Symptoms can come on without an obvious cause, and other times it only takes a sneeze or a bit of extra effort while lifting in the gym.
The injury is persistent, hanging around for weeks, even months.
So how do you confirm that it’s an abdominal muscle strain? And once you’ve confirmed it, how do you get rid of it?
(If you think you’ve injured an Abdominal Oblique muscle specifically, skip straight to our post on self-diagnosing Abdominal Oblique muscle injuries, click here).
So here’s our Sports Physio’s tips and tricks to diagnosing and fixing abdominal muscle injuries.
Can you pull a muscle in your stomach?
The short answer is yes, you can definitely pull a muscle in your stomach.
But like every question, the devil is in the detail!
The abs are made up of layers, with four overlapping muscles running in all directions (top to bottom, diagonally inwards and outwards and one that wraps around horizontally – see below).
But there’s also layers of fascia, thick stringy ligaments and bands of connective tissue holding it all together.
Depending on the action that causes the damage, you could injure any of these structures.
If you pulled a muscle in your stomach, it’s often during a high load, forceful movement in a shortened position – like the last part of an ab crunch or sit up.
As the muscle shortens and the muscle fibres pull everything closer together, it needs to generate more force with less room to move.
Eventually it just runs out of useable muscle length and bam! You’ve got a pulled ab muscle.
If it’s more of a stretched position, like reaching up overhead to lift a heavy box from the top shelf, you can overstretch the connective tissue.
This includes any structure that is designed to store elastic force, such as abdominal fascia and tendons.
As the elastic fibres stretch to store force, they can reach their maximum length and then overload as the force is applied.
Pulled abdominal fascia often doesn’t have the “pop” feeling – it’s more of a painful overstretch than a sudden jolt.
It’s also usually more common in the lower abdominal area, so it often gets mixed up with a pulled lower abdominal muscle.
Lastly, there’s an inguinal or umbilical hernia – a bulge of fatty tissue through a narrow gap in the abdominal wall.
(Or if you’ve already had a hernia repair, you can strain the area around the repair – see here for how to diagnose abdominal pain after a hernia repair).
A hernia usually needs a sudden explosive force or very high load ab muscle force to cause the blow out.
When you’re straining at your max, the pressure builds up in the abdominal cavity and the tissue suddenly gives way.
It results in instant pain, a prolonged ache and the urge to stay doubled over to take all the stretch off the abdominal wall.
What does a torn stomach muscle feel like?
Tearing a stomach muscle isn’t easy – this is because the “abdominal wall” is actually made up of a number of dense layers, with four different muscles overlapping with fascia and connective tissue.
The four muscles are Rectus Abdominus (aka. the “Instagram six pack”), Internal Obliques, External Obliques and Transverse Abdominus.
A pulled stomach muscle typically needs high forces or awkward (cramped or stretched) positions to cause injury.
When it tears, you’ll feel an uncomfortable pop, grab or stab in a small area of the abdominal wall.
It’s more common for this injury to happen during hard abdominal exercises or complex positions.
Often the injury isn’t associated with too much pain – that comes later as it bleeds into the space around the tear.
Straight after the initial injury, you’ll have an awareness of the site of the damage, like a mild tight or pinchy sensation.
That initial feeling after the pulled stomach muscle steadily grows as the bleeding puts pressure on the injury tissue.
It usually peaks around 2-3 days after the incident, then lingers for weeks as it slowly recovers.
And it’s this bleeding response that is directly linked to the healing time! Read on…
Why does a pulled stomach muscle take so long to heal?
The reasons why a pulled stomach muscle is such a persistent and frustrating injury is twofold.
Firstly, the torn stomach muscle causes a small amount of bleeding into the surrounding area.
Unfortunately there isn’t a lot of space in the layers of the abdominal wall.
So that small amount of bleeding is squeezed like an overinflated balloon, putting pressure back on the sensitive muscle damage.
As the bleeding pushes in and occupies space, it causes more pressure on the injury.
More pressure leads to more bleeding, and so the cycle continues for up to 2-3 days.
Secondly, it’s very hard to rest a muscle that’s responsible (in part) for keeping you upright.
Injury an arm muscle and you just use the other one.
Tear a calf muscle and you can use crutches for a few days.
But get a pulled stomach muscle, which braces the spine to keep you upright, and you can’t avoid it.
It never gets complete rest (which isn’t such a bad thing – read more about the problems created by complete rest here) but it frequently gets overloaded in its normal daily work.
So just as its healing and recovering, you reach for a car door, or react to catch a falling pen, or sneeze (THE WORST!!!)
Every little bit of overload means that the healing is disrupted and takes a little longer.
Little setbacks mean that weeks can turn into months and the frustration grows.
So, after confirming the diagnosis of a pulled stomach muscle, we lay out a simple 6 step exercise program to keep you moving forwards to complete recovery.
Diagnosing a pulled stomach muscle
Here’s a simple 4 point checklist to make sure your stomach pain is most likely due to a pulled stomach muscle.
If it doesn’t fit all the criteria, it doesn’t mean that it’s not a pulled stomach muscle.
It just means that you need to think about getting the diagnosis confirmed by your doctor or local health practitioner.
1. An abdominal strain needs excessive muscle loading to become symptomatic.
Common causes of a pulled stomach muscle include unaccustomed abdominal strength exercises (eg. Crunches) and high intensity or sudden abdominal loading (eg. Sneezing or coughing).
Symptoms begin within a few hours to two days after the overload.
If there are no obvious causes of muscle overload, you should be wary of non-muscle causes of abdominal pain.
These include reproductive and digestive conditions and definitely warrant a visit to your doctor.
2. Symptoms can be stirred up with abdominal stretch or abdominal contraction.
Like any muscle injury, the pain from a pulled stomach muscle can be aggravated by activating or stretching the muscle.
However, in the case of organ-related symptoms, this can also generate symptoms due to compression of the area.
Due to this, pain on muscle contraction or stretch shouldn’t be used to determine the diagnosis.
3. It usually feels better overnight but gets sore again with daily activities.
The muscles get a chance to relax and recover overnight, so they feel better on waking.
They still may cause discomfort initially while trying to find a comfortable sleeping position.
Non-muscle causes, such as digestive issues, may worsen overnight and cause discomfort during sleep.
4. It doesn’t worsen when you’re sitting.
Sitting down puts the muscles in a shortened, relaxed position and reduces or eliminates symptoms.
Conversely, symptoms caused by abdominal organs can worsen in sitting.
6 exercises to treat a torn stomach muscle
To fix a pulled stomach muscle, you first need to know what may contribute to further overload. These include:
1. Fast or strong twisting forces. Examples include a golf swing or tennis backhand.
2. Repetitive or excessive stretch. Examples include sprinting or fast running or overhead lifting.
3. Muscle contraction in a stretched position. This includes a tennis serve or butterfly swimming technique.
Each of these elements should be avoided in the early stages of recovery.
As the symptoms begin to subside, you can gradually reintroduce each type of loading. It’s this reloading period that carries the greatest likelihood of reaggravation.
As symptoms allow, you can progress through a strength program. This is to improve the tolerance of the muscles to loading.
Start with the first exercise and perform it until symptoms ease – it usually takes a week or two to noticeably improve.
Once it feels better, move on to exercise #2 and work on that until it settles. And so on…
You can also begin to introduce other strength work, such as squats, as soon as they’re comfortable. Keep all strength work to double leg exercises in the early phases.
What else could it be?
If you feel like you’ve got a pulled stomach muscle but you’re not sure how you did it, or it’s causing other issues, be on the look out for these conditions:
A hernia tends to ache a lot after exertion and is slow to settle
Inguinal ligament strain
A ligament strain at the bottom of the abdominal wall, this injury is similar to a pulled stomach muscle.
The rehab program for Inguinal Ligament Strain is very similar to the pulled stomach muscle program above.
Digestive or reproductive condition
These conditions can get worse at rest or without obvious muscle loading.
If in doubt, get it checked out!
Hip flexor injury
This will feel like a deep muscle strain in the lower abdominal area.
The rehab for it is slightly different from the pulled stomach muscle program listed above.