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 onto the lower ribs. A side strain injury is caused by tearing the internal oblique muscle from the undersurface of one of the lower four ribs or costal cartilages. MRI scans can document the site of a muscle tear, characterise the severity of the 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 virtually certain to occur once early in his playing career and is, after that, unlikely to return. However, there are cases of recurrent side strains that plague bowlers throughout their careers.
Normal anatomy of the anterolateral abdominal wall. The diagram shows internal oblique muscle arising from the iliac crest and inserting into the lower fourth rib under cover of external oblique muscle.
Normal anatomy of the anterolateral abdominal wall. A diagram of the coronal section through the 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 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 possible point at which the internal oblique muscle will likely 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 with a clinical suspicion of a muscular tear. Stripping of the periosteum occurs as the muscular attachment is avulsed from the bony or cartilaginous origin; this can result in excessive bleeding even though the muscle tear may be low grade.
How to Prevent Side Strain
Warming up and stretching the injury before the 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 crucial to cease bowling and to throw 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 before a return to sport.
Please consult your trusted cricket physiotherapist for specific advice.
Common Cricket Injuries
- Back Muscle Pain
- Back Stress Fracture (Fast Bowlers)
- Facet Joint Pain
- Side Strain (Abdominal)
- Shoulder Impingement
- Rotator Cuff Syndrome
- Rotator Cuff Tear
- Bursitis Shoulder
- AC Joint Injury
- Dislocated Shoulder
Cricket Injury Prevention
Common Causes of Upper Back Pain & Injury
Thoracic Spine Conditions
- Scheuermann's Disease
- Spinal Stenosis
- Rib Stress Fracture
Nerve-Related / Referred Pain
Youth Spinal Pain
Teenager Neck & Back Pain
Teenagers can be particularly vulnerable to back pain, mainly due to a combination of high flexibility and low muscle strength and posture control.
The competitive athlete and most individuals who exercise regularly or maintain fitness and core stability control are less prone to spine injury and problems due to the strength and flexibility of supporting structures. Luckily, issues involving the lower lumbar spine are rare in athletes and account for less than 10% of sports-related injuries. Injuries do occur in contact sports and with repetitive strain sports. Your physiotherapist can assist in the resolution of any deficits in this area.
Sports such as gymnastics, cricket fast bowlers, and tennis have a higher incidence of associated lumbar spine problems related to repetitive twisting and hyper-bending motions.
Spondylolisthesis is a significant concern and needs to be appropriately treated by a physiotherapist with a particular interest in these types of injuries. Luckily, most injuries are minor, self-limited, and respond quickly to physiotherapy treatment.
Common Adolescent Spinal Injuries
Lower Back (Lumbar Spine)
Midback (Thoracic Spine)
Neck (Cervical Spine)
For specific advice regarding youth neck or back pain, please seek the professional advice of your trusted spinal physiotherapist or doctor.