New York State Medical Treatment Guidelines for Lower Abdominal Strains in workers compensation patients

The guidelines established by the New York State Workers Compensation Board are designed to assist healthcare professionals in evaluating Lower Abdominal Strains. These directives aim to support physicians and healthcare practitioners in determining the appropriate treatment for this condition.

Healthcare professionals specializing in Lower Abdominal Strains can rely on the guidance provided by the Workers Compensation Board to make well-informed decisions about the most suitable level of care for their patients.

It is important to emphasize that these guidelines are not meant to replace clinical judgment or professional expertise. The ultimate decision regarding care should involve collaboration between the patient and their healthcare provider.

Lower Abdominal Strains

Lower abdominal strains commonly occur in occupational groups engaged in heavy lifting. Individuals experiencing such strains should undergo an assessment for hernias, and if identified, they should be recommended for potential surgical intervention.



For the majority of patients, initial recommendations for medications to address lower abdominal strains include ibuprofen, naproxen, or other NSAIDs from the older generation. Acetaminophen (or its analogue paracetamol) may serve as a viable alternative to NSAIDs for individuals ineligible for the latter, although existing evidence indicates that acetaminophen is slightly less effective. NSAIDs are shown to be as effective in pain relief as opioids (including tramadol) but with fewer impairing effects.

Non-Steroidal Anti-inflammatory Drugs (NSAIDs)

Recommendation: Advised for treating lower abdominal strains.

Indications: NSAIDs are suggested for treatment, with over-the-counter (OTC) options being a reasonable initial attempt.

Frequency/Duration: As-needed usage may be reasonable for many patients.

Indications for Discontinuation: Reasons for discontinuation may include the resolution of lower abdominal strains, lack of effectiveness, or the emergence of adverse effects necessitating cessation.


NSAIDs for Patients at High Risk of Gastrointestinal Bleeding

Recommendation: Concurrent use of cytoprotective drugs such as misoprostol, sucralfate, histamine Type 2 receptor blockers, and proton pump inhibitors is recommended for patients at high risk of gastrointestinal bleeding.

Indications: For patients with a high-risk factor profile who also require NSAIDs, considering cytoprotective medications is crucial, especially if prolonged treatment is contemplated. At-risk individuals include those with a history of prior gastrointestinal bleeding, the elderly, diabetics, and cigarette smokers.

Frequency/Dose/Duration: Proton pump inhibitors, misoprostol, sucralfate, and H2 blockers are recommended, with dosages and frequencies adhering to manufacturer guidelines. There is generally no significant difference in efficacy for preventing gastrointestinal bleeding


NSAIDs for Patients at Risk for Cardiovascular Adverse Effects

Patients having known cardiovascular disease or multiple risk factors for cardiovascular issues should engage in a discussion about the potential risks and benefits associated with NSAID therapy for pain.

Recommendation: Acetaminophen or aspirin stands out as the safest first-line therapy concerning cardiovascular adverse effects.

Recommendation: In cases where NSAIDs are deemed necessary, non-selective NSAIDs are preferable over COX-2 specific drugs.

For individuals concurrently taking low-dose aspirin for primary or secondary cardiovascular disease prevention, to minimize the potential counteraction of the beneficial effects of aspirin, it is advised that the NSAID be consumed either at least 30 minutes after or eight hours before the daily aspirin.


Acetaminophen for Treatment of Lower Abdominal Strains

Recommendation: Acetaminophen is recommended for the treatment of lower abdominal strains, especially in patients with contraindications for NSAIDs.

Indications: Applicable to all patients with lower abdominal strains, encompassing acute, subacute, chronic, and post-operative cases.

Dose/Frequency: Utilize per the manufacturer’s recommendations; it can be employed on an as-needed basis. Caution is warranted as evidence indicates hepatic toxicity when exceeding four gm/day.



Hot and Cold Therapies


Recommendation: Advised for lower abdominal strains.

Indications: Applicable to all patients experiencing lower abdominal strains.

Frequency/Duration: Approximately three to five self-applications per day, as necessary.

Indications for Discontinuation: Discontinue when the condition resolves, in the presence of adverse effects, or if non-compliance becomes an issue.


Heat Therapy

Recommendation: Suggested for lower abdominal strains.

Indications: Suitable for all patients with lower abdominal strains.

Frequency/Duration: Approximately three to five self-applications per day, as required.

Indications for Discontinuation: Cease when the condition resolves, if adverse effects arise, or if non-compliance is observed.



Recommendation: Rehabilitation is advised for the treatment of lower abdominal strains.

Indications: Most patients, especially those with strength deficits and/or significant functional impairments, can benefit from a rehabilitation program. Exercise is a recommended approach for addressing functional deficits, particularly in cases of lower abdominal strains of at least moderate severity. Mild cases often resolve with the elimination of exposures, NSAIDs, and the passage of time.

Frequency/Dose/Duration: The total number of visits may range from as few as two to three for patients with mild functional deficits to 12 to 15 for those with more severe deficits, with documented ongoing objective functional improvement. If ongoing functional deficits persist, exceeding 12 to 15 visits may be warranted, especially with documented improvement towards specific objective functional goals (e.g., range of motion, enhanced ability to perform work activities). As part of the rehabilitation plan, a home exercise program should be developed and executed in conjunction with the therapy.

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