Rectus Abdominis Trigger Points

Introduction

The rectus abdominis is a major core muscle responsible for trunk flexion, posture, and spinal stability. When trigger points develop in this muscle, they can cause abdominal pain, lower back discomfort, and rib tightness, often mimicking digestive issues, hernias, or rib dysfunction.

Name and Area

  • Name: Rectus Abdominis

  • Area: Located in the front of the abdomen, running from the pubic bone to the lower ribs and forming the "six-pack" muscles.

Indications

Rectus abdominis trigger points may contribute to:

  • Pain in the Lower or Upper Abdomen (Mistaken for Digestive Issues, Acid Reflux, or Hernias)

  • Pain That Extends to the Lower Back (Can Mimic Lumbar Spine Dysfunction or SI Joint Pain)

  • Tightness in the Core That Restricts Deep Breathing (Can Feel Like Rib Compression)

  • Pain or Discomfort When Sitting for Long Periods (Common in Office Workers and Drivers)

  • Pain That Increases with Abdominal Movements (Sit-Ups, Crunches, or Twisting Motions)

  • Tenderness in the Lower Ribs or Pubic Region (Can Resemble Costochondritis or Pelvic Pain)

Pain from this muscle is often mistaken for stomach problems, rib dysfunction, or lower back issues.

Muscle Action

  • Flexes the Trunk: Bends the spine forward, essential for core stability and movement.

  • Stabilizes the Spine and Pelvis: Works with other core muscles to support posture.

  • Assists in Forced Expiration: Helps compress the abdominal contents during breathing and core engagement.

The rectus abdominis is crucial for core function, spinal health, and maintaining an upright posture.

Signs and Symptoms

Individuals with rectus abdominis trigger points often report:

  • Pain in the Upper or Lower Abdomen That Feels Like a Deep, Aching Sensation

  • Pain That Radiates to the Lower Back, Ribcage, or Groin (Can Mimic Internal Organ Dysfunction)

  • Abdominal Tightness or Stiffness That Worsens with Core Exercises or Long Sitting Periods

  • Pain That Feels Worse After Eating or With Slouching (Can Resemble Acid Reflux or Digestive Discomfort)

  • Difficulty Taking Deep Breaths Due to Rib or Core Tightness

  • Tenderness When Pressing on the Abdomen (Can Be Mistaken for a Digestive or Pelvic Issue)

Pain worsens with core activation, prolonged sitting, or poor posture.

Perpetuating Factors

Common causes of rectus abdominis trigger points include:

  • Weak Core or Overuse of Abdominal Muscles (Common in Athletes and Those with Poor Postural Control)

  • Excessive Core Exercises Without Proper Form (Sit-Ups, Crunches, or Leg Raises Can Overload the Rectus Abdominis)

  • Prolonged Sitting with a Slouched Posture (Leads to Chronic Core Tightness and Weakness)

  • Digestive Issues or Bloating (Can Increase Abdominal Pressure and Muscle Tension)

  • Pregnancy or Postpartum Recovery (Can Cause Rectus Abdominis Dysfunction and Separation, Known as Diastasis Recti)

Trigger Point Referral Pattern

Trigger points in the rectus abdominis refer pain to:

  • The upper and lower abdomen (Can Mimic Digestive Pain or Stomach Cramps)

  • The lower back and sacral region (Mistaken for Lumbar Spine Dysfunction or SI Joint Issues)

  • The ribs and sternum (Can Resemble Rib Dysfunction or Costochondritis)

Pain from this muscle is often confused with hernias, digestive disorders, or core instability.

Differential Diagnosis

Rectus abdominis trigger points may be mistaken for:

  • Acid Reflux (GERD) (Upper Abdominal Pain or Burning Sensation, Often Worsens After Eating)

  • Hernia (Localized Abdominal Pain or Bulging, Can Worsen with Straining or Lifting)

  • Lumbar Disc Herniation (Lower Back Pain That Radiates to the Abdomen or Hips)

  • Costochondritis (Rib Pain and Tenderness, Worsens with Breathing or Movement)

  • Pelvic Floor Dysfunction (Lower Abdominal Pain That Affects Bladder or Bowel Function)

A thorough core, lumbar spine, and rib assessment is necessary to rule out these conditions.

Associated Trigger Points

Rectus abdominis trigger points often co-exist with:

  • Transverse Abdominis (Deep Core Pain, Affects Postural Control and Breathing Mechanics)

  • Quadratus Lumborum (Lower Back and Hip Pain, Contributes to Pelvic Instability and Postural Imbalances)

  • Diaphragm (Upper Abdominal and Rib Pain, Can Affect Breathing and Core Stability)

  • Adductor Muscles (Groin and Inner Thigh Pain, Common in Athletes and Those with Pelvic Dysfunction)

Anatomy and Innervation

Muscle Origin Insertion Innervation
Rectus Abdominis Pubic symphysis, pubic crest Costal cartilage of ribs 5–7, xiphoid process Lower intercostal nerves (T7–T12)

The rectus abdominis is innervated by the lower intercostal nerves (T7–T12), which also control core activation, posture, and abdominal function.

Patient Examination

A comprehensive examination should include:

  • Palpation: Identify tender nodules along the abdomen and ribcage.

  • Resisted Core Activation Testing: Assess pain and weakness when performing sit-ups, crunches, or leg raises.

  • Postural and Breathing Assessment: Look for anterior pelvic tilt, rib flare, or breathing dysfunction.

  • Abdominal Organ and Digestive Screening: Rule out gastrointestinal or hernia-related issues.

Corrective Actions

Dry Needling

  • Dry needling can release trigger points in the rectus abdominis, reducing abdominal tightness and improving core function.

Manual Therapy

  • Trigger Point Release: Apply deep sustained pressure to tight spots in the abdomen and lower ribs.

  • Myofascial Release: Helps improve circulation and reduce tension in the core muscles.

Stretching

  • Cobra Stretch (Upward Dog Pose): Helps lengthen the rectus abdominis and relieve tension.

  • Seated Side Stretch: Improves rib mobility and deep core flexibility.

Strengthening Exercises

  • Planks (Core Stabilization): Strengthens the deep core without excessive spinal strain.

  • Dead Bugs (Controlled Core Activation): Helps engage the transverse abdominis and improve lumbar stability.

  • Glute Bridges (Posterior Chain Activation): Counterbalances anterior pelvic tilt and core imbalances.

Postural and Lifestyle Adjustments

  • Avoid Excessive Core Flexion Movements (Perform Controlled Core Exercises with Proper Engagement)

  • Ensure Proper Sitting Posture (Use Lumbar Support to Reduce Abdominal Compression)

  • Practice Deep Diaphragmatic Breathing (Reduces Chronic Core Tension and Supports Rib Mobility)

Conclusion

The rectus abdominis plays a crucial role in core stability, spinal support, and posture, but trigger points in this muscle can cause significant abdominal, lower back, and rib pain. By incorporating dry needling, manual therapy, stretching, and core stabilization exercises, individuals can reduce pain, improve mobility, and prevent chronic abdominal dysfunction.

➡️ Learn more about Trigger Points

➡️ Explore our Trigger Point Index

Sources:

  • Travell, J. G., & Simons, D. G. (1983). Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.). Williams & Wilkins.

  • Simons, D., & Travell, J. (1999). The Trigger Point Manual, Volume 2: The Lower Extremities. Williams & Wilkins.