Abdomen injuries

Reffered pain from dorsal spine

Reffered pain occurs with passive rotation of the dorsal spine, which, if it is cause of the problem, should have segmental localized palpable tenderness in the spine.

Sprung rib

Localized tenderness over the 9th to 12nd costal cartilage.

Stitch

Findings

Pain located in the subcostal area and which occurs early on during continuos aerobic exercise.

Cause

Not known, but possibly due to splanchic vascular contraction diverting visceral blood to the muscular system and causing an ischaemic type of pain. A proper warm-up to allow a more gradual redistribution of blood to the muscles seems to prevent the onset.

Spigelian hernia

Findings

There may be quite severe abdominal pain on exercise and very localized tenderness, with a small palpable pit in the abdominal muscles just lateral to the rectus abdominis. The pit is about the size of a little finger tip and is locally tender to palpation. “Sit-ups” can flare the pain.

Cause

A small anterior abdominal wall defect that reaches the spigelian fascia.

Investigations

None are of clinical importance in that MRI and realtime ultrasound invariably do not display the lesion. However, ultrasound may show some muscular ordination. Ultrasound will also display the underlying abdominal organs to exclude them from the diagnosis.

Treatment

Surgical repair of the defect seems to be effective.

Sports

None are specifically relevant.

Rectus abdominis

Findings

Localized tenderness in the rectus abdominis, worse with sit-ups or resisted abdominals.

Cause

Strain of the rectus abdominis, which usually occurs at one of the aponeuroses or close to the lateral wall of the rectus sheath.

Investigations

Ultrasound scan may show unilateral hypertrophy, a tear of muscular dysfunction; MRI may show localized muscle inflammation.

Treatment

a)      Electrotherapeutic modalities to settle the inflammation.

b)      Stop sit-ups, and correct any sporting technical faults.

Sports

a)      In general it is related to too many sit-ups during training. However, be alert to the possible abuse of anabolic steroids(better never use them).

b)      Tennis – the serve may produce a unilateral, enlarged rectus abdominis, possibly because the left hip is pushed forward at the throw up, when the weight is transferred to the left side. The left hip cannot clear out of the way during the hitting phase and the rectus abdominis must “pull the body through” the serve. Simply pulling harder with the abdominal muscles, to achieve a top spin serve, may increase the muscle loading and cause the strain, whilst the wind may disturb the accuracy of the throw-up and influence the muscle activity. MRI- positive, ultrasound- negative tennis players may survive a match or two, but they are best advised to retire and heal properly before returning to tennis.

If it occurs during tennis tournament, it is probably unilateral form. It can be quite debilitating and require local anaesthesia. I wounder if too many people work too hard on their sit-ups for their rectus abdominis “six packs”. These help flexion of the abdomen but do not stabilize the pelives or the spine, which requires transverses abdominis work. Many sports do not require extra strong abdominal flexors.

Epigastric discomfort

The differentials will include referral of pain from the dorsal vertebrae, cardiac ischaemia and, in the elderly, an aortic aneurysm. The epigastric causes of pain often reflect the increased acidity from tension, but in sports like cycling can indicate reflux oesophagitis or subdiaphragmatic compression from the stomach. An antacid, peppermint to “bring up wind” or a charcoal biscuit to absorb gas will reduce this discomfort. Fizzy drinks, which are freely available at tournaments, can contribute to these problems.

Conjoined tendon

Disruption of the conjoined tendons of the abdominal muscles causes pain in the groin and lower abdomen. There is quite marked tenderness to palpation through the inguinal canal of the external ring, which is dilated.

Pubic tubercle

Tenderness is found over the tubercle rather than the symphysis pubis, which suggests conjoined tendon disruption.

Inflammation of the pubic symphosis

There is a low abdominal ache with exercise, especially associated with groin or perineal pain, and tenderness to palpation is found over the pubic bones and symphysis.

Abdominal pains

Apart from the usual medical problems, where the cause is not from sport but whose presence may interfere with sport, check for melaena, which can be associated with long- distance running. No reason has been found for melaena, though a slap of the caecum has been postulated and, in one case, supernumerary ligaments binding the gall bladder. Runners’ diarrhea, which may be a more minor symptom from the same causative mechanism, is very common in long- distance runners.

Renal pain

Haematuria and myoglobinuria can be associated with long periods of exercise or high- intensity exercise  and in themselves are not indicative of renal disease.

"Concise guide to sports injuries, 2^nd edition",Churchill Livingstone, Malcolm T.F. Read,  foreword by Bryan English