There can be many reasons why someone has abdominal pain. Internal organs, such as your small intestine, colon, stomach, liver, gallbladder, pancreas, uterus or ovaries, could be causing your symptoms. Or, the abdominal pain could be from a musculoskeletal condition, such as a nerve impingement from the spine, visceral fascial adhesions, strained muscles, or a dysfunctional pelvic floor. Seeing a physical therapist who specializes in pelvic floor therapy can help determine if your pain is musculoskeletal in nature or if you need to be referred to a different specialist like a gastroenterologist.
For the purpose of today's blog article, I'm going to focus on abdominal pain associated with a musculoskeletal problem and how a physical therapist can help.
When someone has abdominal pain arising from the spine, it can present just like appendicitis, GERD pain, kidney pain, or other visceral organ referral pain patterns. “Both non-musculoskeletal pain and spinal referred pain can be diffuse and aching in nature. Both can cause autonomic symptoms such as sweating, nausea and tachycardia” (Harding, 2007). The difference between non-musculoskeletal and spinal pain is usually movement. A qualified physical therapist will assess the movement of your spine and the segmental mobility of your spine to see if there is an association to your abdominal pain.
Abdominal pain can also be coming from the fascia surrounding the visceral organs. Fascia is a connective tissue that exists throughout the whole body surrounding our bones, ligaments, muscles, tendons, nerves, veins, arteries, and internal organs. “The fascia becomes an organ that can affect an individual’s health” (Bordoni, 2014). A physical therapist who performs visceral myofascial manipulation can help soften and relax the adhesions and restrictions of the viscera. Organs that I commonly treat are the bladder, small intestine, colon, kidneys, urethra, ureters, liver and diaphragm.
You could also strain a muscle of the abdominal region causing abdominal pain. This is often from participating in a strenuous physical activity (e.g., working out, playing sports, sexual intercourse, etc.) that exceeds what your abdominal muscles can handle. Those muscles include the rectus abdominis, external obliques, internal obliques and transversus abdominis. A physical therapist performs muscle tests and palpates the abdominal region to help differentiate and diagnose the muscle strain. If they're a good PT, they should also go beyond the abs to better understand WHY your muscles got strained in the first place. This can help prevent recurrence. Was it simply from being deconditioned or trying a new activity? Or maybe it was from underlying weakness or tightness elsewhere in the body (pelvis, hips, lower back, etc.) that set your abdominals up for injury? This is often where that fascia (connecting everything to each other) comes back into play.
A dysfunctional pelvic floor can also contribute to abdominal pain. The pelvic floor is made up of muscles and fascia that form a sling spanning across the bottom of your pelvis. It consists of 14 muscles in people with female genitalia, and 12 muscles in people with male genitalia. All of these muscles, in combination with other “core” muscles, must be functioning properly to ensure a healthy pelvis for sports and everyday life. Clinically, I have seen the obturator internus muscle refer to the lower quadrant of the abdominal region. A pelvic physical therapist would evaluate the function and mobility of your pelvic floor muscles. This is done by either a vaginal or rectal muscle exam.
Having a physical therapist go beyond the abdominal pain and look at your whole body is key to determining the true source of your condition. At Activcore, our physical therapists are trained to assess the spine and fascial mobility, overall muscle strength and stability, and pelvic floor function to help get to the root cause of your abdominal pain.
Disclaimer: The views expressed in this article are based on the opinion of the author, unless otherwise noted, and should not be taken as personal medical advice. The information provided is intended to help readers make their own informed health and wellness decisions.
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- Bordoni B, Zanier E (2014). Clinical and symptomatological reflections: the fascial system. Journal of Multidisciplinary Healthcare. (7): 401–411.
- Harding G, Yelland M (2007). Back, chest, and abdominal pain. Australian Family Physician. 36(6): 422-429.
- Suleiman S, Johnston D (2001). The Abdominal Wall: An Overlooked Source of Pain. American Family Physician. 64(3): 431-439.