SHIN SPLINTS

Shin splints are characterized by pain on either the inside or outside portion of the shin. Most commonly, the pain occurs after running, but as the symptoms increase, may limit ones ability to run at all. Traditionally, shin splints have been treated by administering anti-inflammatory medications, using ice and strengthening the muscles of the shin.

The secret to successfully treating shin splints is to accurately identify the cause. Pelvic imbalances and/or improper movements of the foot and ankle have to be considered as culprits in creating added strain to the shin. In addition to the remedies mentioned above, treatment must include proper corrections of the muscular and joint imbalances of both the pelvis as well as the foot and ankle.

IT BAND SYNDROME

Iliotibial Band Syndrome is characterized by pain on the outside of the knee, thigh and in some cases the hip. The iliotibial band is a thick, fibrous tissue that begins at the hip and extends to the outer side of the shin (tibia) just below the knee. The band works with several muscles of the thigh to provide stability to the outside of the knee joint.

Treatment of IT Band Syndromes begin with correcting any leg length discrepancies and using proper footwear to address issues of overpronation. Traditional treatment will include icing the affected area, stretching, taking anti-inflammatory medications and in severe cases, administering cortisone injections to further reduce inflammation. An aggressive protocol of deep muscle work and Active Release Techniques to the overactive or tight IT Band is usually very effective in speeding up the recovery time.

PLANTAR FASCITIS

Plantar Fascitis is usually characterized by pain in the area of the heel bone and the sole of the foot. The pain can be pinpoint and local or it can travel along the arch of the foot.

Proper assessment of the foot is essential as Plantar Fascitis pain mirrors the pain associated with a bone spur at the heel of the foot. If the initial evaluation of the involved area is inconclusive, it may be necessary to have a plain film Xray performed to rule out the bone spur.

One must understand that Plantar Fascitis is a condition that develops over time due to joint and muscle imbalances of the lower leg and foot. Treatment must include, stretching and strengthening the calf muscle and well as improving the balance and strength of the small muscles that make up the sole of the foot. In some cases the patient may require orthotics to control improper foot movements.

PATELLAR TRACKING DYSFUNCTION: AKA-RUNNER´S KNEE

This is the most common complaint of the knee for both the avid and casual runner. Another common medical diagnosis with a similar presentation, is Patellar Tendonitis. Both conditions originate from muscular imbalances of the thigh and hamstring as well as misalignments of the pelvis and spine.
Initial treatment consists of reducing the pain and inflammation. This is then followed by correction of the joint and muscular imbalances. We recommend an aggressive program of chiropractic, physical therapy and stabilization training for the entire locomotor system including the pelvis, hip, thigh and leg.

CONCLUSION

Runners injuries are common, but they can be successfully treated with a comprehensive program that looks to reduce pain and inflammation, improve joint movements and coordinate motor control of the muscles of the hip, knee and foot. If you continue to experience pain and discomfort, consider a second opinion from an integrated practice that incorporates the best in physical therapy, chiropractic and rehabilitation.

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The median nerve may be compressed at several levels in the arm: by the ligament of Struthers, in the forearm at the level of the lacertus fibrosus, pronator teres or at the origin of the flexor digitorum superficialis. There is activity related discomfort in the forearm and median nerve paraesthesia. Forced repetitive pronation in weight training may be a cause. The ‘true’ Tinel’s sign (sustained pressure directly over the nerve) reproduces paraesthesia; what is now called Tinel’s sign will be positive at the site of compression and so define the exact level of compression. Symptoms will be reproduced by resisted elbow and wrist flexion (compression at lacertus), resisted pronation (at pronator), or resisted long and ring finger PIPJ flexion (at superficialis arch). Nerve conduction studies are unreliable. Treatment is rest and modification of aggravating factors. Surgical release is occasionally needed.

Carpal tunnel syndrome

Carpal tunnel is no different in the athlete. Mild symptoms are treated with splinting the wrist (in neutral). Surgical release gives excellent relief, but be warned of the persistence of ‘pillar pain’ at the incision site associated with forcible grip for about three months. Note that Kienböck’s (avascular necrosis of the lunate) disease can sometimes present as carpal tunnel syndrome.

Ulnar nerve (handlebar palsy)

The ulnar nerve may be compressed in Guyon’s canal in cyclists as a result of wrist hyperextension and direct pressure from handlebars. Numbness in the ulnar two and a half fingers is the usually presentation. Motor signs are often present. Avoid prolonged riding (for a time); use padded gloves and modify handlebars (may persist for several months) otherwise the most common cause of ulnar nerve compression at this level is a ganglion (picked up on ultrasound).

Anterior interosseous nerve compression

Anterior interosseous nerve compression may present with vague forearm pain and occasionally weakness of flexor pollicis longus, index profundus and pronator quadratus (not able to make ‘OK’ sign Fig. 8). Cause maybe: Anatomic variations in vessels, muscle origins or nerves; Space occupying lumps such as ganglia and lipoma. Management as for pronator syndrome.

Radial nerve (radial tunnel syndrome, RTS)

Radial nerve compression may be confused with or be associated with lateral epicondylitis. Provocative tests for lateral epicondylitis (with straight elbow passive flex wrist or ask patient to hold wrist dorsiflexed against resistance) produces pain over the extensors a few centimetres distal to the lateral epicondyle. Test for RTS: arm straight resisted compression long digit, tenses ECRB and reproduces symptoms. Rested and splinting the forearm in neutral generally resolve symptoms. Numbness in the radial sensory nerve is rarely seen in runners who maintain marked elbow flexion throughout their gait cycle. Technique modification is usually all that is required.

Distal posterior interosseous nerve syndrome

An unusual cause of dorsal wrist pain. Diagnosis is secured if injection of local anaesthetic into the fourth dorsal compartment eliminates symptoms. Transaction of the nerve maybe needed.

Repetitive trauma to the ulnar digital nerve of the thumb occurs in ten pin bowlers, and racquet sports. Equipment and technique modification are necessary to avoid permanent damage. Neurolysis is necessary for more severe cases.

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The most common carpal fracture. Volumes have been written about the appropriate management of this fracture.

Suspected after a fall onto the hand and tenderness over the scaphoid or in the anatomic ‘snuff box’, (scaphoid impaction test, SIT, is positive, Swelling and ‘thickening’ in the AP length of the wrist may be seen. Resisted pinch is painful. The x-rays should include a ‘scaphoid view’ (PA in ulnar deviation).

X-rays may be negative. Place the patients in a ‘scaphoid cast’ and rex-ray at two weeks; if still pain with negative x-rays, consider a truly ‘occult’ fracture, or a scaphoid-lunate ligament injury and obtain stress x-rays and a bone scan.

The median time for union of a scaphoid fracture is twelve weeks (The more proximal the fracture is, the more likely avascular necrosis and / or non-union).

Treatment: Immobilize tubercle or non displaced (no displacement) waist fractures in a short arm cast (including the thumb up to, but not including the IP joint) with the thumb pulp opposed to the pulp of the middle finger for six weeks. If no evidence of union progressing fix the fracture with a Herbert screw. Displaced waist and proximal third fractures are fixed straight away with a Herbert screw. If early mobilization is desired, as with athletes, the fracture is also fixed immediately. Return to sport three weeks after surgery in non contact sports (contact and collision are not permitted until union has occurred and not before six to eight weeks post fracture).

Other carpal fractures

Fractures of the triquetrum are the second or third most common carpal fracture (usually avulsions from the dorsum of the bone). Immobilize in a splint for three to four weeks to allow pain to settle for resumption of activity (occasionally becomes source of ongoing pain and fragment excision and ligament repair may be required).

Fracture of the hook of hamate

These account for 2% of carpal fractures and are common in ‘club’ ‘racquet’ sports (hockey, golf, baseball, cricket and tennis). The mechanism of injury is an impact between the base of the club, bat or racquet and hypothenar eminence (The handle of a cricket bat is sprung to absorb impact and so a ‘batsman’ is less likely than a ‘batter’ to incur fracture). The golfer implodes the ground on the swing.

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The clinical signs of fracture are important (pain, swelling, deformity and loss of function). Diagnosis is confirmed by x-ray. Early movement is the key for a swift return to full function (so the fracture must be of a stable pattern, or be rendered stable by splinting or surgical fixation). Outcomes deteriorate if active range of motion is delayed beyond three weeks.

A fracture is reduced under appropriate anaesthetic by closed or open means and rendered stable. (Confirm by x-ray and repeat one week post injury and later as necessary).

If the fracture cannot be made stable by splinting, surgical fixation is necessary.

In general, displaced fractures involving joint surfaces will require reduction and surgical fixation. Note the called ‘clip’ or avulsion’ fractures, the bony equivalent of a tendon or ligament rupture, will usually require surgical repair.

Distal phalanx fractures

These result from a direct blow, often with the finger being ‘crushed’ between the bat and ball. The hallmark is a subungual haematoma. The nail plate maybe lifted out of the nail fold, suggesting that the fracture was, displaced and that a significant injury to the nail bed has occurred. A painful subungal haematoma under pressure may be relieved by drilling the nail plate with a sterile 19 or 19G needle, x-rays should then be taken as such (surgical cleaning of the fracture site, with accurate repair of the nail bed, magnification, and fracture fixation where appropriate give the best result; some surgeons feel a haematoma involving more than 25% of the nail plate is an indication for its removal to allow nail bed repair).

Bony mallet

Catching a finger on the ground ball, or opponent may result in avulsion fractures of the extensor tendon (bony mallet) or less commonly avulsion of the flexor tendon (this latter one is more serious and usually less recognized). Almost always require surgical treatment. Note: occasionally the tendon will pull away from the bone chip and be found in the palm.

The bony mallet (if no more that 30% of the joint surface is involved and no joint subluxation) is treated in a hyperextension splint (maintain for at least 6 - 8 weeks,) Instruct patient in skin care and changing splints.

Middle and proximal phalanges, metacarpals

Transverse fractures of the middle phalanx (distal to the insertion of flexor superficialis) result in extension of the distal fragment, those proximal to its insertion are flexed. Transverse fractures of the proximal phalanx usually result in the interossei flexing the proximal fragment. Transverse fractures of metacarpals tend to have the distal fragment flexed by the long flexors. Reduction and neutralization of the deforming forces may be possible using buddy and extension block splinting.

However short oblique, and spiral fractures of the phalanges and metacarpals may shorten/rotate and so require surgical fixation. Rotation is assessed with the fingers in flexion. The fingers should not cross and the tips should individually point to the tubercle of the scaphoid.

‘Boxer’s fracture’

Boxers fracture (a fracture of the neck of the small finger metacarpal and a result of bar-room brawling) is usually best treated in a resting splint with the hand in the safe position until pain and swelling subside (7-10 days) followed by active mobilization. Such fractures generally do not require fixation despite what appears to be marked x-ray deformity.

Dislocations and collateral ligament injuries

Dorsal dislocation of the PIPJ is common. Closed reduction (direct traction) is possible immediately, on the field, or later, under digital block. Following reduction joint then gauge stability. (The volar plate is avulsed from the middle phalanx, possibly with a bony fragment). Splinting straight for seven to ten days then ‘buddy taping’ (or dorsal block splint) for three weeks is recommended and during strenuous activity (for a further six to eight weeks).

If a dislocation will not reduce easily because of soft tissue interposition or entrapment of the dislocated phalangeal metacarpal head. Then open reduction required.

For partial collateral ligament ruptures, start immediate motion, protect with buddy taping for six to eight weeks (depending on residual tenderness).

Complete ruptures (controversial) either splint or surgically repair.

Metacarpophalangeal joint dislocations (rare) require open reduction as are thumb, collateral ligament injuries.

Skier’s thumb (Game keeper’s thumb)

This common injury occurs from sudden forced radial deviation (with/without hyperextension) of the thumb phalanx on the metacarpal with disruption, partial or complete, of the UCL/MCP (ulnar collateral ligament of the MCP) of the thumb; often seen in skiers (the ski stock handle door not protect from it) and football. Present with ulnar sided pain, swelling and instability. Xrays may show a bony avulsion. Graded as Type I (sprain, splint for 6 weeks in S-Thumb [Johnson and Johnson] and then when return to vigorous sports), Type II (partial tear, same splint) and III (complete tear, >30° abduction possible, needs surgical repair and protect postop. in S-Thumb for 6 weeks and in vigorous sport). Athletes seem reluctant to seek treatment for such ‘minor’ injuries. Rupture of UCL/MCP (Grade III) thumb often requires open exploration and repair as it is almost impossible to tell whether or not the avulsed ligament has come to lie superficial to the adductor aponeurosis (Stener lesion). However most surgeons will not explore where stable ( <30° abduction) injuries. (Exploration of older Injuries similarly shows the ligament folded back on itself beneath the adductor aponeurosis).

Mallet/baseball finger

Closed rupture of the distal extensor tendon results in the ‘mallet’, or ‘baseball’ finger. (Provided no joint subluxation, or fracture one third or less of the articular surface) splint the DIP joint in slight hyperextension for six to eight weeks (even if present after 7-19 days). In supple fingers if a swan neck deformity develops at the PIPJ include this joint in the splint for three to four weeks (in slight flexion). Commercial splints are available.

Rupture middle slip

Rupture of the middle slip of the extensor mechanism over the PIPJ is commonly missed and results in a boutonniere deformity ( difficult to correct).

Suspect in a ‘jammed’ PIPJ, when the joint is swollen, and tender over its dorsum. Specific tests; inability to actively extend the last 10-15 degrees at the PIPJ and the Elson test (flex the PIPJ to a right angle, ‘over the edge of a table’ ask the patient to extend the PIPJ, a central slip rupture will display no movement of the middle phalanx and the distal phalanx will tend to extend). Lack of full extension, although full passive extension of the PIPJ by tenodesis when the wrist and metacarpophalangeal joints are fully passively flexed, indicates rupture. Later signs are fixed flexion of the PIPJ with decreased passive DIPJ flexion with PIPJ fully extended.

Splinting is the most effective treatment. First correct PIPJ flexion and then DIP flexion (may take a minimum of eight weeks or longer to achieve the desired results).

Ruptures of the extensor mechanism at the level of the MPJ may occur (a ruptured sagittal band, on the radial side of the long finger). There is localized pain, swelling and an inability to actively extend the MPJ. Note the patient can maintain full extension of the joint if it is passively extended.

Triggering (extensor tendon subluxing between the metacarpal heads) of the finger at MPJ rather than PIPJ level may later present. If seen early these injuries respond to splinting the MPJ in extension for three weeks. Other joints are left free. If seen late the tear is best repaired.

Rarely may see at MPJ level a longitudinal split in the extensor tendon and rupture of the dorsal MPJ capsule (result of a direct blow, as in boxing martial arts). Surgical repair is indicated.

Flexor tendon avulsion (‘Jersey’ finger)

Flexor tendon avulsion is not common and not well recognized (from an attempt to grab the jersey or equipment of an opposing player (‘jersey’ finger). Not able to flex DIPJ bruising is present and a tender lump in the palm. The ring finger commonly affected. Players of ‘Oztag’, a variation of touch football in which a ‘tackle’ is effected by ripping a velcro fastened tag from the shorts of an opponent, incur this injury.

Early repair is best. Later repair is difficult because of swelling and collapse of the flexor sheath; If there is no pain and little functional deficit leave; Hyperextension of the DIPJ with or without ‘weakness’ in the finger may be treated by DIPJ fusion; Two stage tendon reconstruction is difficult.

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• Stop bleeding (direct pressure)
• Relieve pain (digital/wrist block)
• Assess injury (and splint)
• Path of Recovery
• Pain relief
• Protection Physiotherapy

A digital, or wrist block is the best way of relieving pain (Lignocaine 2%, without adrenaline, in doses not exceeding 5mg/kg, any nerve injury must have been assessed and documented prior to the nerve block).

Splinting the injured part is a simple (sadly often forgotten) way of providing effective and rapid pain relief. Splint as it lies or in the ‘safe’ position, (the wrist in about 30º extension, metacarpophalangeal joints 70–90º flexed, and the interphalangeal joints fully extended. The thumb, if included, is held parallel to the index finger). In this position the collateral ligaments are at their longest.

The coach can correct faulty technique and advise the medical team on the demands of the sport. But the patient is primarily responsible for their own recovery. Only the patient can do and carry out the given advice.

Pain relief, protection and physiotherapy are the three ‘Ps’ on the path to recovery.

Pain relief. Use ice, crepe and elevation (to reduce pain and swelling). Analgesics are used. Ice, heat, laser and TENS will also reduce pain.

Steroids (betamethasone *‘Celestone’* or methylprednisolone *‘Depomedrol’* have no place in acute injury. Useful in chronic inflammatory conditions (only two or three injections be given in one area). Complications with prolonged use included skin atrophy, fat necroses, infection and tendon rupture.

Athletes (under pressure to get back into competition) may request a ‘pain killing injection’. The injection of local anaesthetic is not indicated. If the hand is too painful to stand up to a the demand of competition it is not ‘ready for them’.

Protection. Continue splinting from acute phase of injury if necessary to stabilize and protect. (Allows protected movement (buddy taping’ to a healthy digit is easy and useful), apply tape so as not to interfere with joint movement, be careful when buddying an injured small finger to the right ring finger as a deforming rotatory forces may be applied to the injured digit). Dynamic splinting is best and often used in combination with static splints (at night). (S-Thumb will protect thumb or wrist).

Surgery may be necessary to get stability and protection.

Physiotherapy. Early active movement should begin as soon as possible. When pain settles, stability is established, and movement returns, stretching and strengthening are started. Any impediment to movement should be removed. (Pain, instability and oedema).

Oedema is lessened by movement, elevation, ice, and pressure from elastic bandages (Coban or similar) or tailor made gloves. Massage, laser, and intermittent positive pressure (Masman pump) will help.

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Rehabilitation is facilitated by a team approach. The basic team comprises in order of importance

• The injured athlete.
• The physical therapist- physiotherapist have the most scientific training (other types include masseuse)
• The doctor.
• Others; orthotist, brace maker, strapper, coach, exercise trainers, dietitian, psychologist, dentist, nurse, first aid personal, peer group, family and friends.

Diagnosis

History

present injury, past, athletic, social, family and psychological histories where required

Examination

including measurement of impairment and function, comparison with unaffected limb and review of biomechanical factors.

Investigations

this may include specific functional tests, pathology, radiology and nuclear medicine investigations where appropriate

Problem list

particularly if the injury is complex or severe.

Acute injury management

Begins immediately and can be performed by the athlete or any other capable person. This phase lasts the first 24-48 hours.

It consists of protecting the individual from further harm, resting, and icing the injury. Compression and elevation are used to minimize edema and haemorrhage and drugs are used for analgesia, anti-inflammatory properties and muscle spasm relief.

Acute injury management is summarized by the acronym P R I C E. Occasionally more extensive treatment or surgery is required.

Drugs

In general the authors feel that drug use should be minimized and the other components of injury management emphasized.

Drugs used in rehabilitation of sports injuries are of four main groups.

1. Analgesics - paracetamol, codeine, opiates and local anesthetic agents.

2. Anti- inflammatory medications are used extensively and have analgesic properties as well as causing moderation of the inflammatory response to injury. A short course of 3-7 days can be useful. Compliance is better with once or twice daily dosing. Topical and parental antiinflammatory medications are now available. Gastric ulceration, hypertension and renal impairment are among the side effects.

3. Anti spasmodics and sedatives are utilized to reduce muscle spasm and consequent pain, stiffness and immobility in the first 48 hours. They also induce drowsiness and can aid sleep. Benzodiazepams are used with caution as they affect balance, coordination and judgment.

4. Corticosteriods are usually used in chronic injuries. They have anti inflammatory, immunological and metabolic effects. They are injected intra-articularly or into connective tissue around tendons e.g. in subacromial bursitis. Their efficacy has been established. There are severe potential complications such as septic arthritis and tendon rupture these agents should be used by experienced practitioners only. Do not use on the Achilles tendon.

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Three concepts help with the understanding of the rehabilitation process these are impairment, disability and handicap.

Injury causes an individual an impairment. This is the injury at the tissue level e.g. ruptured medial collateral ligament of the knee.

Impairment usually causes a disability This is a loss of function e.g. walking with a limp and unable to run. This in turn may cause a handicap this is an individuals inability to perform tasks or engage in activities.

e.g. the professional footballer is unable to compete for the rest of the season due to the knee injury which causes loss of playing time, reducing his income and prematurely ending his career. This causes some reactive depression.

From this example the need for the physician to consider the medical, physical, psychosocial, vocational and leisure requirements of the injured athlete is apparent.

The areas covered in this article and further articles are

• the principles of rehabilitation
• treatment modalities
• specific examples
• complications of inadequate or incorrect
• rehabilitation prevention

Principles of rehabilitation

The process of athletic injury rehabilitation aims to minimize tissue damage and allow a safe return to activity. It is based on the science of tissue healing, knowledge of joint biomechanics, physiology of muscular strength and endurance, and the neurophysiological basis of skill retraining. Successful programs are based on an understanding of these constraints, which, when properly applied, permit the progressive activity of joints and muscles. Muscular strength, endurance and power are redeveloped while flexibility and cardiovascular fitness are maintained. Precipitating factors are identified and addressed to minimize reinjury.

To understand, grade and treat injuries the physician needs to identify the tissues involved. This chapter focuses on muscle-skeletal injury and rehabilitation of bone, ligament, muscle, tendon, connective tissue and neuromuscular structures combining to produce coordinated, purposeful movement. The treatment of other injuries is covered in relevant chapters.

The healing process involves inflammatory, repair and remodeling phases. There are detrimental effects of immobilization, muscle wasting and weakness and subsequent joint damage. This leads to further immobilization and reflex inhibition ‘a vicious circle’. Early mobilization is usually indicated.

Lack of motion of joints results in shortening of capsular and other connective tissue structures supporting the joint, loss of lubrication and alternating compression between joint surfaces deprives articular cartilage of nutrition.

There are detrimental systemic effects of immobilization, these begin within hours and become clinically important within days. They include cardiovascular deconditioning, nervous system depression, skin sores gastrointestinal complaints (constipation), thromboembolic genesis, bone resorbtion and respiratory impairment.(3) Thus the expression ‘MOVE IT OR LOSE IT’

An understanding of the sport or activity is required, many injuries are sport specific and communication is enhanced if the physician has some basic knowledge of the sports requirements. ‘Profiling’ is a concept that matches an individuals physiognomy with the type of athletic activity and in team sports their role.

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Alcohol drinking during pregnancy is found to have many negative effects. Here are few.

• The mothers who drink during pregnancy take longer time to recover from alcohol’s effects after the child birth.
• Drinking during pregnancy badly affects the mother-child relationship. The mothers are not confident about the bonding with their child.
• Even if a mother drinks once in a month it is found to have an effect on mother-child bonding.
• The more a woman drinks, the longer she has to stay in hospital to recover from the effects.

So, mothers… please keep yourself away from alcohol to stay closer to your child.

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Occurrence of Netball Injuries

According to various facts and statistics - Netball represents 7% of adult and 4% of child sports related injuries reported to emergency departments in hospitals in Australia. This shows how the high presence of netball injuries and the need to prevent their happening.

Causes and Type of Netball Injuries

• In case of netball injuries among adults, ankles, knees and hands are most affected. In case of children, hands (particularly fingers) and ankles are most affected.
• Knees are most injured part in general among netball players.
• Generally, netball injuries are mostly sprains and strains with exception of fingers. In case of fingers, injuries are fractures or dislocations.
• Falling when playing, colliding with opponents, overuse, over-exertion and hitting with the ball - are the common causes of injuries.

Prevention and Safety Tips for Netball Players

Prepare well for the game

You can prevent injuries while playing, with good preparation at the start. Go for a simple fitness testing to assure yourself that your body is fit for play. Also, fitness programs designed for netball players can help you develop the strength, co-ordination and flexibility, which are important for safe play. Pre-participation screening can help find out potential musculo-skeletal problems and avoid overuse injuries. And, the best advice is - warm up and stretch before participating in the competition and also before training.

Learn better techniques and practices

Make sure that you are perfect in all the basics of netball, like - body balance, good control on landing, move forward quickly, and catch passes rapidly. Be alert to learn correct playing techniques advised by the sport experts from time to time.

Play safe

First and best thing you need to do is to see that goal posts are firmly fixed to the ground and are padded properly. Also, regularly check and maintain netball surfaces to avoid hazards. Do not play netball on slippery surfaces. More importantly, take extra care and professional advice while selecting footwear.

Other safety tips

1. Drink adequate water before and during play to prevent dehydration
2. Use a broad spectrum sunscreen in high UV conditions, and avoid playing in extreme weather conditions
3. Make sure there are qualified first aid personnel to help you out when injury happens
4. When injured get adequate treatment and full rehabilitation before you resume to play

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A strain is the term used to describe a stretch or a tear of a muscle or tendon. Therefore an abdominal muscle strain is an injury to one of the muscles of the abdominal wall. This injury is caused mostly during a forceful activity when the muscle is stretched too far. In such cases the muscle fibers are torn and, most commonly, it would mean microscopic tears in the muscle. But at times in severe injuries the muscle can rupture from its attachment. It is usually the Rectus abdominis muscle which is damaged in an abdominal strain but other muscles in the stomach area can be affected.

Though serious abdominal strains are very rare, sportspersons are at high risk of acquiring moderate abdominal strains because of the amount of stress they apply on the abdomen muscle during their sports performances. Ruptures occur in weightlifters, throwers, gymnasts, rowers, wrestlers, tennis players and pole vaulters.

A violent, poorly performed movement of the trunk may become the reason for an abdominal muscle strain. Other reasons include- overstretching and overstressing the abdominal muscles.

Symptoms of Abdominal Muscle Injury

• Immediate pain in the area of the injury
• Difficulty to flex the injured muscle due to extreme pain
• Muscle spasm due to injury
• Swelling and bruising visible
• Unbearable pain and immobility if the injury is closer to the ribs, pubic bone or hipbone

The severity of the injury is graded according to the discomfort caused by the injury:

1. Grade 1 (Mild): Only a few muscle fibers are injured. This usually does not limit activity. Symptoms include stiffness; discomfort when moving the affected area and bruising. Recovery time is around three weeks.
2. Grade 2 (Moderate): Large numbers of muscle fibers are injured. This will limit ability to perform activities such as crunches or twisting movements. Symptoms include pain while stretching and the injury site is tender to the touch. Recovery time is up to six weeks.
3. Grade 3 (Severe): The injured muscle is ruptured. Severe injury that can cause pain with normal activities. Symptoms include intense pain. In some cases, abdominal organs push through the tear (Abdominal Hernia - occurs when there is weakness in abdominal muscles allows stomach contents to bulge through the muscle wall. Abdominal hernias can occur in the lower abdomen near the groin, near the belly button, and in the area of previous surgical scars.). This requires surgery. Recovery time is around three months.

What the Specialist or the Doctor does?

• An anti-inflammatory medication
• Ultrasound for diagnosis
• A full rehabilitation program to avoid re-injury (laser treatment may be used)
• A steroid injection if there is inflammation of the tendon followed by rest for 2 weeks.
• Operate in severe cases

Things to be taken care after the injury

There is a high risk of an abdominal pain getting misdiagnosed and the consequences in such cases could be serious. The pain should be investigated properly with appropriate diagnostic equipment. Proper rehabilitation methods should resort you back to the state of perfect health.

It is difficult to cure the abdominal injury as there is no way to splint the abdomen and give it a complete rest. Therefore, it becomes imperative to allow the muscle to cool down and allow the inflammation to come down. Exercise should be avoided in order to let the muscle heal on its own; otherwise it might lead to further spasm or pain. However, gentle stretch that doesn’t stress the injury can be done. If the athlete returns to training before the injury is healed completely, inflammation might occur.

The sooner you give your abdominal muscle sufficient rest, the faster will you recover. In case of severe muscle rupture the recovery will depend on how bad the strain is.

In all cases a regular stretch and warming up prior to exercising, cooling down afterwards and awareness about the right stress to put during the exercise will prevent any such state of discomfort.

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