second or third degree strain:

• a first degree strain is damage to a few muscle fibres

• a second degree strain is damage to a more extensive number of muscle fibres
• a third degree strain is a complete rupture of the muscle itself

Groin Strain Signs & Symptoms

In the case of a grade one Groin Strain the signs may not be present until after the activity
is over. There may be a sensation of cramp or tightness and a slight feeling of pain when
the muscles are stretched or contracted.

A grade two Groin Strain causes immediate pain which is more severe than the pain of a
grade one injury and produces pain on walking. It is confirmed by pain on stretch and
contraction of the muscle. A grade two Groin Strain is usually sore to touch.

A grade three strain is quite rare in the adductor muscles. There is an immediate burning
or stabbing pain and the athlete is unable to walk without pain. In the case of grade two
and three injuries, a large bruise will appear below the injury site after a few days - this is
caused by bleeding within the tissues.

Groin Strain Treatment

What you can do

The immediate treatment for any muscle injury consists of rest, ice, and compression. Ice
packs can be applied for periods of twenty minutes every couple of hours (never apply
ice directly to the skin as it can cause an ice burn). The ice packs relieve pain and reduce
bleeding in the damaged tissue. This can help to reduce the injury rehab time.

Resting may be the common sense approach, but it is one that is often ignored by
competitive athletes. This is unwise, since it does not take much to turn a grade one strain
into a grade two, or a grade two strain into a grade three. As a general rule, grade one
Groin Strains should be rested from sporting activity for about 3 weeks, and grade two
injuries for about 4 to 6 weeks.

In the case of a complete rupture an opinion from an orthopaedic doctor is required. The
torn muscle may have to be repaired surgically and the rehabilitation afterwards will take
about 3 months.

Groin Strain Prevention

What you can do

The following measures may have the effect of reducing the chances of sustaining a
muscle strain:

• Warm up prior to matches and training is thought to decrease muscle stretch

injuries because the muscle is more extensible when the tissue temperature has
been increased by one or two degrees. Warm pants (compression shorts) are
extremely effective at maintaining muscle temperature, even in cold conditions.
They provide warmth and support and are extremely effective at preventing
muscle injuries.
A good warm up should last at least 20 minutes - starting gently and finishing at
full pace activity. Practicing sport specific activities helps tune coordination and
prepare mentally for competition.
Professional Warm Up Guide
• Recovery after training sessions and matches can be enhanced by performing a
cool down. Ideally the cool down session should take place the day after the
activity. This is thought to help muscles get rid of waste products. This is also the
ideal time to do stretching exercises.
Professional Cool Down Guide
• Maintaining good muscle strength and flexibility may help prevent muscle strains.
Muscle strength allows a player to carry out match activities in a controlled
manner and decreases the uncoordinated movements which can lead to injury.
Core strength exercises using a Swiss Ball are ideal. Tight muscles are associated
with strains and stretching on a mat should also be practiced to maintain muscle
length and prevent injury.
Guide to Core Strengthening Exercises
• Diet can have an effect on muscle injuries. If a player's diet is high in
carbohydrate in the 48 hours before a match there will be an adequate supply of
the energy that is necessary for muscle contractions. However, if the muscles
become short of fuel, fatigue can set in during training or matches. This fatigue
 can predispose a player to injury. Carbohydrate and fluids can be replenished
during training and matches by taking an energy drink or energy gel periodically
during activity.

IlioPsoas Syndrome Injury

Pain at the front of the hip may be due to a Hip Flexor muscle strain. The IlioPsoas
muscle is most commonly affected. The IlioPsoas muscle is comprised of the Iliacus and
Psoas muscles. The IlioPsoas sits deep down, in front of the hip joint, its main job being
to flex the hip (bringing the leg out in front of the body) as when kicking a ball.

The IlioPsoas attaches to the thigh bone via the IlioPsoas tendon. In between this tendon
and the hip joint lies the IlioPsoas Bursa (a small sac of fluid). IlioPsoas Syndrome is the
name given to a condition in which the tendon and/or the bursa become inflamed and
irritated.

A person suffering from IlioPsoas syndrome may have pain in the hip and thigh region,
as well as hip stiffness and in some cases a clicking or snapping hip. Treatment aims to
settle the condition down and then improve the strength and flexibility of the hip muscles,
involving 6 weeks of rehabilitation, before a gradual return to full activity.

Common IlioPsoas Syndrome signs & symptoms:

• Pain when lifting the knee up.

• Pain when attempting to kick.
• Pain during hip flexor stretch.

IlioPsoas Syndrome Injury Explained

Pain at the front of the hip may be due to a Hip Flexor muscle strain. The IlioPsoas
muscle is most commonly affected. The IlioPsoas muscle is comprised of the Iliacus and
Psoas muscles.

The IlioPsoas muscle lies in front of the hip joint and sits quite deeply, below the surface
of the skin. Its main job is to flex the hip (bringing the leg out in front of the body) as
when kicking a ball. The IlioPsoas attaches to the thigh bone via the IlioPsoas tendon (a
tendon is a structure which attaches muscle to bone).
In between the tendon and the hip joint lies the IlioPsoas bursa (a small sac of fluid).
Bursae are present wherever moving parts occur, and help to reduce friction. They are
normally found around joints and where tendons, muscles or ligaments pass over bony
prominences.

IlioPsoas Syndrome is the name given to a condition in which a person has IlioPsoas
bursitis (irritation and inflammation of the IlioPsoas bursa) and/or IlioPsoas Tendonitis
(irritation and inflammation of the IlioPsoas tendon). The condition occurs primarily in
gymnasts, dancers and track athletes and is caused by repetitive hip flexion.

IlioPsoas Syndrome Signs & Symptoms

A person suffering from IlioPsoas syndrome may have pain in the hip and thigh region,
as well as hip stiffness and in some cases a clicking or snapping hip. The physiotherapist
should be able to diagnose the condition through manual tests, but it can be confirmed by
an ultrasound or MRI scan.

IlioPsoas Syndrome Treatment

What you can do

The initial aim in the treatment of IlioPsoas syndrome is to allow the condition to settle
down and pain to decrease through rest, electrotherapy and anti-inflammatory
medications. Ice packs can be applied for periods of twenty minutes every couple of
hours (never apply ice directly to the skin as it can cause an ice burn). The ice packs
relieve pain and reduce bleeding in the damaged tissue. This can significantly reduce the
total rehab time.
Once the acute pain has settled down, a 6 week programme of flexibility and
strengthening exercises for muscles around the hip can begin, followed by a gradual
return to full activity. Resistance bands are ideal for strengthening the muscles around the
hip.

As with all overuse injuries, IlioPsoas syndrome can be caused by doing too much, too
soon. When beginning or stepping up any exercise, gradual progress must be made. For
example, it is impossible to increase from running 2 miles per day one week to running
10 miles per day the next week, without the body being put at risk of various problems.

As well as progressing gradually, your body has to be prepared for increased physical
demands. Core strength exercises to help improve the stability of the trunk and pelvis are
an important component of the rehab programme, as well as the prevention of overuse
problems in the pelvis and groin. The Stabiliser Pressure BioFeedback device is an
excellent tool to help ensure that your Core Stability exercise technique is correct. More
advance mat based and Swiss Ball exercises can help to develop Core Strength for sports.

Guide to Core Strengthening Exercises

IlioPsoas Syndrome Prevention

What you can do

Warm up prior to sporting activity is thought to decrease muscle and tendon injuries
because the tissues are more extensible when the tissue temperature has been increased
by one or two degrees. Warm pants (Compression Shorts) are extremely good at
maintaining muscle temperature in the groin and pelvic region, even in cold conditions.
They provide warmth and support and are very effective at preventing muscle injuries.

A good warm up should last at least 20 minutes - starting gently and finishing at full pace
activity. Practicing sport specific activities helps tune coordination and prepare mentally
for competition.

Professional Warm Up Guide

Maintaining good muscle strength and flexibility may help prevent overuse injuries. Core
strength exercises using a Swiss Ball are ideal. Tight muscles are associated with injury
and stretching on a mat should also be practiced to maintain muscle length and prevent
injury.