| What We Treat
Undiagnosed Abdominal Pain
Abdominal pain is medical territory first. Some abdominal wall pain is genuinely musculoskeletal — but that’s a diagnosis reached after the more important causes have been ruled out, not before.
Overview
When Is Abdominal Pain Musculoskeletal?
The abdominal wall contains layers of muscle and connective tissue that can be strained, and the nerves supplying it can become entrapped. However, the abdomen also contains organs whose problems present as pain, and the lower thoracic spine refers pain around the abdominal wall. The order matters here: abdominal pain should be assessed medically first. Physiotherapy has a role once the abdominal wall has been established as the source.
Use the buttons to see the main considerations.
Assessment Comes First
Abdominal pain warrants medical assessment before being attributed to the abdominal wall. Organs including the appendix, gallbladder, bowel, kidneys, ovaries and pancreas all present as abdominal pain, and some are urgent. Your GP or an urgent care service is the right first stop.
Symptoms
How It Tends to Feel
Features suggesting the abdominal wall rather than something inside the abdomen:
Pain on Tensing the Abdomen
Pain that increases when you lift your head and shoulders off the bed, tensing the abdominal muscles.
Reproduced by Pressing
A specific tender point on the abdominal wall that reproduces your usual pain.
Changes With Position
Pain varying with posture, twisting or spinal movement.
Well Localised
A specific area you can indicate, rather than diffuse or generalised discomfort.
Unrelated to Eating or Bowels
No relationship to meals, bowel habit, or passing urine.
No Systemic Symptoms
No fever, vomiting, weight loss or feeling generally unwell.
Causes & Risk Factors
What Drives Abdominal Wall Pain
Once other causes have been excluded, these are the usual musculoskeletal sources.
Muscle Strain
Following heavy lifting, a prolonged cough, or a rapid increase in abdominal training.
Referred Thoracic Pain
Lower thoracic joint or nerve root irritation referring around the abdominal wall in a band.
Nerve Entrapment
A cutaneous nerve trapped as it pierces the abdominal wall, often after surgery or pregnancy.
Post-Surgical Scarring
Scar tissue after abdominal surgery can be a source of localised pain and restricted movement.
Post-Partum Changes
Abdominal wall separation and altered muscle function after pregnancy can produce discomfort and weakness.
How We Can Help You
Treatment & Management
Where the abdominal wall is genuinely the source, treatment is straightforward. The first job, though, is making sure that conclusion has been reached properly.
What the evidence says
Abdominal wall pain is a recognised and under-diagnosed cause of chronic abdominal pain, and Carnett’s sign — pain that increases rather than decreases when the abdominal muscles are tensed — is a useful clinical test pointing towards the wall rather than the contents.
Recognising abdominal wall pain matters because it can spare people repeated investigation of the abdominal organs. That said, it remains a diagnosis reached after appropriate medical assessment rather than instead of it.
When to Seek Help
Red Flags — Seek Medical Assessment
Abdominal pain should be assessed medically. These features need urgent attention:
⚠ Call 999 or attend A&E if you notice:
- Severe, sudden or rapidly worsening abdominal pain
- A rigid, board-like or exquisitely tender abdomen
- Vomiting blood, blood in the stool, or black tarry stools
- Fever, feeling faint, rapid heartbeat, or looking pale and unwell
- Abdominal pain with chest pain, breathlessness, or pain spreading to the back or shoulder
Abdominal pain has many causes, some of which are surgical emergencies. Please see your GP or an urgent care service before assuming a musculoskeletal cause, and call 999 for any of the features above.
Common Questions
Frequently Asked Questions
Can physiotherapy help abdominal pain?
Sometimes, where the abdominal wall itself is the source — a muscle strain, a trapped nerve, referred pain from the thoracic spine, or post-surgical scarring. It is not appropriate for pain arising from the organs, which is why medical assessment comes first.
How can you tell it’s the abdominal wall?
The most useful test is whether the pain increases when you tense your abdominal muscles by lifting your head and shoulders. Pain from inside the abdomen usually decreases when the muscles are tensed, because the wall shields it. Pain from the wall increases.
Should I see my GP first?
Yes. Abdominal pain warrants medical assessment before it is put down to the abdominal wall. That ordering matters — missing an organ cause because a musculoskeletal explanation was accepted too readily is exactly the error to avoid.
Could it be coming from my back?
It can. The lower thoracic nerve roots supply the abdominal wall and refer pain around the flank and abdomen in a band. If your medical assessment is clear and the pain changes with spinal movement, the thoracic spine is worth examining properly.
Medical Assessment First, Then Treatment
Once the abdominal wall has been established as the source, a clear plan for the muscles, nerves and joints actually involved.
Book Your Initial AssessmentThis page is for general information only and isn’t a substitute for individual medical advice. Abdominal pain should be assessed by a doctor. If you have any of the red flag symptoms above, seek emergency medical care immediately.