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Rectus Abdominis Strain

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(Redirected from Rectus Abdominal Strain)

Other Names

  • Rectus Abdominis Strain
  • Rectus Abdominal Strain
  • Rectus Abdominis Tear

Background

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Rectus Abdominis Strain - Review Pod

History

  • Unknown

Epidemiology

  • Incidence is not well described in the literature

Introduction

Anatomical schema of the rectus abdominis (RA) muscles[1]

General

  • Common, debilitating injuries, especially seen in tennis players
  • Treatment involves a sports specific rehabilitation program emphasizing eccentric and plyometric movements

Biomechanics in Tennis

  • Abdominal musculature plays significant role in trunk and core stability
  • During the serve, large amount of angular momentum is transferred to the racquet
    • This includes trunk rotation and flexion after lumbar extension
    • The RA is most commonly injured from this position
  • There doesn't seem to be a big difference with different types of serves[2]


Anatomy of Rectus Abdominis

  • The anterolateral abdominal wall is made up of 4 flat muscles
  • They are separated at midline by the linea alba, a strong midline fibrous structure
  • Rectus abdominis
    • Paired straplike muscles, separated at the midline by the linea alba
    • Origin: anterior surface pubic symphysis, upper border of pubic crest
    • Insertion: 5th, 6th, 7th costal cartilage
  • Actions
    • Primary: flex the spine, compress the abdominal and pelvic cavities.
    • Secondary: assists in respiration by pulling the chest downward, depressing the lower ribs.

Risk Factors

Sports

  • Tennis

Differential Diagnosis

Differential Diagnosis Groin Pain

Clinical Features

History

  • Patients can typically describe an injury involving eccentric concentric action
  • Less commonly, acute direct blows to the abdomen
  • They may endorse some delayed onset muscle soreness (DOMS)
  • A history of prior, similar episodes is common

Physical Exam

  • Tenderness to the affected RA, usually below the umbilicus
  • Recommend examining the abdomen during isometric, concentric and eccentric contraction
    • Useful to help stratify lesion severity[3]

Special Tests

  • Needs to be updated

Evaluation

A 27 year-old male professional tennis player suffering RA pain during serving; clinical history revealed four episodes of RA injury. Axial T1 MR image shows scar tissue within the left muscle (arrow)
At the site of pain pointed out by the patient, there is diffuse edema of the left rectus abdominis muscle. There is an area of loss of muscle echopattern (about 24 x 11 x 8 mm) filled with fluid. There is no collection external to the muscle belly, within the rectus sheath. Left inferior epigastric vessels are patent. A comparison was done with the contralateral muscle as well as ipsilateral muscle at asymptomatic level.[4]

General

  • Usually, a clinical diagnosis which is fairly straight forward
  • Generally easy to differentiate from intra-abdominal illnesses
  • Imaging studies are not necessarily required to make the diagnosis

Radiographs

  • Can be useful to evaluate for a rib fracture
  • Not routinely required

Ultrasound

  • Characterized by disruption of normal echogenic fibrillar pattern
  • Fluid filled clefts traversing the disorganized muscle
  • Usually seen on the deep surface of the muscle belly[5]

MRI

  • Provides the most useful, precise information of lesional extension
  • Muscle tear shows focal high intensity signal with muscle disruption
  • Scar tissue generates low intensity signal on all pulse signals

Classification

Clinical Grading System[3]

  • Slight to mild: provocative maneuvers do not elicit pain
  • Moderate: Painful trunk “sit‐up” motion (concentric contraction)
  • Severe: Painful isometric contraction (Valsalva maneuver) and simple overhead reaching

Management

Rehabilitation program for RA injuries in tennis players[6]

Nonoperative

  • Initial treatment
    • Discontinue/ abstain from offending activities
    • Ice and cryotherapy
    • Avoid tennis practice

Operative

  • There are no surgical indications for RA strains

Rehab and Return to Play

Rehabilitation

  • 5 step protocol proposed by Maquirrian et al[7]
    • Pain and inflammation control, rest
    • Isometric strengthening and stretching
    • Concentric strengthening
    • Eccentric‐plyometric strengthening
    • Maintenance and re‐injury prevention

Return to Play/ Work

  • Needs to be updated

Prognosis and Complications

Prognosis

  • Needs to be updated

Complications

  • Inability to return to sport

See Also

References

  1. ↑ Balius, Ramon, et al. "Ultrasound assessment of asymmetric hypertrophy of the rectus abdominis muscle and prevalence of associated injury in professional tennis players." Skeletal Radiology 41 (2012): 1575-1581.
  2. ↑ Chow, J. W., J. H. Shim, and Y. T. Lim. "Lower trunk muscle activity during the tennis serve." Journal of science and medicine in sport 6.4 (2003): 512-518.
  3. ↑ 3.0 3.1 Lehman, Richard C. "Thoracoabdominal musculoskeletal injuries in racquet sports." Clinics in Sports Medicine 7.2 (1988): 267-276.
  4. ↑ Case courtesy of Maulik S Patel, Radiopaedia.org, rID: 64819
  5. ↑ Connell, David, et al. "Sonography and MRI of rectus abdominis muscle strain in elite tennis players." American journal of roentgenology 187.6 (2006): 1457-1461.
  6. ↑ Maquirriain, Javier, Juan P. Ghisi, and Antonio M. Kokalj. "Rectus abdominis muscle strains in tennis players." British journal of sports medicine 41.11 (2007): 842-848.
  7. ↑ Maquirriain, J., et al. "Abdominal muscle strain injuries in the tennis player: treatment and prevention." Med Sci Tennis 3 (2002): 14-15.
Created by:
John Kiel on 6 July 2025 17:51:34
Authors:
Last edited:
3 August 2025 21:56:06
Categories:
Groin | Acute | Abdominal
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