A Fresh Look at Abdominal Wall Pain in Athletes

Abdominal wall pain in athletes is not uncommon; however, it is often misdiagnosed or mistreated. Over the last several years, I have seen a number of young men between the ages of 16-25 that present with pain in the abdominal wall and groin following a sports injury. Many of these athletes are collegiate soccer players, basketball players or cross country runners.  All of them had an injury that happened during sport while they were quickly changing direction, cutting, kicking a ball or twisting.

The diagnoses I have run into range from sports hernia (athletic pubalgia) to groin pull to “we have no idea what to do with you.” Unfortunately, many of these athletes have over a year trying to figure out what is wrong with them. They have frequently been to multiple medical doctors, had MRIs, CT scans and many other medical tests and seen one or more doctors of physical therapy with minimal to no relief. By the time they get to our office, they are frustrated, anxious and plain fed up. Treating these athletes requires a multidisciplinary approach, time, patience and extensive knowledge of the spine, trunk and pelvic girdle.

An important part of treating athletes with abdominal wall and groin pain is to know how and when to address the psychological aspect of this injury, and in my opinion, it is the mostimportant aspect of treatment. When an athlete is kept out of the sport for weeks, months or greater than a year, there is a huge psychological impact.  Athletes' identities are often tied to their sport. When they are unable to play or compete, they often go through a mourning period and, sometimes, depression. I have found that openly discussing how athletes are coping, asking them to help write their goals and truly having them participate in their treatment goes a long way. It often gives them a little piece of control when they feel like they cannot control anything.  Additionally, we often refer them to work with a sports psychologist to address what is outside our scope of practice.

From a physical therapy standpoint, these athletes often present with similar impairments, such as tightness and hypomobility in the thoracic spine, pelvic obliquities, impaired postural control, dysfunctional movement patterns, dysfunctional breathing and muscle imbalances in the abdominal wall and pelvic girdle. Too often, practitioners spend a majority of their time working or releasing the adductors, hip flexors and glute strength. While these are all important components of the issue, simply addressing these will not address the root of the problem.

Since every athlete is different, there is no cookie cutter way to help these athletes heal from their injuries. However, I often begin with the basics - it is so surprising to me that the 

basics are often forgotten! Here are a few things I nearly always need to address:

1. Posture:How are athletes standing and sitting? Do they stick their rib cage out? Round their spine? Tuck their pelvis?

2. Breathing: Are they using their diaphragm or gripping their abdominal muscles?

3. Spinal mobility: what does their thoracic and lumbar spine look like? Is it moving well?

4. Muscle imbalances: Do they know how to use their deep core (hint if they can't breathe, they don't!). Are they over recruiting the obliques? How is the posterior chain or adductor strength (remember, tightness is often associated with weakness)?

Remember, these injuries are often more complex than they appear at first glance, but they don't have to be. Just break each movement pattern down, and start from the basics! If you are an athlete with unresolved abdominal wall or groin pain, let us know how we can help! 

Dr. Edwards is a doctor of physical therapy, board certified orthopedic specialist, author and CEO/founder of Precision Performance & Physical Therapy.