From the Research
Anterior cutaneous nerve entrapment syndrome (ACNES) should be treated with a conservative, non-invasive approach, including sequenced osteopathic manipulation techniques, active release techniques, instrument-assisted soft tissue mobilization, directional cupping, stretching, and strengthening exercises, as this approach has been shown to result in 100% pain reduction and complete resolution of functional limitations in a recent case study 1.
Diagnosis of ACNES
ACNES is a commonly overlooked cause of chronic abdominal pain resulting from compression of the terminal branches of the thoracoabdominal intercostal nerves as they pass through the rectus abdominis muscle. The condition is diagnosed clinically through:
- Carnett's test (increased pain when abdominal muscles are tensed)
- Pinch test (increased pain when skin and subcutaneous tissue are pinched at the painful site)
Treatment Approach
The treatment approach for ACNES should prioritize conservative, non-invasive measures, including:
- Sequenced osteopathic manipulation techniques
- Active release techniques
- Instrument-assisted soft tissue mobilization
- Directional cupping
- Stretching and strengthening exercises This approach has been shown to be effective in resolving ACNES, with a recent case study demonstrating 100% pain reduction and complete resolution of functional limitations 1.
Comparison with Other Studies
Other studies have suggested the use of local anesthetic injections, corticosteroids, and surgical neurectomy as treatment options for ACNES 2, 3, 4, 5. However, these studies are older and of lower quality compared to the recent case study 1, which prioritizes a conservative, non-invasive approach.
Key Points
- ACNES is a commonly overlooked cause of chronic abdominal pain
- Conservative, non-invasive treatment approaches are effective in resolving ACNES
- Sequenced osteopathic manipulation techniques, active release techniques, instrument-assisted soft tissue mobilization, directional cupping, stretching, and strengthening exercises are recommended as first-line treatment
- Local anesthetic injections, corticosteroids, and surgical neurectomy may be considered as alternative treatment options, but are not recommended as first-line treatment due to the availability of more recent and higher-quality evidence supporting conservative approaches 1.