Will is suffering from pain in his abdominals

April 19, 2016

Hi, I was hoping that you could give me some advice on a possible muscle strain please?

I’m a 35 year old man and I’ve been a little out of shape for the last couple of years – the odd workout here and there, but no regular exercising. I want to get fit again and decided to do some Pilates about a month ago. After the second session I developed some pain in my lower left abdominals. The pain came on the day after the Pilates session and it is located about 3-4 inches below and about 2 inches to the left of my belly button. It’s not really a sharp pain, it’s more a sore ache that comes and goes through the day. It seems to be more pronounced when I lean forward or crouch down. I’ve tried pushing my fingers into the area, but that doesn’t seem to make it worse. I can’t see or feel any bulge sticking out, like a hernia.

The Pilates session was quite heavily focused on core work and the abs in particular, so this makes me think I’ve likely strained an abdominal muscle. I understand that it’s in the same region as my bowels and bladder, but I haven’t noticed anything else being affected – going to the toilet is normal (although I have noticed that sometimes the soreness gets slightly worse when doing a pee).

I rested for the past month and the soreness slowly improved to the point where I thought it had gone away. But yesterday I did some exercises with light dumbbells and the pain came back during the workout and is there today too.

Do you agree that it is most likely a muscle problem or could there be something else going on?

Do you have any suggestions as to what I can do to speed up my recovery?

Thank you very much for your help.


April 19, 2016

Hi Will

Excluding all things that may be GI related you may have an issue with the abdominals – Pilates can be anything and everything from lying on your back wiggling your legs in the air to a full abdo session to decent control based exercise – the latter is best, but it’s often too late to know what you’ve done!

Rest is normally the right thing to do for a muscular sprain of any type – rest a bit, stretch a bit, strengthen a bit and normally all is OK. So when you’ve rested and been pretty sensible and yet your symptoms still persist you need a different take.

This may well be a very small hernia, that has not yet allowed anything to push through – being is so small. Things that usually make this noticeable is straining and coughing etc – neither of which I don’t think you have.

Generally when you damage muscle you know about it pretty much straight away, not a day later.

This maybe because you don’t have an issue with the muscle per se, but you feel muscular pain. This is pretty common when you irritate/overload/impinge nervous tissue – which maybe (probably is) related to your back. The muscle “stiffens” up to protect the nerve and to you it feels like a strain, rather than protective muscle tone.

If you want to get a speedy result it may be worth your while going to see someone who can, and let them differentiate between muscle and nerve, back and hip, cause and symptom.

It might be all about how you do things, rather than what you’re doing….

The Guru

Six Physio

Will replied thanking the Guru:

Hi Guru,

Thanks very much for your reply.

The discomfort seems a lot better today than yesterday – still there occasionally, but an improvement. The workout I did on Sunday definitely aggravated it, but it seems to be improving faster than it did originally, a month ago.

The Pilates session I did originally did involve a lot of lying on my back with my legs up in the air! I’m not very flexible, so maybe it was a bit too much for me.

It is interesting that you say it could possibly be a small hernia – I tried coughing and also tensing my ab muscles, but they didn’t make the discomfort worse.

Regarding the possibility of a nerve versus muscle origin of the pain, who would you suggest I see about this? Would my GP be able to tell or should I try to see someone with a different specialism?

In the meantime, would you suggest resting for the moment? I have the option of going to a yoga class this week, but I’m not sure if that’s a bad idea until I find out the cause of the problem.

Thanks again for your help,


The Guru responded:

Hi Will

Good news that you’re feeling better – but you want to get better, not just feel it.

Not sure about the yoga – most issues are “over stretch” issues so is go easy on any type of stretching.

GP, Physio, Osteo etc doesn’t really matter – you want someone to tell you what’s up and why.

Rest, in view of everything you’ve done is the best option at the moment, but do get seen by someone.

The Guru

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Guru Responded

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