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Core Muscle Injuries
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What is a core muscle injury?

Core muscle injuries involve a tear or a series of micro-tears of the muscles of the core, which includes all of the muscles from the chest to mid-thigh. The most common core muscle injuries are to the muscles connected to your pubic bone. You may have heard the core muscle injury referred to in the past as a "sports hernia." Core muscles can include the abdominal muscles, oblique muscles and thigh muscles. Many core injuries involve more than one muscle in the core, which ranges from mid-chest to just above the knee.

Core muscle injuries can involve any of these body structures. Among the more common core injuries are to rectus abdominus muscle (known commonly as "your abs") and the three adductor muscles that make up your inner thigh.

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What can cause a core muscle injury

A core muscle injury can occur over time or suddenly, and it is not limited to athletes. Anyone performing any type of activity, be it from sports, work or a recreational endeavor such as walking or jogging, can sustain a core muscle injury.

They can occur from overstretching abdominal muscles by over-extending at the waist, or over-stretching inner thigh muscles while performing a split. The repetitive nature of swinging a golf club can cause a core muscle injury. It is important to understand that you do not have to do something "wrong" in order for a core muscle injury to occur.

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Core muscle injury symptoms

There are many types of core muscle injuries, thus there can be varying symptoms. Each person can experience different levels of pain with their injury. Some people may report a sharp, shooting type of pain, whereas others may experience a slow, dull ache over time.

Some common symptoms for a core muscle injury may include:

  • abdominal or groin pain after an acute injury
  • abdominal or groin pain that worsens over weeks, months or even years
  • chest or rib pain
  • heightened pain during and after activity
  • minimal pain while at rest
  • unilateral or bilateral pain
  • fleeting pain that appears or disappears on one or two sides
  • pain that moves from abdomen to groin or thigh
  • increased pain or discomfort with exertion such as sprints, kicks, lifts
  • increased pain or discomfort when coughing, sneezing or turning over in bed
  • hindering optimal performance
  • inability to perform daily activities

Core muscle injuries are varied

Given all the body parts that make up the core, from muscles to ligaments to bones, there are 121 different combinations of core muscle injuries. The more common core muscle injuries include the rectus abdominus and the adductor muscles in the thigh.

Below is a list of common variants and syndromes for core muscle injuries:

  • Rectus Abdominis/Adductor Variant: The most common variant, this involves severe, exertional pain related to the insertion of the rectus abdominis onto the pubis—in other words, where the muscle is attached to the pubic bone. Classically, a tear or an attenuation of the rectus abdominis insertion causes the syndrome as well as possible secondary pain near the adductor insertion sites onto the pubis.
  • Adductor Longus Variant: The main source of the pain is the adductor longus muscle.
  • Pectineus Variant: The main source of the pain is the adductor pectineus muscle.
  • Spigelian Variant: The pain isn't due to a hernia, but rather to a vertical extension of the same musculofascial shredding that characterizes the more classic rectus abdominis variant.
  • Baseball Pitcher/Hockey Goalie Syndrome: This tends to occur in the aforementioned athletes and primarily involves scarring and fibrosis of the fascia or epimysium that covers the adductor muscles below where they attach to the pubic bone. This scarring constricts the muscle and causes pain.
  • Osteitis Pubis Variant: This variant involves pain caused by inflammation of the pubic bone and/or attached muscles.
  • Iliopsoas Variant: The pain emanates mainly from the site where the psoas muscle, which is located on the side of the lumbar region of the vertebral column, connects with the rear of the neck of the femur bone. The pain results from bursitis—inflammation or irritation of the fluid-filled sacs that reduce friction in that part of the hip joint. The bursitis is a condition that is secondary to the instability caused by the weak attachment of the abdominal muscles to the pubic bone.
  • Gracilis Variant: In this variant, the pain emanates more from the gracilis muscle, which extends down the inside of the thigh, than from the adductor longus muscle.
  • Athlete's Rib Syndrome aka Rower's Rib: This condition particularly affects rowers, tennis players and boxers. It occurs when the abdominal muscles that are interwoven with the lower most intercostal muscles—which run between the ribs and help form and move the chest wall—dislocates the 11th and 12th ribs and/or cartilages attached to those ribs.
  • Superior Rectus Variant: This syndrome is a combination of the Spipgelian and athletes rib variants.
  • Sartorius Variant: Most common in women, this variant involves considerable pain at the site where the long sartorius thigh muscle is inserted into the pelvis, in addition to pain in the lower abdominal muscles.
  • Snapping Hip Syndrome: This can occur when muscles or tendons slide over one of the hip's bony protrusions. Usually it is caused by a tightness in these muscles and tendons, and most often affects people, such as athletes and particularly dancers, who repeatedly have to bend at the hip. It is more common among young athletes because muscle tightness often accompanies growth spurts, and in women.
  • Round Ligament Syndrome: The round ligament of the uterus can cause pain with exertion in some women. It is important to distinguish this from other core muscle injuries and gynecologic disorders (such as endometriosis).
  • Adductor Avulsion Variant: The adductor longus muscle can partially or completely avulse, or tear away, from the pubic bone, resulting in considerable pain.
  • Adductor Calcification Syndromes: These are often seen in bull riders. Often, years after the initial injury, the calcification that results from this trauma causes severe inflammation and pain. This can also be a result of PRP (platelet-rich plasma) injections into the adductors.
  • Iliotibilal Tract Syndromes: The iliotibial tract or iliotibial band, is a thick strip of tissue connecting several muscles on the outer sides of the thighs. Pain in this area can be a secondary result of athletes compensating for what is primarily an abdominal muscle problem.
  • Rectus Femoris, Quadratus or Pectineus Syndromes: Pain can occur either primarily or secondarily along other insertion sites or bursae related to these muscles and tendons.
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