Oblique Muscle Pain: Trigger Points Or Muscle Strain?

The obliques are two separate muscles, the external oblique, and the internal oblique, and make up the sides of the abdomen. People sometimes refer to the obliques as the waist muscles.

Trigger points in the muscles can cause referred pain throughout the abdominal area and bands of pain across the back. The abdominal pain mimics many medical conditions such as heartburn, urinary tract infections, and hernias. If you are experiencing unexplained abdominal pain, it could be trigger points in the obliques.

Oblique strain pain is contained in the area of the strain. The pain does not refer to other areas of the body. Soreness may cover a large area around the muscle, but there will be a more tender and painful spot when pressed. Depending on the severity of the strain, there may be redness, bruising, and swelling.

Oblique Muscle Referred Pain Pattern
Contents of Article


    Oblique Muscles

    Where Are The Oblique Muscles?

    The obliques connect the ribs, top of the hip (iliac crest) to the fascia of the abdominals and lower back. Fascia is strong sheets of connective tissue shown as the shaded gray sheets in the images above.

    What Movements Do The Oblique Muscles Control?

    • External Oblique
      • Bends the body side to side ie. side bends (lateral flexion)
      • Aids with twisting the body side to side (rotation)
      • Aids with bending the body forward (flexion).
      • Assists with forced exhalation (forcing air out when breathing)
      • Compresses the abdominal wall (keeps organs in place)
    • Internal Oblique
      • Works with the external oblique
      • Bending the body side to side like doing a side bend (flexion)
      • Twisting the body side to side (rotation)
      • Aids with bending the body forward
      • Assists with forced exhalation (forcing air out when breathing)

    Looking for detailed muscle anatomy? The Oblique Muscle Anatomy Page has origin, insertion, innervation, and blood supply information. It also lists agonists and antagonists for each muscle action.

    Oblique Muscles Trigger Points Symptoms:

    The obliques location means the muscles are always working. Twisting, turning, bending at the waist, taking deep breaths and exhaling are movements that we do subconsciously. Pain and soreness caused by trigger points or a muscle strain will quickly remind you how often you use these muscles.

    Trigger points in the oblique muscles can cause, mimic, and contribute to many medical conditions. It is important that if you are experiencing ongoing pain that you consult with your doctor. Abdominal pain can be a sign of a serious medical condition and should not be ignored.

    Other symptoms:

    • Pain in the waist area
    • Pain in the groin area
    • Pain in the low abdomen
    • Finger-like projections of pain through the abdomen
    • Band of pain across the upper back below shoulder blades
    • Band of pain across the lower back just above hips
    • Heartburn and indigestion

    What Causes Trigger Points To Develop In The Oblique Muscles?

    • Abdominal scars from surgery
    • Constipation
    • Over-exercising muscles (twisting and side bending exercises)
    • Lifting Weights
    • Golf
    • Rowing
    • Bowling
    • Raking leaves
    • Lifting using tools like shovels or pitchforks to dig and pick up heavy items
    • Chronic coughing
    • Sitting for long periods of time
    • Slouching posture

    TWD Recommends

    If you have rounded shoulder, forward head posture, or a habit of slouching, correcting your posture will reduce muscle pain. The Truweo Posture Corrector is adjustable and comfortable. It gently pulls your shoulders back, which helps retrain muscle memory to maintain proper posture. Many people notice an immediate reduction of pain and tension. Start slowly, wearing the brace for short periods throughout the day, slowly increasing the time-worn.

    How To Avoid Development of Trigger Points In The Oblique Muscles

    • Sitting for hours a day and especially slouching while sitting can cause the obliques to shorten and become tight. It is important to take breaks to stand up, walk around, and do stretches to help maintain muscle health. If you work at a desk, a standing desk will make it easier to alternate to sitting and standing. If you tend to slouch while sitting, consider using lumbar support to help maintain proper spine alignment, which will ease the stress on the oblique muscles.
    • Exercise targeting the abs and obliques. Be sure to warm up before starting and stop when muscle fatigue begins.
    • When lifting items, do not twist the body. Bend at the knees and use your legs to lift the object. Secure the item before moving, turning your body, NOT twisting at the waist to step off.
    • If you are sneezing and coughing due to allergies or illness, your chest and abdominal muscles may become sore. Talk to your doctor about medications that suppress chronic coughing and sneezing.
    • Constipation affects the oblique muscles and all muscles in the abdomen, low back, and pelvic region. If you tend to have frequent constipation, talk to your doctor about dietary changes and other methods to help bring relief.

    Oblique Muscles Trigger Point Treatment

    Warning: The abdominal cavity is the location of most of our internal organs. Do not ignore the pain in the abdomen. If you are uncertain of the origin of your pain, you should see your doctor and rule out a medical condition.

    Trigger points in the oblique muscles and other abdominal muscles can mimic other medical conditions. Persistent pain in the abdomen should always be examined by a physician.

    When a medical cause is ruled out, we recommend that you find a massage therapist, physical therapist, or a chiropractor trained in trigger point therapy to show you how to apply proper treatment. Improper treatment can lead to more pain and may contribute to digestion issues.

    Once you understand how to search, find, and treat trigger points in the abdominal area, The Trigger Point Therapy Workbook is an excellent book to learn how to treat oblique trigger points and other trigger points throughout the body.

    Keep in mind trigger points respond better to several short treatments throughout the day. Over-stimulation and prolonged pressure tend to aggravate trigger points.

    How Long Before I Feel A Reduction In Pain?

    It depends. If the trigger point has developed recently, a few days of treatment will usually take care of it. However, if the trigger point has been in place for an extended period, it may take a few weeks to deactivate.

    It is also important to remember that if trigger points are discovered in the obliques, it is likely there are other TrPs in other abdominal muscles. These will also need to be deactivated for maximum pain relief.

    The good news is that you will feel some pain relief and better mobility with each treatment. You should continue treatment until the trigger point is deactivated (gone) for the treatment to stick and be successful.

    Interesting facts:

    • The oblique muscles can contribute to pain and discomfort in the abdomen and groin area. It can contribute to burning and discomfort in the urinary tract, bladder and can contribute to incontinence. If you are suffering from any of these symptoms, you should have a medical evaluation to rule out underlying medical conditions.
    • Pain in the back when taking a deep breath can signal trigger points in the obliques and/or the rectus abdominis muscles.

    Oblique muscle pain and symptoms can be similar to, contribute to, and be affected by these medical diagnoses:

    • Painful rib syndrome
    • Slipped Rib
    • Costochondritis
    • Acid Reflux
    • Heartburn
    • Appendicitis
    • Ulcers
    • Gallbladder Disorder
    • Hiatal Hernia
    • Inguinal Hernia
    • Colic
    • Constipation
    • Urinary Incontinence
    • Urinary Tract Infection and Disease
    • Pancreatitis
    • Diverticulosis
    • Testicle Pain
    • Ovarian Cyst
    • Endometriosis
    • Prostatitis
    • T6 T7 T8 T9 T10 T11 T12 radiculopathy
    • L1 L2 L3 or L4 radiculopathy


    Other muscles that should be considered and examined:


    Satellite trigger points associated with the oblique muscles:

    If you find trigger points in the obliques, you will likely find trigger points in other muscles. These are known as satellite trigger points. Be sure and check these muscles:

    • Serratus anterior
    • Iliocostalis thoracis
    • Longissimus thoracis
    • Adductor Longus
    • Adductor Brevis
    • Adductor Magnus
    • Pectineus
    • Gracilis

    TWD Recommends

    Cureve Hot Cold Pack can be used for warm and cold treatments. It is recommended that you use cold packs for injuries, swelling, and after a TrP treatment. Use a warm treatment when the muscle is tight and needs to relax.

    External And Internal Oblique Strains

    When you strain an oblique muscle, you immediately know it happened. Because the obliques play a role in most movements in the trunk, a slight movement in the trunk of the body produces pain.

    Symptoms of a strain:

    • Pain and stiffness in the abs, waist, and sometimes the lower back
    • There is an extremely tender area where the muscle strain occurred
    • Movements such as bending over or twisting to the side may cause pain
    • Laughing, coughing, and sneezing may be painful
    • Your abdominal muscles may feel weak
    • There may be redness, bruising, and swelling in the area of the muscle strain

    What Causes Oblique Strains?

    Oblique strains are caused by overextending or stretching the muscle. Some examples are:

    • Chronic coughing and sneezing can cause a strain in the obliques.
    • Lifting a heavy item and twisting at the waist throws the body off balance and can result in a strain.
    • Golfers, tennis players, and batters in baseball can strain the obliques when players swing with arms extended and twisting at the waist.
    • Baseball pitchers shot putters, javelin throwers, and bowlers strain the muscle when twisting, pushing off, and extending the arm while throwing.

    Oblique Strain Treatments

    First, stop the activities that cause pain. You may have to sit out sports activities, stop exercising, and limit bending and twisting of the trunk muscles as much as possible for a time. Because the obliques are muscles that aid in holding the body upright, standing and sitting for extended periods may be painful. Take breaks throughout the day and lay flat on your back to give the muscle a chance to relax. A support brace can help if you must sit or stand for long periods.

    Chronic coughing and sneezing are stressful for the oblique muscles and can cause extreme pain. Laying down flat can make coughing and sneezing worse. You may want to use pillows to prop up the upper body. Better yet, use a recliner in a laid-back position to relieve the muscle and keep your upper body elevated enough to suppress coughing and sneezing.

    Use Warm and Cold Packs

    Warm/cold packs are also helpful for relieving pain. In the first 48 - 72 hours after the onset of pain, it is better to use cold therapy for 20 minutes per treatment. Treatments should be at least an hour apart and should be applied several times throughout the day.

    After 72 hours, you can begin alternating cold and warm treatments. Use cold therapy for 20 minutes, wait at least an hour, and apply a warm pack for 20-30 minutes. Do this as often as needed throughout the day.

    Use Compression and Support To Relieve Pain

    Providing support and compression to an oblique strain not only helps relieve pain but can also aid in speeding up the healing process. A Velcro low back brace works well to provide support to the oblique muscles. Look for a wideband brace that will provide support from the bottom of the ribs to the hip bone for lower oblique strains. If the strain is up high around the sternum and high ribcage a rib brace provides the best support.

    TWD Recommends

    If you have low back pain or need abdominal support, the Professional's Choice Back Brace will help reduce your pain and stiffness. The waist wrap and 2 side straps are easily adjusted and provide support compression to the low back and abdomen. It is the only low back brace TWD recommends because it works!

    Warm and Cold Gels

    Warm and cold creams and gels are an excellent way to relieve pain between warm and cold treatments. Sombra Warming Gel is a favorite of mine and my clients for its gentle warming and superb pain relief. It warms the area without the hot burning of many other over-the-counter warming creams.

    Biofreeze is also another recommended favorite. It is the best product to use immediately after an oblique strain because it cools the area. It also provides excellent pain relief.

    Both these analgesic gels are highly recommended and can be used several times a day if needed. Honestly, it comes down to personal preference as to which to use.


    NSAIDS (non-steroidal anti-inflammatory medications) such as Advil, Aleve, and Motrin can also help relieve pain. NSAIDS are safe when used in moderation but can cause digestive issues and have been linked to an increase in heart attacks and decreased collagen production. Collagen is a necessary component of healing.

    How Long Does It Take For An Oblique Strain To Heal?

    Healing times can vary depending on the severity of the strain. Mild strains can heal in a couple of weeks. However, severe strains can take several months to heal.

    Mild or Grade 1 Strain

    Mild strains happen when a small number of muscle fibers tear. If a small number of fibers tear, you will feel it, and after a few minutes, the pain recedes. You can continue with normal activities but, there will be soreness around the area of the strain. The more fibers tear, the more pain and soreness you will experience. Mild strains typically heal within a few days to 3 weeks.

    Moderate or Grade 2 Strain

    Moderate muscle strains happen when a significant number of muscle fibers tear. There is immediate pain, sometimes accompanied by a tearing or popping sensation. Again depending on the number of muscle or tendon fibers torn, moderate strains take 3-12 weeks to heal.

    Severe or Grade 3 Strain

    Grade 3 strains are the most serious and usually require medical care. A severe strain occurs when over half of the fibers in a muscle tear. Severe strains take a minimum of 10-12 weeks but can take up to 6 months to heal. Thankfully, grade 3 oblique strains are rare.

    Time, Patience, and Rest Are The Keys To Healing The Oblique Muscles

    The external and internal obliques are workhorses of our bodies. They are involved directly or assist other muscles in most movements of the trunk. There are no quick remedies to speed healing. Time, patience, and rest are required for healing and reducing the risk of reinjury.

    Muscles with similar pain patterns

    Rectus Abdominis
    Diaphragm Muscle
    Iliospsoas Muscles