How can I tell if stomach pain is a muscle strain or something inside?

Muscle pain usually follows a moment or a cough, sits at one spot that hurts to press, and hurts when you tense to sit up. Pain that came without a moment, spreads, comes in waves, or comes with fever, vomiting, or changes in bowels or urine points inside. If you are not sure, see a doctor first.

Is it a hernia or a pulled stomach muscle?

An inguinal hernia is usually a lump in the groin that comes out when you cough or stand and goes back when you lie down. An umbilical hernia bulges at the belly button. A strain has no lump. A hernia lump that turns hard and painful and will not go back needs the emergency department now.

When is stomach pain an emergency?

Go to the emergency department now for severe or worsening stomach pain, pain with fever or repeated vomiting, pain after a blow to the stomach or lower ribs, sudden pain in a testicle, or lower stomach pain if you could be pregnant. Call 995 for stomach pain with fainting, or upper stomach pain with sweating and breathlessness.

Abdominal Muscle Strain or Something Else?

Q: What does a pulled stomach muscle feel like?

A sharp pull at one spot, at a moment you can name, such as a serve, a set of crunches or a sneeze, followed by an ache. Sitting up in bed, coughing, sneezing, laughing and reaching up to a shelf catch it. The spot hurts to press, a bigger tear can bruise, and lying still eases it.

Written by Shiv Mohan Banka, Principal Physiotherapist at Phoenix Rehab, AHPC A1302278J.Clinically reviewed by Louise Yow, Principal Physiotherapist & Director, AHPC A1300363H.Last reviewed 7 October 2026.

An abdominal muscle strain is a stretch or tear in one of the stomach muscles: the six-pack down the front, or the obliques at the side. It follows a serve, a twist, hard sit-ups or a coughing fit, and hurts at one spot when you sit up, cough or tense. Stomach pain with fever or vomiting needs a doctor first.

Key takeaways

An abdominal muscle strain is a stretch or tear in the six-pack muscle (rectus abdominis) or the obliques at the side of the trunk.
A strained stomach muscle hurts at one spot you can press, and it catches when you sit up from lying, cough, sneeze or twist.
Many stomach pains are not the muscle. Pain with fever, vomiting or a blow to the stomach, or pain that movement does not change, goes to a doctor first.
A side strain sits low on the ribs, on the side opposite the bowling or throwing arm, and it often comes back.
Pain on sitting up leaves before the trunk can take a full-speed serve, throw or delivery. We measure both sides before the sport comes back.

What is an abdominal muscle strain?

Four muscles make up the front and sides of your stomach wall. The rectus abdominis is the six-pack, two straps running from the lower ribs to the pubic bone. The external and internal obliques wrap around the sides, from the lower ribs to the top of the pelvis. The transversus abdominis sits deepest, like a belt. A strain is a stretch or a tear in one of them, most often where the muscle meets the ribs or the pelvis.

A side strain is the name sport gives to a tear of the side muscles where they attach to the lowest ribs. Fast bowlers, tennis players and baseball players get it on the side opposite the arm they bowl, serve or throw with.

What does a pulled stomach muscle feel like?

A sharp pull at one spot, at a moment you can name: the serve, the last rep, the third sneeze. After that, an ache. Sitting up in bed catches it, and so do coughing, sneezing, laughing and reaching up to a shelf. The spot hurts to press. A bigger tear can bruise. Lying still, it eases.

How it happens, in the order to check

1. A serve, a smash, a throw or a delivery

The arm goes back and up, the trunk arches and twists, then the whole body whips forward. The stomach muscles on the opposite side are stretched hard and then fire hard in the same second. The tennis serve, covered in tennis injuries. The jump smash in badminton. The spike in volleyball. The pitch and the swing in baseball and softball. Fast bowling in cricket.

2. A twist at speed

A full golf swing after weeks off, covered in golf injuries. A long kick across the body in football. A kick or a knee thrown hard in Muay Thai.

3. The gym

Sets of sit-ups and crunches well past what you usually do. Hanging leg raises, the ab wheel, a heavy lift with the breath held. See gym injuries.

4. A cough, a sneeze or vomiting

Weeks of coughing after a chest infection, or a bout of vomiting, can strain the stomach muscles with no sport at all. Ask yourself whether you have had a fever, and whether you still feel unwell. If you have, the pain goes to a doctor before it goes to a physiotherapist.

Stomach pain: muscle, or something inside?

A website cannot settle this for you. A doctor can, and the clues below tell you when to ask one.

It points to the muscle when you can name the moment or the cough, the pain sits at one spot you can cover with two fingers, pressing it hurts, tensing your stomach to sit up or lift your head hurts, and lying still eases it. You eat as usual, your bowels and urine are normal, and you have no fever.

It points inside when the pain came on without a moment, sits deep or spreads, comes in waves, or stays the same whatever position you are in. Or when it comes with fever, vomiting, loss of appetite, a change in your bowels or urine, blood anywhere, or after eating.

Some clues overlap. Appendicitis also hurts when you cough or when the car goes over a bump. A muscle strain does not cause a fever. If the pattern is mixed, or you are not sure, see a doctor first.

When the pain is not in the muscle

Appendicitis. Pain that starts around the belly button and moves to the lower right side of the stomach over hours, often with loss of appetite, nausea, vomiting or a fever. The emergency department.
Gallbladder. Pain under the right ribs, often after a fatty meal, that can spread to the right shoulder blade, with nausea. With fever or yellow eyes or skin, it is an emergency.
Kidney stone or kidney infection. Pain in the back or side, below the ribs, that comes in waves and can spread to the groin. You cannot get comfortable in any position. Burning on passing urine, blood in the urine, or a fever.
Stomach or bowel. Burning upper stomach pain, pain with diarrhea or constipation, bloating, black or bloody stools, or vomiting blood.
An injury inside after a blow. A handlebar, a tackle, a fall onto the side or a road accident can injure the spleen under the left ribs or the liver under the right ribs. Pain at the tip of the left shoulder, dizziness, or a pale, clammy feeling can be bleeding inside. The pain can start mild. The emergency department, even if you feel fine at first.
Testicle. Sudden pain in a testicle, or swelling of the scrotum, sometimes felt only as lower stomach or groin pain, in boys and young men especially. The emergency department now.
Pregnancy. Lower stomach pain when you are pregnant or could be, with or without bleeding. The emergency department. If you are pregnant, stomach pain goes to your obstetrician first.
Heart and the main artery. Upper stomach pain with sweating, breathlessness, nausea, or pain into the arm or jaw can be the heart. Sudden, severe pain in the stomach or back in an older person, especially a smoker, can be the aorta. Call 995.
Bleeding into the muscle. On blood thinners, a cough or a strain can bleed into the six-pack muscle. A painful, growing lump or bruise in the stomach wall needs the emergency department now.
Shingles. A burning or stabbing band of pain on one side of the trunk, before any rash appears. A doctor the same day.

Abdominal strain, side strain, rib strain, hernia or sports hernia?

Once a doctor has ruled out the causes above, or the pattern fits the muscle, these are the conditions that look alike.

Condition	How it started	What you notice	What it needs first
Abdominal muscle strain (rectus abdominis)	Crunches, sit-ups, a serve, a kick, a coughing fit	One sore spot down the front, worse sitting up from lying, coughing and laughing. Tender to press. No lump	Stop the movement that did it. A physiotherapist if it is not easing
Side strain (oblique strain)	Bowling, serving, throwing or a swing	A sharp pull low on the side, on the lowest ribs, opposite the bowling or throwing arm. The next delivery or serve catches it	Stop bowling, serving or throwing. A physiotherapist to stage the return
Intercostal muscle strain	A twist, a reach or a coughing fit	Pain between two ribs, higher up, that catches on a deep breath	A doctor first for chest pain with breathlessness
Rib fracture	A fall, a blow, a tackle	Pain on one rib, worse on a deep breath and when pressing the rib	A doctor. The emergency department if you are short of breath
Inguinal hernia	A lift or a strain, or no moment at all	A lump in the groin that comes out when you cough or stand and goes back when you lie down	A doctor soon. The emergency department if the lump turns hard, painful and will not go back
Umbilical hernia	Often no moment. Common after pregnancy and with weight around the stomach	A soft bulge at the belly button that grows when you cough or strain	A doctor soon. The emergency department if it turns hard and painful, with vomiting
Sports hernia (inguinal-related groin pain)	Kicking, sprinting and cutting, over weeks	Pain low in the stomach wall near the pubic bone and groin, worse with kicking and sit-ups. No lump	A physiotherapist, after a doctor has ruled out a true hernia
Hip flexor strain	Sprinting, kicking	Pain in the crease at the front of the hip, worse lifting the knee	A physiotherapist
Diastasis recti	Pregnancy, or weight carried around the stomach	A ridge or dome down the middle of the stomach when you sit up. Usually little pain	A physiotherapist. A doctor for a bulge at the belly button

How long does a pulled stomach muscle take to heal?

An everyday strain from crunches or a coughing fit usually settles over a few weeks. The pain on sitting up and coughing goes first. The tenderness to press goes last.

Strains from a serve, a throw or a delivery are slower, and they come back. A study of professional baseball over 20 years counted 393 abdominal muscle strains. Players spent an average of 27 days (position players) to 35 days (pitchers) on the injured list, 70% to 78% of strains were on the side opposite the throwing arm, and 12% were reinjuries.¹ In a study of 10 fast bowlers with side strain, the strain sat on the non-bowling side, and 6 of the 10 were recurrences.²

Those are full-time athletes with medical teams. The point for a Saturday player is the same. Pain on getting out of bed and the trunk taking a full-speed serve are two separate tests, and the second one is the one that decides.

Abdominal strain treatment: who does what

A doctor (your GP, a polyclinic doctor or the emergency department) examines the stomach, rules out the causes inside, and decides whether you need a blood test or a scan. Whether you need an ultrasound or an MRI is a decision for your doctor.
A surgeon decides on and repairs a hernia, and sets the limits on lifting and sport after the operation.
A physiotherapist assesses and treats the strain itself: settling it, getting the trunk turning and reaching again, building strength in the stomach and side muscles, then bringing the serve, the throw or the lift back in stages.

The four stages for a stomach muscle strain

In the Phoenix Recovery Protocol the work starts at Calm & Protect: the serve, the crunches and the heavy lifts stop, while walking, full breathing and getting out of bed carry on. Move & Mobilize brings back turning, side-bending and reaching overhead without the catch. Rebuild & Strengthen loads the trunk in order: holding still against a load first, then lowering under control, then turning against resistance, each side measured against the other. Return & Perform brings back the serve, the smash, the throw or the delivery on a counted ladder, from half pace to full, then match play. Side strains get the slowest ladder, because they are the ones that come back.

What we measure

Where it hurts. Pressing along the six-pack, the side and the lowest ribs, against the other side.
The tensing test. You lift your head and shoulders off the bed while we press the sore spot (Carnett’s test). Pain from the stomach wall usually stays the same or sharpens. Pain from inside usually eases. It sorts likely from unlikely. It does not rule anything out, and anything that does not fit goes back to a doctor.
Trunk rotation. How far you turn each way, sitting, in degrees.
Side plank. How long you hold, in seconds, on each side. This is the number we watch most in a side strain.
Curl-up and lowering. Sitting up from lying, and lowering under control from sitting, counted.
Rotation strength. Turning against a cable or band, each side.
Cough, sneeze and the bed. Whether they still catch.
The sport itself. Serves, smashes, throws, swings or deliveries, counted at rising effort, and where in the movement it catches.

Tested, not dated. The plan moves on when the measures say so.

What you can do this week

If the pain came without a moment, or you have a fever, vomiting or pain after a blow to the stomach, see a doctor first. Everything below is for a strain.
Stop the movement that did it: the serve, the crunches, the heavy lift.
Keep walking, and keep breathing fully. Holding your breath to guard the spot stiffens the ribs.
Hug a pillow against the sore spot to cough, sneeze or laugh.
Get out of bed by rolling onto your side and pushing up with your arms, instead of sitting straight up.
No sit-ups, crunches or heavy lifting until sitting up from lying and coughing no longer catch.
A cold pack in the first days or warmth after, whichever eases it more.
Pain relief and anti-inflammatory medication are a decision for your doctor or pharmacist.

Is this normal?

Usually expected: after a strain, sitting up in bed, coughing and laughing catch at the same spot for the first week or two. The spot stays tender to press after the movement pain has gone. A bruise that tracks lower down the stomach over a few days after a bigger tear. Some stiffness turning to that side.

Worth getting checked: a strain that is no better at all after two weeks. The first full serve, throw or delivery catching the same spot each time you try. A strain that has come back more than once in a season. A lump that appears in the groin or at the belly button.

When to see a doctor first

Call 995 for stomach pain with fainting or collapse, or with a pale, cold, sweaty feeling. For upper stomach or chest pain with sweating, breathlessness, nausea, or pain into the arm or jaw. For sudden, severe pain in the stomach or back, especially if you are older or smoke. For stomach pain after a road accident or a hard fall with dizziness or confusion.
Go to the emergency department now for severe or worsening stomach pain, pain with a fever, or pain with repeated vomiting. For pain that started around the belly button and moved to the lower right. For a stomach that is hard and tender everywhere, or hurts with every step or jolt. For any stomach pain after a blow to the stomach or lower ribs (a handlebar, a tackle, a fall), especially under the left ribs or with pain at the tip of the left shoulder, even if it seems mild. For sudden pain in a testicle or swelling of the scrotum. For a hernia lump that has turned hard and painful and will not go back. For lower stomach pain if you are pregnant or could be. For vomiting blood, or black, tarry stools. For pain under the right ribs with fever or yellow eyes or skin. For a growing, painful lump or bruise in the stomach wall if you take blood thinners. For pain in the back or side that comes in waves with a fever, or that stops you keeping fluids down.
See a doctor the same day for stomach pain that does not change at all with movement, position or pressing. For pain under the right ribs after meals, with nausea. For pain in the back or side that comes in waves, without a fever. For burning on passing urine, or blood in the urine or the stool. For a burning band of pain on one side of the trunk, with or without a rash.
See a doctor soon for a bulge in the groin or at the belly button that appears when you cough, strain or stand and goes back when you lie down. For stomach pain with weight loss you cannot explain, or a change in your bowels that lasts for weeks. For groin and lower stomach pain with kicking and sprinting that has not settled, covered in groin pain.

Where are you with this right now?

1. It is easing week by week

You can name the moment: the set of crunches, the serve, the week of coughing. Sitting up in bed catches less each morning, you can laugh without holding your side, and the bruise has gone from purple to yellow. That is a strain behaving as expected. Bring the sport back in steps, half pace before full. You do not need us for this, and we would rather say so.

2. The pain has gone, and the serve still catches

Five weeks since the serve that did it. Getting out of bed is fine now, and you can sneeze without bracing.

On Saturday you went back to doubles at the community club. The easy rallies felt fine. Then the first full serve, and the same spot low on your left side, on the bottom rib, pulled again. You finished the game serving underarm. Since then you have sat out two league ties, and the racquet bag has stayed in the car boot.

Rest made sense in the first week. In your own weeks since, rest took away the pain on sitting up and left the serve where it was.

Getting out of bed no longer hurts. Has anyone measured how long that side holds a side plank against the other one?

If you are not sure it is the muscle, or the pain has changed, a doctor sees you first. If it is the muscle and it is still catching, one Assessment & Treatment with a physiotherapist presses, tests and measures both sides, treats what is limiting you in the same visit, and tells you which stage you are in.

3. You have had an operation, or you have a date

After a hernia repair, stomach surgery or a C-section, your surgeon sets what you lift and when sport starts, and we work inside those limits. See physiotherapy after surgery. A gap down the middle after pregnancy starts with diastasis recti. Your surgeon’s protocol takes precedence.

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If it is months on and the serve, the throw or the lift still catches, the Stalled Recovery Review is three weeks with the same physiotherapist. The first visit measures both sides of the trunk and the movement itself. The next two measure how they respond.

All of it runs on the same four stages. The Phoenix Recovery Protocol explains what each stage works on and what you have to meet to move up. No referral needed to start.

Next step

Find out which stage you are in

Pain is the first thing to leave. Movement and strength are the last things trained back, and most people stop before that part is done. One Assessment and Treatment is a single 45-minute appointment at $230, nett, no GST. Your therapist finds what is actually limiting you, treats it in the same appointment, and you leave with your current stage and a written plan.

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Prefer to phone? Each of our five clinics has its own number on the clinics page. No referral needed to book.