The tears usually occur low in the abdomen and can be adjacent to the pubic bones—where the rectus abdominis inserts, or attaches—or they can be slightly higher. They’re often near an area where common hernias occur. Many patients think they have strained a deep hip flexor muscle, the psoas major, or health care providers have told them that they’ve strained it.

The injury can come from several actions. One is the forceful lengthening of the ab muscles while they are trying to contract—that is, eccentric action, or “negatives.” For example, if you perform a dumbbell curl, the biceps works and shortens as you raise the dumbbell in a concentric action, or “positive.” When you lower the dumbbell, the muscle is still working but lengthening in an eccentric action—most muscle strains occur during such moves. The negative in abs can occur when two players collide, as in hockey, football or soccer. It can occur with overuse, which leads to a severe strain or tear. The muscle can also be so overstretched that the local area loses its ability to contract. The ab muscle functionally behaves as if it is torn.

You can’t necessarily pinpoint the pain. Rather, the entire lower quadrant of the abdomen may feel sore and usually feels painful during activities such as abdominal training or quick or explosive movements in sports; for example, direction change, starting a sprint or jumping. I recall watching one NBA player who had torn or overstretched his rectus abdominis. When he’d jump and dunk the ball, he’d land, bend forward, place his hand on his lower abdomen and wince.

Unlike a simple muscular strain, which heals in weeks, the ab tear can last for years. It may last until it is repaired. I have seen patients lose a season because the team physicians did not recognize the injury. One first-round draft choice lost the first three years of his professional career. Once he had the problem repaired, he returned to play. Those cases occurred in the 1990’s. It’s less likely to take so long today for a professional athlete to be diagnosed with this injury. The term “sports hernia” has circulated enough for most doctors who work in sports medicine to recognize it.

If you have similar symptoms but haven’t had a proper diagnosis, you may not have access to doctors who are familiar with the problem. You may be dealing with the injury and can’t find an answer, as happened to a recent patient who’s an avid weight trainee. If that’s your situation, perhaps you can find a hockey or soccer team doctor who may be able to help you diagnose the injury. The tear, or overstretch, of the rectus abdominus usually requires repair. There are now two main repair methods, and the doctor you see will choose which to use.