Side Strain

What are Side Strain Injuries?

Side strain is a muscular tear or strain of the abdominal muscles.  They can occasionally include the ribs (where the abdominals attach).  It can also include impingement of the muscles between the bottom rib to the top of the pelvic bone

How do Side Strain Injuries occur?

Common in fast bowlers playing cricket, the side strain occurs with the fast rotation of the trunk or upper body but can also occur with repetitive trunk movements.  It often occurs after a small break (2-6 weeks) in training or sport and followed by a sudden return at near full intensity.  Often these may start out as small amounts of pain after or during activity that is not limiting but niggling and then followed by a sudden burst.

What are the symptoms of a Side Strain Injury?

There will often be pain or tenderness around the area of the ribs along the side and/or front of the trunk or ribcage. Other symptoms can include

  • Pain when bending or twisting to the side or away from the side of pain.
  • Coughing, sneezing or deep breaths
  • Abdominal contractions (like sit-ups)

How severe is the injury?

Best to begin with a clinical diagnosis in which the injury can be classified as either:

  • Acute or insidious onset muscular tear/strain (of the internal oblique muscle) or impingement
  • Insidious onset bony (rib) bruising / fracture / impingement

You can get an MRI to assess the bony reactions which will assist in determining the severity of the injury.  This can include stress reactions, intramuscular swelling and size of tears. Ultrasound will help to confirm the muscle injury but is often not required.

Muscular injuries are often classified on a 3-grade basis and this can be done in the clinic. 

  • Grade 1 is a muscular strain where minimal damage may have occurred to the muscle. You will often be able to contract the muscle, okay but stretching it or moving it under great force will be painful
  • Grade 2 will effectively be a moderate size tear in which it will be painful to contract the muscle and movement will be severely limited
  • Grade 3 is very rare and will often have extensive bruising.  It involves a lot of weakness and initially a lot of pain.

Treating Side Strain Injuries

It depends firstly on whether it involves the bone or not and whether it has significant structural changes around the bone.  In some cases, a period of active rest may be required to allow the swelling to go down. 

Anti-inflammatories are not recommended for acute muscle tears in the first few days as it may slow down the healing process.

Treatment for isolated muscular tears often commences in the first 48 hours with progressive muscular contractions to help the muscle heal more effectively.  Range of movement and strengthening can occur in the first few days with minimal pain.  Then after the first 5-7 days more intense strengthening can normally begin (depending on the grade and your body’s healing ability).  This can include strengthening at length, position-specific strengthening and fast-paced strengthening.

In cases of both bone and muscular injuries, it is crucial to identify all the contributing factors before the injury and since the injury occurred.  This is dependant on your sport or activity.  Impingement related issues can improve with taping.  Modifications to training volume and intensity may be required as you progress back to sport/activity.

Sometimes anti-inflammatories or injections may be beneficial to remove chronic swelling or to reduce the reaction at the bone.

How long will recovery take?

Simple (grade 1) muscle strains can see a return to sport in 2-4 weeks however predisposing issues may still be present.

Grade 2 muscle injuries and minor bony injuries including impingement can see a return, sometimes with limitations over 4 to 8 weeks depending on the activity.  Some predisposing issues may still be relevant and present.

Grade 3 muscle injuries and significant bony stress injuries with significant bony changes may take several months to return to full activity.

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