What is ACNES?

• ACNES (Abdominal Cutaneous Nerve Entrapment Syndrome) is a condition where a small nerve that travels through the abdominal wall becomes entrapped or irritated, typically where it pierces the abdominal muscles. This causes chronic, localized abdominal pain, often misdiagnosed as a gastrointestinal or internal organ issue.
• The pain is typically sharp, burning, or stabbing, and usually worsens with certain movements, muscle activation, or pressure in a specific spot. It’s more common than previously thought and is often overlooked in differential diagnoses of abdominal pain.

Why does it happen? 

ACNES occurs when one of the anterior cutaneous branches of the intercostal nerves (T7–T12) becomes compressed or irritated as it passes through the abdominal wall, especially through the rectus sheath.

Common Causes Include:

• Sudden or repetitive twisting movements or strain
  
• Post-surgical scarring (especially laparoscopic surgery)
  
• Rapid weight gain or loss
  
• Pregnancy
  
• Trauma or blunt abdominal injury
  
• Prolonged coughing or abdominal straining
  
• Sometimes, the cause is idiopathic (unknown)

Myths vs facts?

Myth	Fact
“It’s all in your head.”	False – ACNES is a real, nerve-related pain syndrome.
“It must be a problem with your stomach or intestines.”	False- ACNES is a neuromuscular issue, not gastrointestinal.
“Only surgery can fix this.”	False- many non surgical treatments can be very effective , including physiotherapy
“If scans are normal, there’s no issue.”	False- ACNES doesn’t show up on most imaging, diagnosis is clinical , often using a carnett’s test

What things can be done to help? 

1. Things you can try at home to reduce pain before you see us?
   1. Activity Modification
      1. Avoid repetitive bending, twisting, or abdominal straining.
      2. Modify lifting strategies.
   2. Heat Therapy
      3. Applying a warm compress to the painful area can ease muscle guarding.
   3. Gentle Abdominal Massage
      4. Light circular massage over the painful area may reduce nerve irritation.
   4. Diaphragmatic Breathing
      5. Helps reduce abdominal wall tension and improves neuromuscular control.
   5. Posture Awareness
      6. Poor posture can increase abdominal wall strain. Try sitting and standing tall, especially if you notice pain when slouching.
   6. OTC Pain Relief
      7. Use NSAIDs (ibuprofen) as advised by your doctor to reduce inflammation.
2. Other MDT members who should be involved
   Treating ACNES often requires a multi-disciplinary approach:
   • GP or Pain Specialist: For diagnosis, referral, and possibly nerve blocks or medication.
   • Physiotherapist : For movement retraining, nerve gliding, pain management, and postural correction.
   • Surgeon (if needed): In rare cases where conservative management fails.
   • Psychologist: For support in chronic pain management and coping strategies.
   • Occupational Therapist: For advice on daily activities and ergonomics if functional limitation is significant.
3. What does the research say?
   Recent research indicates:
   • Up to 10–30% of chronic abdominal pain may be due to ACNES, yet it’s frequently missed.
   • Carnett’s sign (increased pain when abdominal muscles are tensed) is key for diagnosis.
   • Local anesthetic injections often provide diagnostic and therapeutic benefit.
   • Conservative treatments including physiotherapy, activity modification, and nerve mobilisations have shown good outcomes in many patients.
   • Surgery (neurectomy) is a last resort and only for refractory cases.

How can we, at ph.therapy, help?

At ph.therapy, we approach ACNES with a detailed, evidence-based, and patient-centred plan:

1. Thorough Assessment
   • We perform a detailed assessment including movement analysis, posture, abdominal palpation, and Carnett’s test to confirm or support the diagnosis.
   • We’ll also assess for associated musculoskeletal issues (e.g. thoracic spine stiffness or core dysfunction) that could be contributing.
2. Pain Education
   • We help you understand why the pain is happening, how nerves behave, and what you can do to take control.
   • Education reduces fear and empowers self-management.
3. Manual Therapy
   • Gentle soft tissue release or myofascial techniques to reduce local nerve irritation.
   • Neurodynamic techniques or nerve glides to mobilise the affected nerve and reduce entrapment.
4. Movement & Exercise Therapy
   • We’ll guide you through a graded return to movement, including:
     • Core re-training to offload the abdominal wall.
     • Postural retraining.
     • Functional rehab to get you back to work, sport, or daily activity.
   • Focus on desensitising the area and restoring normal movement patterns without flaring symptoms.
5. Multidisciplinary Collaboration
   • We’ll liaise with your GP or specialist if diagnostic confirmation or additional interventions (e.g., nerve blocks) are needed.
   • We advocate for a team approach to ensure nothing is missed and you get comprehensive care.
6. Ongoing Support
   • You’ll receive a personalised rehab plan, regular check-ins, and tools for self-management.
   • We understand this condition can be frustrating – we’re here to support your journey to recovery.