Side Strain (Abdominal)
What is an Abdominal Side Strain?
Side strains are an injury almost unique to cricket's fast bowlers. Javelin throwers are the only other athletic participants who also regularly strain the side abdominal muscles.
In bowlers, side abdominal strains occur on the non-bowling side of the body and the majority are strains of abdominal muscle insertions on to the lower ribs. Side strain injury is caused by tearing of the internal oblique muscle from the under surface of one of the lower four ribs or costal cartilages. MRI scans can document the site of a muscle tear, characterise the severity of injury, and monitor healing. Bony stress lesions (such as stress fractures of the 10th or 11th ribs) can occur but are less common.
There is a traditional belief that a side strain is almost a ‘rite of passage' for an elite fast bowler that is almost certain to occur once early in his playing career and is thereafter unlikely to return. However, there are cases of recurrent side strains that plague bowlers throughout their career.
Normal anatomy of the anterolateral abdominal wall. The diagram shows internal oblique muscle arising from the iliac crest and inserting into lower fourth rib under cover of external oblique muscle.
Normal anatomy of the anterolateral abdominal wall. Diagram of the coronal section through abdominal wall shows three flat muscles. Internal oblique muscle lies immediately underneath ribs.
What Causes Side Strain?
Side strains are strongly related to bowling speed, with the fastest bowlers much more likely to suffer this type of injury. It is postulated that the mechanism of injury for internal oblique muscle strain is sudden eccentric contracture with rupture of muscle fibres. An eccentric contraction is one that stops a muscle or joint from excessively lengthening.
Movements associated with bowling and throwing cause lengthening of the muscle, which is then subjected to superimposed eccentric contraction, making it vulnerable to rupture.
In research studies focusing on fast bowlers, the muscle tear occurs on the non–bowling arm side. For example, in a right-handed bowler, the left arm is initially hyperextended and then forcefully pulled through to allow the right arm to follow through and release the ball. In the hyperextended position, the internal oblique muscle on the left side can be assumed to be at maximum tension or eccentric contraction. The sudden vigorous motion from this eccentric contraction or pull through that allows the dominant shoulder to flex and release the ball is the probable point at which the internal oblique muscle is likely to rupture. A similar mechanism can be proposed for other throwing sports.
How is Side Strain Diagnosed?
MRI appears to be a sensitive test for evaluating side strain injury, showing an abnormality in all patients who had a clinical suspicion of a muscular tear. Stripping of the periosteum occurs as the muscular attachment is avulsed from the osseous or cartilaginous origin; this can result in excessive haemorrhage even though the muscle tear may be low grade.
How to Prevent Side Strain
Warming up and stretching the injury before spells of bowling is very important. Keeping the torso warm and performing a series of trunk rotation and side flexion exercises are recommended.
Side Strain Treatment
It is important to cease bowling and throwing immediately after injury and ice the painful area. For best results and reduced recovery time, seek professional treatment for a side strain. Most side strain injuries require 4 to 6 weeks of rehabilitation prior to a return to sport.
Side Strain Treatment Options
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FAQs for Abdominal Side Strain
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Please contact PhysioWorks for more information or advice.
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