Managing side strains in athletes

A side strain is a condition that is commonly seen in cricket players and is characterised by a tear in one of the side abdominal muscles where it attaches to the lower ribs.

The chest comprises of 12 rib bones on each side of the body. Each rib attaches to the spine at the back of the body and then travels around to the front of the chest.

Numerous muscles of the abdomen, shoulder and back attach to one or more ribs. The muscle involved here primarily attaches above, to the ribs and below to the pelvis and also on the strong connective tissue of the lower back. It acts to side bend the spine and rotate the spine to the same side.

During contraction or stretch of this muscle, tension is placed through the muscle. When this tension is excessive due to too much repetition or high force, the involved muscle can tear. This is known as a side strain. Side strains typically involve tearing of the muscle at its insertion on the side of the body.

In addition to cricket players, side strains also sometimes occur in other sports, such as javelin throwers, rowers and hockey players. A side strain can occur either suddenly from a forceful bowl, particularly if not warmed up properly or gradually over time from excessive or repetitive activity like overtraining. It typically occurs due to a sudden contraction of the muscle when it is in a position of stretch such as during the fast bowling action.

In cricket fast bowlers, side strains tend to occur on the non-bowling arm side of the body. One typically experience a sudden, sharp pain or pulling sensation in the side of the chest in the region of the lower ribs or abdomen during the provocative activity. Pain typically occurs suddenly during a forceful bowl, but can also occur gradually over time such as over the course of a match or training session.

Athletes with this condition typically experience pain that increases with activities that place strain on the affected muscle. These activities may include bowling, throwing, heavy lifting, rowing, side sit ups, twisting, turning or side bending.

It is also common for affected athletes to experience pain or stiffness after these activities with rest, especially upon waking in the morning or at night.

Patients with this condition may also experience swelling, muscle spasm, weakness and bruising in the side abdominal region.

A thorough subjective and objective examination from a sports medicine specialist is usually sufficient to diagnose a side strain. Further investigations, such as a MRI or ultrasound, are sometimes required to confirm diagnosis, determine the severity of injury and monitor healing.

With appropriate physiotherapy management, most patients with a side strain can make a full recovery in a period of 4-6 weeks. In more severe cases, recovery may take longer. It is important to note that there is a high recurrence rate with this injury.

The writer is a physiotherapist Harambee Stars & Mathare United

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