Side Strain (Abdominal)

jarred edwards physio john miller physio

Article by J EdwardsJ Miller

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.

side strain

In bowlers, side abdominal strains occur on the non-bowling side of the body and the majority is 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.

side strain

Diagram 1

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.

side strain

Diagram 2

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 a reduced recovery time, seek professional treatment for a side strain.

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Side Strain Treatment Options

  • Bed Rest
  • Early Injury Treatment
  • Avoid the HARM Factors
  • Soft Tissue Injury? What are the Healing Phases?
  • What to do after a Muscle Strain or Ligament Sprain?
  • Acupuncture and Dry Needling
  • Sub-Acute Soft Tissue Injury Treatment
  • Core Exercises
  • Biomechanical Analysis
  • Proprioception & Balance Exercises
  • Agility & Sport-Specific Exercises
  • Medications?
  • Ergonomics
  • Real Time Ultrasound Physiotherapy
  • Soft Tissue Massage
  • Brace or Support
  • Dry Needling
  • Electrotherapy & Local Modalities
  • Heat Packs
  • Joint Mobilisation Techniques
  • Kinesiology Tape
  • Neurodynamics
  • Physiotherapy Instrument Mobilisation (PIM)
  • Prehabilitation
  • Strength Exercises
  • Stretching Exercises
  • Supportive Taping & Strapping
  • TENS Machine
  • Video Analysis
  • Yoga
  • Helpful Products for Side Strain

    Abdominal (Side) Strain

    FAQs for Abdominal Side Strain

  • Common Physiotherapy Treatment Techniques
  • What is Pain?
  • Physiotherapy & Exercise
  • When Should Diagnostic Tests Be Performed?
  • Massage Styles and their Benefits
  • What Causes Post-Exercise Muscular Pain?
  • Can Kinesiology Taping Reduce Your Swelling and Bruising?
  • Chest Pain: Is it a Heart Attack or Your Spine?
  • Heat Packs. Why does heat feel so good?
  • How Much Treatment Will You Need?
  • How to Achieve the Best Standing Posture
  • Sports Injury? What to do? When?
  • What are the Common Massage Therapy Techniques?
  • What are the Early Warning Signs of an Injury?
  • What is a TENS Machine?
  • What is Chronic Pain?
  • What is Nerve Pain?
  • What is Sports Physiotherapy?
  • What's the Benefit of Stretching Exercises?
  • When Can You Return to Sport?
  • Why does Back Pain Recur?
  • Why Kinesiology Tape Helps Reduce Swelling and Bruising Quicker
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    Last updated 29-Aug-2018 09:12 PM

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