Unexpected and dangerous cause of left side pain after workout named## Contribution

After cycling or training, pain in the left side is often attributed to muscles, although sometimes the cause is more serious. Surgeon of the Scandinavian Health Center Dmitry Monakhov told "Gazeta.Ru" how even a minor impact to the hypochondrium area can result in a hidden spleen injury and why it's important not to delay examination.

"During a fall from a bicycle or during a collision in a gym, a hard part of equipment or exercise machine hits the left side and delivers a point impact to the hypochondrium area. This could be a handlebar, the end of a crossbar, a barbell, the edge of a machine, or a stand. The spleen is located under the ninth to eleventh ribs, and when strongly compressed, it gets caught between the object and the rib-vertebral framework," he explained.

As a result of the impact, a rupture of the splenic capsule (the outer membrane of the organ) or blood vessels occurs, forming a hematoma and internal bleeding. The damage may not develop immediately: during sudden braking of a bicycle, an unsuccessful jerk of equipment, or a fall, tissue displacement occurs, and bleeding increases gradually, with symptoms appearing later.

"Initial examinations, including visual inspection, ultrasound, or X-ray without contrast, often don't show pathology. Blood can accumulate under the organ's capsule without free fluid, making results appear normal. Vascular complications, such as pseudoaneurysm (damage to the vessel wall with a cavity filled with blood) or micro-ruptures, are detected later - after 12-24 hours. The gold standard for diagnosis in stable patients remains abdominal CT with intravenous contrast, which helps detect even small injuries," he said.

Warning signs that should raise concern: increasing pain in the left hypochondrium, weakness, dizziness, paleness, cold sweat, nausea, and rapid pulse.

"A characteristic signal is pain in the left shoulder, caused by irritation of the diaphragm by blood (Kehr's sign - referred pain in the shoulder when blood accumulates under the diaphragm). With such manifestations, you need to seek medical help urgently," the doctor warned.

Hospitalization is required for increasing pain, fainting, vomiting, dropping blood pressure, rapid pulse, mottled skin, or left shoulder pain during inhalation. It is especially important not to wait if the patient is taking anticoagulants (medications that slow blood clotting) or antiplatelet drugs (medications that prevent platelet aggregation). In these situations, bleeding may intensify even with a minor impact.

"When a spleen injury is suspected, doctors assess hemodynamics (indicators of blood movement and circulatory stability). If the condition is stable, a contrast CT is performed to determine the degree of damage and the presence of bleeding. With unstable indicators, a quick ultrasound is performed, and emergency measures are taken immediately," the expert explained.

For minor injuries, conservative treatment is possible: observation, laboratory test monitoring, and dynamic examination. If active bleeding is found on CT, angioembolization is performed (a minimally invasive procedure to block the vessel and stop bleeding), which allows preserving the organ and avoiding open surgery.

"When massive blood loss develops, signs of peritonitis appear (inflammation of the peritoneum - the membrane covering the abdominal organs), or conservative treatment doesn't produce results, surgical intervention is performed. After removal of the spleen, patients are prescribed vaccination against encapsulated bacteria (microorganisms surrounded by a dense shell, such as pneumococci and meningococci) for infection prevention," the expert warned.

According to the doctor, the risk is higher for people taking blood-thinning medications, the elderly, and patients with an enlarged spleen after infections. Increased attention is also required for combined abdominal injuries. In such cases, hospitalization and repeated examinations are more often prescribed. Recovery after minor injuries takes several weeks, with more severe injuries - up to several months. After embolization or surgery, the rehabilitation period (recovery after illness or surgical intervention) increases, but with timely treatment, the prognosis remains favorable.

"On a bicycle, body protection, correct posture, and a firm grip on the handlebars help. When braking, it's better to shift weight backward and reduce speed in advance. Don't attach rigid objects to the handlebars, watch for end caps, and keep distance from curbs and posts. In the gym, use spotting when working with a barbell, secure plates