Treatment of Abdominal Muscle Strain
Initial treatment consists of rest, ice, compression, and nonsteroidal anti-inflammatory drugs (NSAIDs), followed by progressive physical therapy to restore flexibility and strength once pain and swelling subside. 1
Acute Phase Management (First 48-72 Hours)
- Apply the RICE protocol immediately: Rest the affected muscle, apply ice for 15-20 minutes every 2-3 hours, use compression wrapping to minimize swelling, and elevate if possible 1
- Prescribe NSAIDs to reduce pain and inflammation during the acute phase 1
- Avoid activities that reproduce the pain, particularly eccentric movements and trunk rotation that stress the abdominal wall 2
- Restrict strenuous exercise and athletic activities until acute symptoms resolve 1
Rehabilitation Phase (After Initial Symptoms Subside)
- Initiate physical therapy focused on restoring flexibility through gentle stretching exercises 1, 3
- Progress to strengthening exercises once pain-free range of motion is achieved, targeting the specific injured muscle group (rectus abdominis, internal/external obliques, or hip flexors) 1, 2
- Implement core strengthening programs that are sport-specific if the patient is an athlete, as this is crucial for preventing recurrence 2
- Use spray-and-stretch techniques combined with home stretching programs for persistent symptoms 3
Return to Activity Guidelines
- Ensure adequate warm-up before intense exercise to prevent reinjury, as inadequate preparation is a key risk factor 1
- Avoid excessive fatigue during training, as this increases strain injury risk 1
- Progress gradually through sport-specific movements before full return to competition 2
Diagnostic Considerations
- Reserve MRI for cases requiring radiologic confirmation when the diagnosis is unclear based on history and physical examination alone 1, 2
- Consider MRI if symptoms persist beyond expected recovery time or if there is concern for complete muscle tear requiring surgical intervention 1
Important Caveats
The diagnosis is typically clinical based on acute pain during strenuous activity affecting muscles that cross two joints and contain high percentages of fast-twitch fibers 1. The long-term outcome is usually excellent with few complications when managed appropriately 1. However, recurrence rates can be significant (23.5% in elite athletes), emphasizing the importance of complete rehabilitation before return to full activity 4.