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Oblique Muscles: Abdomen, Groin, Testicular Pain

The obliques consist of two separate muscles, the external oblique and internal oblique. The muscles are located at the side of the abdomen and are often referred to as the waist muscles.

Trigger points in the muscles can cause pain throughout the abdominal area and the pain can be similar to many medical conditions. You may also have bands of pain across the middle and lower back.

If you strain an oblique muscle, you know immediately something happened. Oblique strains cause sharp, stabbing, or cramping pain around the bottom of the rib cage.

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.

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)
External Oblique Muscle
Internal Oblique Muscle
Internal Oblique Muscle

For detailed anatomy information:  External and Internal Obliques Anatomy


Oblique Muscle Trigger Points

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 almost constantly. Pain and soreness caused by trigger points or a muscle strain will quickly remind you how often these muscles are used.

Trigger point symptoms and oblique strain pain are very different. Trigger points in the obliques not only cause pain in the area of the muscles but can also contribute to a host of concerning symptoms. An oblique strain, on the other hand, will cause localized pain in and around the area of the strained muscle fibers.

Oblique Trigger Point Pain and Symptoms

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 or symptoms listed below that you consult with your doctor. Abdominal pain can be a sign of a serious medical condition and should not be ignored!

Trigger Points Signs and 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 low back just above hips
  • Heartburn and indigestion
  • Pain in the pelvic area
  • Testicle pain
  • Bladder pain and incontinence

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

 

External and Internal Oblique Muscle Pain Pattern

Obliques Pain Referral: Pain high in the abdominal area (heartburn like symptoms) low abdominal area including the groin, pelvic area, and painful bands in the upper back and lower back.

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 a lumbar support to help maintain proper alignment of the spine 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 item. 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 and feel your chest and abdominal muscles becoming sore, talk to your doctor about medications that suppress chronic coughing and sneezing.
  • Constipation not only affects the oblique muscles but 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 that can help bring relief.

Oblique Trigger Point Treatment

Warning: The abdominal cavity is the location of most of our internal organs and pain in this area should not be ignored. 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 serious medical conditions. Severe and persistent pain in this area should always be examined by a physician.

When a medical cause is ruled out I recommend finding 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 not only oblique trigger points but also other trigger points throughout the body.

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

TWD Suggestions For Oblique Muscles Trigger Points

Sombra Warm Therapy Pain Relieving Gel is highly recommended for trigger point and chronic pain relief. It relaxes the muscles without the burning heat of other creams. (not sold in stores)

Biofreeze Pain Relieving Gel cools the area much like ice discouraging inflammation. It provides excellent pain relief between cold treatments. Recommended by medical professionals and trainers.

The Trigger Point Therapy Workbook is the best resource to learn how to treat and manage your TrP muscle pain. Learn the methods and have the knowledge to relieve muscle pain throughout the body.

It is natural to slump while sitting. The Vertteo Full Lumbar Black Support is larger than other supports and helps you sit up straight comfortably reducing back and abdominal pain.

How Long Before I Feel A Reduction In Pain?

It depends. If the trigger point is fairly recent it can be resolved in a few days of treatments. However, if the trigger point has been in place for an extended period it may take a few weeks to fully deactivate.

It is also important to remember that if trigger points are found 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 must continue treatment until the trigger point is totally deactivated (gone) for the treatment to stick and be successful.

Other muscles that should be considered and examined in conjunction with the obliques muscles:

Satellite trigger points associated with the oblique muscles:

If you find trigger points in the external or internal oblique it is likely you will find trigger points in some or all of these muscles:

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

Interesting facts about the oblique muscles:

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

Internal and external 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

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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 of the body slight movements can produce pain.

The signs of an oblique strain:

  • If it is a mild strain you will feel a sudden stabbing pain or cramping sensation near the bottom of the rib cage
  • Moderate to severe strains cause an extremely sharp pain and cramping sensation at the bottom of the rib cage
  • Twisting and bending at the waist is painful
  • Forceful exhaling can cause pain
  • Cough‌ing, sneezing, hiccups, etc. often cause sharp pain
  • Pain is often constant when standing or sitting
  • Pain tends to decrease while lying down

What Causes An Oblique Strain?

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

  • Chronic coughing and/or 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

External and Internal 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 extremely stressful for the oblique muscles and can cause extreme pain. Laying down flat can make coughing and sneezing worse. Limit twisting and bending at the waist as much as possible. A brace that compresses the obliques and abs can bring tremendous relief.

 

Compression Support to Relieve Pain

If you are considering a support brace I recommend the Professional's Choice Low Back Support. This brace is wide enough to give the obliques support, allows you to adjust the compression to your comfort level and provides warmth that will help keep the muscles relaxed. It is my go-to brace for rib pain, back pain, and abdominal support. It is not available in stores but can be ordered online at Amazon.

 

Warm and Cold Packs

Warm/cold packs are also helpful for relieving pain. 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. See the article P.R.I.C.E. Protocol for more information about treating a recent muscle strain.

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

For trigger point pain use a cold pack for 20 minutes after the treatment, then warm therapy as needed for relief.

If you are looking for a hot/cold pack the Cureve Natural Therapies Hot Cold Pack is excellent for abdominal and back treatments. The large size provides a full treatment, it can be warmed in the microwave, chilled in the freezer and best of all it remains pliable when cold. I use the Cureve products and recommend them!

 

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 as well as 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

NSAIDS (non-steroidal anti-inflammatory medications) such as Advil, Aleve, and Motrin can also help relieve pain. Personally I recommend these only when needed. NSAIDS are safe when used in moderation, but can cause digestive issues, and has 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 greatly vary depending on the severity of the strain. Mild strains can heal in a couple of weeks but severe strains can take several months to heal.

Mild or Grade 1 Strain

A mild strain happens when a small number of muscle fibers tear. If a minuscule number of fibers, you feel it, and after a few minutes the pain recedes and you continue on with a little soreness. 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 are when a significant number of muscle fibers tear. Again depending on the number of tears, moderate strains take 3-12 weeks to heal.

Severe or Grade 3 Strain

Grade 3 strains are the most serious and may require medical care. A severe strain happens 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.

 

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