Core muscle injury occurs when the deep layers of the abdominal wall weaken or tear. There is no defect of the abdominal wall or protrusion of abdominal contents outside the normal cavity, as with a hernia. Instead, the injury occurs where the abdominal muscles attach in the pelvis, and can cause tears in the tendons and muscles in the area. Nerve irritation also can occur and contribute to uncomfortable symptoms of numbness or tingling.

Repetitive hip and pelvic motions typical in sports can cause injury to the lower abdominal area. Imbalances between the hip and abdominal muscles can, over time, cause overuse and injury. Weakness in the abdominals and lack of conditioning also might contribute to the injury. Aggressive and unsafe abdominal exercise programs can cause or aggravate a core muscle injury.

Chronic groin pain is a hallmark symptom of core muscle injury. It occurs in 5% to 18% of athletes. Sharp groin pain with exertion is also a typical symptom.

Pain often occurs with intense sprinting, kicking, twisting, or cutting, and decreases rapidly with rest. However, basic tasks, such as sitting up in bed, can be painful. Athletes can lose a significant amount of training and competition time due to core muscle pain or related groin pain.

With core muscle injury, you may experience:

• Sharp or stabbing pain in the groin or lower abdominal region that occurs mainly with running, sprinting, cutting, pivoting, kicking, or twisting.
• Pain felt while doing situps.
• Pain on one side of the groin.
• Pain or numbness that radiates into the inner thigh.
• Pain in the groin when coughing or sneezing.
• Little to no pain in the groin when resting, sitting, or sleeping.
• Tenderness to touch or pressure put on the lower abdominal area.

Note: If you have groin pain that isn’t relieved with rest, you could have another potentially serious medical condition involving the digestive, urinary, or reproductive systems. Consult your physician

If you see a physical therapist first, they will conduct a thorough evaluation that includes taking your health history. They may ask whether you:

• Experience groin pain while sprinting, twisting, or kicking.
• Have had any injuries to your hip, low back, or groin.
• Recently completed any intense abdominal or core strengthening exercises.
• Get significant relief from your groin pain if you rest or don’t participate in your regular sport or exercise routine.
• Feel pain in your groin when coughing, sneezing, or bearing down.
• Recall a particular movement or incident when you first felt pain in the area.
• Experience groin pain that limits your desired level of sports performance.

Your physical therapist also will conduct standard strength tests of your hip muscles, and perform other tests to measure the flexibility of your hip and thigh muscles. They will assess how well you can isolate or contract specific muscles. They also will conduct a thorough examination of your hip and low back movements.

Your physical therapist may use additional tests to determine if you have any other hip joint, knee joint, or lumbar spine injuries.

To reach a specific diagnosis, your physical therapist may collaborate with a sports medicine doctor or other health care provider. Your doctor may order further tests (MRI, ultrasound, or X-rays) to rule out other injuries to your hip, low back, or pelvis, and further confirm the diagnosis of a core muscle injury.

Conservative treatment of core muscle injuries includes changes to your activities and physical therapy. Your physical therapist will use treatments to target the problems found during their evaluation. They will design a personalized treatment program for you based on your condition that focuses on your goals to help you safely return to your sport or normal activity levels.

Some cases of more severe core muscle injury may require surgery. A conservative course of treatment that includes physical therapy for four to six weeks is the first recommendation for most patients. If groin pain continues after that time, surgery may be recommended. A recent study found that 50% of patients with core muscle injury recovered with conservative treatment. If you decide to have surgery, your physical therapist can guide you in regaining your strength and flexibility after the surgical procedure.

Treatment Without Surgery

Physical therapy will focus on addressing the key problems found during your evaluation. These problems often include poor hip strength and flexibility, and a reduced ability to activate or turn the abdominal muscles to keep the pelvis stable during intense activity.

Physical therapy treatments will address your condition without causing pain or making your pain worse. Your physical therapist also will teach you to modify sport or training activities that cause groin pain or hinder your recovery. Ice may also be applied to decrease pain. Your physical therapist may advise you to:

• Avoid aggressive or painful stretching.
• Avoid kicking or sprinting.
• Avoid doing situps.

Your physical therapy treatment may include:

Icing and compression. During the early phases of injury or when you have high levels of pain, applying ice and compression to the area may decrease your pain level.

Stretching. Your physical therapist may show you how to perform hip and low-back exercises to gently stretch your muscles. They will teach you how often and how long to do these exercises to match your condition to improve muscle flexibility and decrease pain.

Muscle retraining. Your physical therapist will teach you to target and move your abdominal and hip muscles. This is a key part of your treatment, as certain muscles may not be working well due to your injury.

Strengthening. Your physical therapist will teach you targeted hip and core strengthening exercises that do not aggravate your injury once you are having less pain.

Manual therapy. Your physical therapist may perform hands-on (manual) therapy to stretch and mobilize affected soft tissue and joints based on your evaluation. Hands-on therapy can improve your hip-joint mobility and range of motion, decrease muscle pain, and improve flexibility.

Return-to-sport drills. Once you can progress without pain, your physical therapist will slowly add movements specific to your sport or activity to your treatment program. For example, you may return to running and light sport-related drills to prepare your body for the full stress of participation in your sport.

Core muscle injury is challenging to prevent because of the stress and strain placed on the pelvis and hips during some sports. A prevention program is recommended for people with the highest risk for a core muscle injury. Those at high risk include males and females who participate in soccer, hockey, and football. A prevention program may include:

• Abdominal and core strengthening exercises.
• Exercises to strengthen the hip muscles.
• Exercises to improve flexibility and decrease strain across the lower abdominal area, where core muscle injury often occurs.

All physical therapists are prepared through education and experience to treat core muscle injuries. However, you may want to consider:

• A physical therapist who is experienced in treating athletes with a core muscle injury. Some physical therapists have a practice with a sports or orthopedic focus.
• A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in sports physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.

You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you’re looking for a physical therapist (or any other health care provider):

• Get recommendations from family, friends, or other health care providers.
• When you contact a physical therapy clinic for an appointment, ask about the physical therapists’ experience in helping people with a core muscle injury.
• Be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.

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