Side Strain in Depth AKA: Tear of the Oblique Muscles

The Injury

A Side Strain is fairly common cricket injury, where it typically occurs in bowlers. It is an injury that can occur in any sport or activity requiring extreme twisting of the upper body; divers, rugby players and javelin throwers can be susceptible. A Side Strain refers to a tear of the Internal Oblique, the External Oblique, or the Transversalis fascia at the point where they attach to the four bottom ribs . The Internal Oblique and External Oblique muscles are located between the lower ribs and pelvis, on both the left and right side. They work together to produce twisting movements or side bending of the trunk and also work in conjunction with the other abdominal and lower back muscles to stabilise the core area.

In cricket the bowlers suffer the Side Strain on the non bowling arm side as a result of a forcible contraction of the muscle on that side while they are fully stretched as the bowling arm is cocked for bowling. The affected muscle is forcibly stretched and contracted beyond its limits and the muscle tissue becomes torn. Depending on its severity it is classified as a first, second or third degree strain:

• A first degree Side Strain is damage to a few muscle fibres.
• A second degree Side Strain is damage to a more extensive number of muscle fibres.
• A third degree Side Strain is a complete rupture of the muscle itself.

Signs & Symptoms

With a grade one Side Strain a bowler may attempt to carry on. There may be a sensation of tightness and a slight feeling of pain during the match or practice, this is usually in the region of the lower ribs, at the level of the elbow. Continuing to bowl is not wise, because it is pretty easy to extend the muscle tear and convert a grade one into a grade two Side Strain.

There is immediate pain with a grade two Side Strain that occurs during a movement such as bowling or throwing. It is more severe than the pain of a grade one injury. This pain is present with any minor movement of the trunk. It is confirmed by pain on stretching (leaning away from affected side) and contraction of the muscle (leaning towards the affected side). A grade two Side Strain is usually sore to touch.

A grade three Side Strain is a complete rupture of a muscle and is a serious injury. All trunk movements and even taking a deep breath can be painful. After a few days with grade two and three injuries a large bruise will appear below the injury site caused by bleeding within the tissues.

Treatment

The immediate treatment for a Side Strain injury consists of rest, ice, and compression (never apply ice directly to the skin). This is aimed at reducing the bleeding and damage within the muscle tissue. Resting may be the common sense approach, but it is one that is often ignored by eager sports players. This is unwise, since it does not take much to turn a grade one Side Strain into a grade two, or a grade two Side Strain into a grade three Side Strain.

As a general rule, grade one Side Strains should be rested from bowling and throwing activities for about 3 weeks, and grade two Side Strains for about 4 to 6 weeks. In the case of a complete rupture the Internal Oblique or External Oblique muscles the rehabilitation afterwards will take about 2-3 months.

Treatment in the early stages is the same for all Side Strains. An Ice Pack can be applied for twenty minutes every two hours, and a compression bandage applied. This should help to limit bleeding in the tissues. After the early days have been spent resting more active rehabilitation can be started under the supervision of a Chartered Physiotherapist.

After a week, gentle resistance exercises and side stretching are important as they help to align the scar tissue that forms during the healing process. By aligning the scar tissue along the normal lines of stress the tensile strength of the healing muscle is enhanced. At first gentle resistance can be provided by Resistance Bands. The sets and repetitions are gradually increased and eventually Core Strengthening exercises can be initiated.

Core Strength and Core Stability exercises can improve muscle function across the trunk and pelvis and this can reduce the risk of another Side Strain. Core strength exercises on an Exercise Mat using a Swiss Ball and Resistance Bands are ideal to improve functional movement and reduce injury risk. Once Core Strength is improved, then a return to functional activity is possible. With a grade one Side Strain gentle jogging can be initiated around 12 days after injury and straight line sprinting and bowling activities can usually be started after 3 weeks.

Prevention

The following measures may have the effect of reducing the risk of sustaining a muscle strain:

• Warm up prior to matches and training is thought to decrease muscle stretch injuries because the muscle is more extensible when the tissue temperature has been increased by one or two degrees. A good warm up should last at least 20 minutes – starting gently and finishing at full pace activity. Practising sport specific activities helps tune coordination and prepare mentally for competition.
  Professional Warm Up Guide
• A cool down can enhance recovery after training sessions and matches. This is thought to help muscles get rid of waste products. This is also the ideal time to do stretching exercises and stop the tightening of muscles overnight or the following day.
  Professional Cool Down Guide
• Maintaining good muscle strength and flexibility may help prevent muscle strains. Muscle strength allows a player to carry out match activities in a controlled manner and decreases the uncoordinated movements which can lead to injury. Specific strengthening can help prepare the player for overstretched positions, for example in bowling, the extremes of the movement including the rotational components can be strengthened in the gym to lessen the likelihood of injury whilst playing.
• Some research has indicated that tight muscles increase the risk of muscle injury. Stretching on a Gym Mat is helpful to maintain muscle length and prevent injury.
  Guide to Stretching Exercises
• Diet can influence muscle injuries. Increased carbohydrate in the 48 hours prior to a match provides adequate supply of the energy that is necessary for muscle contractions. Fatigue can set in during training or matches with insufficient carbohydrate. This fatigue can predispose a player to injury. Carbohydrate and fluids can be replenished during training and matches by taking Energy Gels and Energy Bars.
• Avoid over bowling in cricket. A record should be maintained of the number of deliveries bowled and care should be taken to avoid sudden increases to the normal workload. The number of deliveries bowled per session should be increased gradually and adequate rest periods should be provided to prevent fatigue.