**6. Abdominal muscle strain**

Several muscles converge in the abdomen: rectus, internal and external obliques and also the transverse and the pyramid

On physical examination is difficult to establish the diagnosis because beneath these muscles is the abdominal cavity that contains different organs that also can cause pain.

Not all the abdominal pain has an muscle origin and it is our challenge to know what signs or symptoms differentiates the different pathologies.

Whenever an athlete refers abdominal pain, we should start the physical examination away from the zone of pain and gradually get closer to the area that the athlete describes as being the most annoying in appearance, swelling, deformity, tumors, etc.

If we suspect a muscular abdominal tear [6], part of the physical examination would be to ask the athlete to do a sit up and putting an effort on the abdominal area. There will be patients in which you have to ask the athlete to contract the abs against resistance in order to get a painful response (figure 10).

**Figure 10.** In a sit up position ask the patient to hold it against resistance

Other conditions to rule out are:

**5. Flexor muscle strain**

142 Muscle Injuries in Sport Medicine

ming, etc.)

Another common injury is the forearm flexor injury.

resistance; pain should arise in the medial side (figure 9).

**Figure 9.** With the wrist straighten ask the patient to flex it against resistance

**6. Abdominal muscle strain**

transverse and the pyramid

For example in sports requiring abduction and external rotation after a sudden adduction internal rotation of the can cause forearm flexor muscles to be injured (e.g., baseball, swim‐

The pain from this injury can be provoked by asking the athlete to flex the wrist against

In some athletes (those with a pronator injury) a hematoma can be present. Pain can be provoked with pressure on the lateral side of the elbow joint forcing the elbow into valgus.

Several muscles converge in the abdomen: rectus, internal and external obliques and also the

On physical examination is difficult to establish the diagnosis because beneath these muscles

is the abdominal cavity that contains different organs that also can cause pain.

Once injured, there will be tenderness around over the forearm flexor muscles.

Apendicitis.- IPain localized to the bottom and right side of the patient, this is called McBur‐ ney's point. (Right lower quadrant). Pain may also be around the navel and usually is accom‐ panied by nausea and vomiting and will likely have evidence of malaise and in some cases fever (figure 11).

The athlete may have exacerbation and decrease in symptoms while in some cases the pain is only present when there are changes in the speed or change of direction. It is not unusual for

Overview of Different Location of Muscle Strain

http://dx.doi.org/10.5772/56622

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The symptoms can be vague and often undefined because of the convergence of various anatomical structures. Pain could be due to a sport's hernia, osteitis pubis, nerve pain (neurally

A physical examination can begin examining the painful area to rule out that pain that could be from a node or an inguinal hernia (in all the cases there is tenderness).If the lesion is muscular in origin, pain should increase when the athlete is asked the patient to perform hip

the athlete to have no pain when running forward without changing direction.

referred pain), bursitis, tumors, etc.

flexion against resistance (figure 12).

**Figure 12.** With the knee flex at 90° ask the patient to raise it against resistance

limited in the affected leg.

Other provocative maneuvers are to have the athlete lift the leg (with the knee extended) (figure 13a), against resistance or the examiner takes the leg in extension and do some abduction movement (figure 13b, 13c). Si hacemos este movimiento de forma contralateral con la pierna no involucrada podremos ver que el rango de movimiento está limitado en la pierna afectada. Similar tests of the contralateral (uninvolved) leg will show just how much range of motion is

**Figure 11.** The doctor´s hand is palpating the Mc Burney´s point which is painful at the pressure in appendicitis, all the other target points usually are just related to pelvic inflammation.

PELVIC INFLAMMATORY DISEASE.-This disease occurs mostly in women who may have a pelvic infection. Pain may be related to both iliac fossae.

GASTRITIS, COLITIS, ULCER.- Pain may have been present for many hours of duration coincident with swelling, presence of abdominal gas, bloating, and burning over the stomach area. Pain can also be referred from the colon.

In abdominal pathologies unrelated to the muscle and if we have any doubt, it is best to refer the athlete to a specialist and not cause more damage by waiting and see if the symptoms disappear. This is a very valuable time if the cause is pain comes from an organ of the ab‐ dominal cavity.
