When we pull a muscle in our back or leg, we know what’s causing our pain. But we can also pull any of the 4 layers of muscles that crisscross the abdomen (the “abs”). Then, we worry about some sort of internal illness, when it’s nothing more than a muscle strain.
We diagnose this by gently palpating the patient’s abdomen while they lie relaxed on the exam table. Then we palpate more deeply. This may cause a certain degree of pain — we ask the patient to remember how much.
Then we palpate the same area while the patient tries to do a sit-up, flexing their abs. If this clearly hurts more than when we palpated while they relaxed, we have the diagnosis. Some patients have their pain brought out simply by performing a sit-up, without our touching them; that’s a muscle strain for sure. And even occasionally, we get a history of recent exercise with weights, lifting heavy boxes, etc., which really convinces us. Treatment is the same as for any Muscle Strain, various pain medications, maybe ice or heat, but mainly just waiting until it goes away. Knowing that the pain is “just a muscle,” & not appendicitis, etc., is a big help.