Abdominal strain: what physical therapists want you to know

There are many reasons for belly pain, but if your abdominal area hurts after exercise or doing chores, for example, an abdominal strain could be the cause. Similar to how you can strain (or pull) a hamstring or calf muscle, your core muscles can also be pulled. After all, you use your core muscles daily — even when you cough, sneeze, or laugh. 

You may think it’s best to rest and avoid movement when healing from an abdominal strain, but light exercises and stretches can be very beneficial in rehabilitating a pulled abdominal muscle. Engaging in movement can also help prevent future strains, not only in your abdomen, but in other areas of your core, too — including your lower back.

Read on to learn more about how to treat and prevent abdominal strain. Get exercises from Hinge Health physical therapists to help alleviate pain and increase your mobility.

What is an abdominal strain?

An abdominal strain is a pulled or partially torn abdominal muscle, says Renee Bullis, PT, DPT, a physical therapist at Hinge Health. Anyone can experience an abdominal strain, but certain activities can increase the risk, such as those that involve contact (e.g., football), twisting (e.g., tennis), or throwing (e.g., baseball). 

The abdominal muscle groups that are most susceptible to strain include:

• Rectus abdominis. This vertical pair of muscles are also known as the “six-pack” muscles and span from your ribcage down to your pelvis. They help you bend and stretch your back, like with sit-ups or getting out of bed. They also help to keep your back and spine stable.

• Internal and external obliques. These muscles wrap around the front and sides of your abdomen. They enable you to rotate your torso (like when you put on a seatbelt or hit a tennis ball) and bend to the side.

• Transverse abdominis. This is the deepest muscle layer in your core, wrapping around your lower abdomen. It’s a stabilizing muscle, meaning it supports your spine and pelvis. 

Abdominal strain vs. hernia: what’s the difference?

Hernias and abdominal strains can both be painful, but they’re not the same. A strain is a pulled muscle whereas a hernia is a weak spot, or opening, in your abdominal muscles that allows organs or soft tissue to protrude through, Dr. Bullis says. That’s why some people with hernias feel — or even see — a slight bulge in their abdomen, and it’s usually only painful in that area. With an abdominal strain, you may feel pain in just one spot or in a general area of your abdomen, says Dr. Bullis.  

An abdominal strain weakens the affected muscle, so it can raise your risk of developing a hernia. Gentle exercises can help repair an abdominal strain. “An abdominal strain is likely going to get better over time with movement as the tissues heal,” Dr. Bullis says. “You may not experience much change in symptoms with a hernia.” Some hernias require surgery to fully heal.

Causes of abdominal strain

You can get an abdominal strain from an acute injury, such as overreaching to hit a tennis ball or lifting something heavy that your body wasn’t prepared for. Strains can also develop over time from overuse. More causes of abdominal muscle strains include:

• Repetitive motion. Doing too much of any movement can strain your muscles. For example, if you do too many crunches every single day when your body isn’t used to doing that, it can stress your abdominal muscles. 

• Overdoing exercise. There are so many benefits to working out, but there is such a thing as doing too much — especially if your body isn’t ready yet. For example, if you lift something heavy from an awkward position or do a lot of vigorous workouts in one week, you could strain your muscles.

• Not mixing up your movement. "If you do a lot of intense exercise without giving your body a break to do different activities, it could contribute to a strain in the abdominal area," says Dr. Bullis. If you do a vigorous core workout, that could mean doing gentle walking the next day or two.

• Tight muscles. Staying in the same position, like hunched over a computer, for extended periods of time can tighten your muscles — and simple movements like twisting your torso suddenly could cause an abdominal strain. You can prevent muscles from becoming overly tight by taking breaks from sitting every 30 minutes or so. Also, doing warm-up exercises before you work out can help loosen up tight muscles.

• Prolonged coughing or sneezing. Ever had a stubborn cold or respiratory virus that just won’t go away? Sneezing and coughing that go on for several days — or weeks — can strain your core muscles. Every time you sneeze or cough, the muscles in your abdomen contract. If they’re constantly contracting, they can become overworked.  

• Pregnancy. Your abdominal muscles stretch as your baby grows in your uterus, which can increase your risk of abdominal strain, Dr. Bullis says. Pregnant people may also experience abdominal separation (diastasis recti), which is a very normal (and often painless) part of pregnancy. The core muscles that run vertically down the front of the abdomen wall separate, forming a gap down the middle to make space for the growing baby. The core muscles can heal after delivery, or several weeks postpartum, with the right strengthening exercises.  

Symptoms of abdominal strain

The symptoms of an abdominal strain can vary based on its severity and location. Strains can happen when the muscle is overstretched or, in some cases, when small or large tears develop. While the idea of a muscle tear might sound alarming, it’s actually a common injury, and most strains heal well with the right care. Here are some common symptoms of abdominal strain.

• Sharper pain, usually with movement 

• Dull ache, either at rest or with movement 

• Tightness

• Muscle spasm

• General weakness in your core

• Difficulty engaging your abdominal muscles

• Swelling

• Bruising

The above exercises are recommended by Hinge Health physical therapists to treat abdominal strain. When you’re experiencing pain from an abdominal strain, stretching and gentle mobility exercises like these can offer relief by increasing blood flow to the area and easing muscle tension.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Treatments for a

bdominal strain

Most abdominal strains will heal after a few weeks of ‌conservative treatments. These may include:

• Targeted exercises and physical therapy.When you feel discomfort of any kind, staying active can feel worrisome. But movement is medicine for abdominal strains. Most cases of abdominal strain heal from doing light exercises and stretches — not avoiding them. “A physical therapist can give you exercises that are appropriate for you based on your injury, your goals, when you’re having pain, and what movements aggravate it,” says Dr. Bullis. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit.

• Keep moving. Going on walks and doing gentle exercises can increase blood flow to the injured area. It can also prevent tightness and improve range of motion. You want to work those muscles, but you might need to modify your exercise intensity, Dr. Bullis says.

• Try ice and heat. Ice reduces swelling and inflammation, whereas heat eases muscle tension and increases blood flow to the area. Some people may find more relief from one versus the other, but you could also find both helpful. Try applying heat or ice, especially if your injury is new. 

• Give yourself a massage. Gentle rubbing and kneading around the affected muscle can loosen it and increase blood flow to the area. 

• Consider over-the-counter medication. Pain relievers, such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol), can help ease the pain of an abdominal strain. It’s important to make sure that you can safely take these medications based on your medical history, and they should be a short-term solution to help you get back to normal activity.

• Ask about a brace. “An abdominal brace can help protect the abdominal wall, but it’s more often used for severe injuries,” says Dr. Bullis. If you think a brace may help, talk to your doctor or physical therapist first. A brace should not replace exercise therapy. It’s a temporary tool to help you feel comfortable enough to do your exercises. Remember, movement is what enables healing. 

How to prevent a pulled abdominal muscle

If you’ve strained an abdominal muscle, you may be more likely to reinjure it. That’s because muscle strains can sometimes cause some scar tissue buildup, Dr. Bullis says. “Scar tissue is known to be weaker and less pliable than normal tissue, which can increase your risk of another strain in the future.” But you can reduce your risk (even if you’ve never pulled an abdominal muscle) with these prevention strategies.

• Start with a warm-up. Before you work out, play a sport, or do strenuous everyday activities that involve rotation, side-to-side movements, or other movements that generate force, prepare your body for the activity. To warm up, gently perform movements that mimic the activity you’ll be doing, or do the exercises above. Warmed-up muscles are more elastic and less prone to injury.

• Strengthen your core. “Your core stabilizes your spine as your limbs — and other parts of your body — do different movements,” says Dr. Bullis. “You use your core while doing many things, even when walking, running, and standing.” Performing core exercises like planks and oblique twists can help keep all of your core muscles strong, and reduce your risk of a strain. Workouts like yoga and Pilates are also good ways to strengthen your core. 

• Change positions. Switch up how you sit in your chair and get up more often to move around, says Dr. Bullis. Too much sitting can weaken core muscles, including your abdominals. Those muscles also become tight if you’re in the same position for a long time. Set a timer every 30 to 45 minutes as a reminder to move. 

• Increase flexibility. Tight abdominal muscles are more prone to injury when reaching, twisting, bending, or lifting, especially if you’re moving quickly. Doing a daily stretching routine can help you stay flexible and reduce your risk of straining a muscle.

PT tip: Pay attention to your position

“When you have an abdominal strain or pain in the abdomen, you tend to round your back forward,” says Dr. Bullis. While it may offer some initial relief, this hunched-over posture can contribute to even more tightness in your core muscles. Pay attention to your posture, and if you notice that you’re sitting or standing with your shoulders rounded forward, move around to loosen them up.

How Hinge Health can help you

If you have pelvic pain or symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References 

1. Copley, M., & Johnson, S. C. (2023). Abdominal Wall Muscle Injuries in Athletes. Current Physical Medicine and Rehabilitation Reports, 11(2), 235–241. doi: 10.1007/s40141-023-00402-w

2. Johnson, R. (2006). Abdominal Wall Injuries: Rectus Abdominis Strains, Oblique Strains, Rectus Sheath Hematoma. Current Sports Medicine Reports. 5(2):p 99-103. doi: 10.1097/01.CSMR.0000306528.74500.bf 

3. Maquirriain, J., Ghisi, J. P., & Kokalj, A. M. (2007). Rectus abdominis muscle strains in tennis players. British Journal of Sports Medicine, 41(11), 842–848. doi: 10.1136/bjsm.2007.036129