Atlas · Abdomen

Internal Obliques

Deep lateral abdominal aching from internal oblique trigger points beneath external layer

Body region

Abdomen

Trigger points

documented in this muscle

Common symptoms

patterns cataloged

Common causes

contributory factors

Illustrated overview

Internal Obliques · Anatomy 1. Anatomical view of the illustrated muscle. — **Internal Obliques · Anatomy 1**
Anatomical view of the illustrated muscle.
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Trigger points

Select a trigger point

1. TrP1

Location. Deep side of abdomen

Internal Obliques — Internal Oblique · Common trigger-point sites — Trigger point map

Referred pain map

Map not available

Pain referral. Side of abdomen, lower chest

Pain Pattern

Side of abdomen
Lower rib area
Groin
Lower back

What This Pain Feels Like

A deep lower abdominal and groin pain that can convincingly mimic a hernia, gynecological condition, or urological problem. The pain worsens with twisting movements and core engagement, often running diagonally from the hip toward the midline. Some patients experience a sensation of bladder urgency or pelvic pressure that has no identifiable urological cause. Because the internal obliques lie beneath the external layer, the trigger points can be difficult to locate and are frequently overlooked during standard examinations.

What Patients Report

Deep ache in side
Pain with twisting
Groin discomfort

What Makes It Worse

Trunk rotation
Coughing
Side bending
Core exercises

Browse related exercises (1)

Symptoms patients report

Deep side pain Deep lateral abdominal aching from internal oblique trigger points beneath external layer

Rib discomfort Lower costal margin discomfort from trigger points near the rib cage attachment sites

Groin pain Referred inguinal aching from lower internal oblique trigger point referral patterns

Pain with trunk rotation Sharp deep trunk pain during rotational movements from internal oblique taut bands

Costal margin pain mimicking rib pathology Upper internal oblique trigger points at the costal margin create pain mimicking rib fracture or costochondritis

Upper lateral abdominal ache Taut bands near the costal attachment create diffuse aching in the upper lateral abdominal wall

Pain with deep breathing Rib expansion during deep inspiration stretches upper internal oblique taut bands provoking pain

Side stitch-like pain Upper lateral trigger point activation during exertion creates a persistent side stitch sensation

Tenderness along lower rib margin Palpation along the costal margin reveals point tenderness at internal oblique attachment sites

Inguinal pain mimicking hernia Groin ache resembling inguinal hernia from lower oblique fiber tension near inguinal canal

Lower abdominal cramping Spasmodic lower abdominal wall pain from sustained contraction of inferior oblique fibers

Groin discomfort Deep groin crease ache from trigger point referral along inguinal ligament attachment

Pain with Valsalva maneuver Increased intra-abdominal pressure during straining loads sensitized lower oblique fibers

Suprapubic ache Referred dull pain above pubic symphysis from lower internal oblique trigger points

Common causes

Twisting Forceful or sustained trunk rotation overloads internal oblique fibers causing taut bands

Coughing Repeated forceful expiratory contraction strains internal oblique muscle fibers progressively

Sports Rotational sporting activities demand repetitive internal oblique activation causing cumulative fatigue

Core exercises Intensive core training with rotation components overloads internal oblique muscle fibers

Carrying items Asymmetric load carrying forces internal obliques to stabilize trunk against rotation

Excessive oblique exercises High-volume rotational core exercises overload the upper internal oblique fibers at their costal attachments

Chronic cough Repeated forceful coughing generates sustained internal oblique contraction creating ischemic trigger points

Rib fracture with secondary guarding Post-fracture protective guarding of the internal obliques creates persistent secondary trigger points

Thoracolumbar scoliosis Spinal curvature creates asymmetric internal oblique loading on the concave side of the curve

Prolonged side-lying posture Sustained lateral recumbent position compresses upper internal oblique fibers against the costal margin

Heavy lifting with poor form Excessive lower abdominal wall strain during lifting overloads inguinal oblique fibers

Sports hernia-type activities Repetitive cutting and twisting motions stress lower oblique insertions near inguinal region

Chronic straining (constipation) Repeated Valsalva maneuver during bowel movements overworks lower abdominal wall musculature

Post-inguinal hernia repair adhesions Surgical scarring restricts lower oblique mobility creating secondary trigger points

Excessive hip flexor and abdominal training Combined hip flexor and core overtraining fatigues lower oblique and inguinal region muscles

Treatment & self-care

Immediate Relief

Gentle Abdominal Self-Massage

Lie on your back with your knees bent and feet flat on the floor to relax the abdominal wall. Using your fingertips, apply gentle, circular pressure along the lower side of your abdomen, from the hip bone toward the midline. When you find a tender area, hold gentle sustained pressure for 20-30 seconds. Do not press deeply or forcefully, as the abdominal wall is sensitive.

Duration: 5-10 minutes per session
Frequency: 1-2 times daily
Expect: Possible temporary comfort; compare the same movement before and after massage.

Caution Seek urgent medical evaluation if you notice a visible bulge in the groin or abdomen, have fever, or experience changes in bowel habits. These may indicate a hernia or other condition requiring medical attention.

Immediate Relief

Moist Heat to Lower Abdomen

Apply a warm, damp towel or microwavable heat pack to the lower side of the abdomen. Lie in a comfortable position with knees bent. Ensure the heat is comfortably warm but not hot enough to burn. Allow the warmth to relax the deep abdominal muscles before stretching.

Duration: 15-20 minutes per session
Frequency: 1-2 times daily, especially before stretching
Expect: Possible temporary warmth and comfort before gentle movement.

Exercises

Side-Lying Oblique Stretch

Lie on the unaffected side with your bottom arm extended overhead. Slowly reach your top arm overhead as well, creating a long arching stretch along the entire affected side. You should feel a gentle stretch through the lower abdomen and side. Avoid forcing the stretch. Breathe deeply and allow the side to open gradually.

Duration: 30-second holds, 3 repetitions per side
Frequency: 2-3 times daily
Expect: Work toward more comfortable trunk movement; track bending or turning.

Exercises

Dead Bug Exercise for Controlled Core Activation

Lie on your back with your arms extended toward the ceiling and your hips and knees bent at 90 degrees. Slowly lower your right arm overhead while extending your left leg toward the floor, keeping your lower back pressed into the ground. Return to the start and repeat on the opposite side. This gently strengthens the obliques without aggressive twisting.

Duration: 8-10 repetitions per side, 2 sets
Frequency: Once daily
Expect: Build trunk strength and coordination for everyday tasks.

Lifestyle Changes

Pelvic Floor Relaxation Breathing

Sit or lie comfortably. Inhale slowly through your nose for 4 counts, allowing your belly and pelvic floor to gently expand. Exhale slowly through your mouth for 6 counts, allowing complete relaxation without actively engaging the core. Focus on releasing tension in the lower abdomen and pelvic floor with each exhale. This counteracts the chronic tension that perpetuates internal oblique trigger points.

Duration: 5 minutes per session
Frequency: 2-3 times daily, especially during stress
Expect: Practice releasing pelvic-floor tension without pushing; track pelvic comfort and daily function.

Professional Treatment

Professional Evaluation to Rule Out Hernia or Organ Pathology

Consult a physician if lower abdominal or groin pain persists beyond 3-4 weeks, or immediately if you notice a visible bulge, have fever, or experience bowel or bladder changes. A physical examination and possibly imaging studies are needed to rule out inguinal hernia, gynecological conditions, or urological problems before attributing symptoms solely to trigger points.

Duration: Initial evaluation: 30-60 minutes
Frequency: As needed based on symptom severity and persistence
Expect: A working diagnosis and an individualized treatment plan, with progress judged by the relevant daily activity.

Caution Do not delay evaluation if there is a visible groin bulge, fever, unexplained weight loss, blood in urine or stool, or progressive worsening of symptoms despite self-care.

Differential diagnosis

Hernia
Rib dysfunction
Groin strain
Rib fracture
Costochondritis
Intercostal neuralgia
Slipping rib syndrome
Gallbladder disease (right side)
Inguinal hernia
Sports hernia (athletic pubalgia)
Iliopsoas bursitis
Adductor strain
Inguinal lymphadenopathy

Associated Trigger Points

External obliques
Transverse abdominis
External obliques TrP1
Intercostal muscles TrP1
Rectus abdominis TrP3
Serratus anterior TrP1
Transversus abdominis TrP1
External obliques TrP2
Rectus abdominis TrP2
Iliopsoas TrP1
Pectineus TrP1
Adductor longus TrP1

Key Takeaways

Deep lateral abdominal aching from internal oblique trigger points beneath external layer
Lower costal margin discomfort from trigger points near the rib cage attachment sites
Referred inguinal aching from lower internal oblique trigger point referral patterns
Sharp deep trunk pain during rotational movements from internal oblique taut bands
Upper internal oblique trigger points at the costal margin create pain mimicking rib fracture or costochondritis