Transverse Abdominis (TVA) Trigger Points

Introduction

The transverse abdominis (TVA) is a deep core muscle responsible for core stabilization, spinal support, and intra-abdominal pressure regulation. When trigger points develop in this muscle, they can cause lower abdominal pain, lower back discomfort, and postural instability, often mimicking hernia pain, digestive issues, or sacroiliac (SI) joint dysfunction.

Name and Area

  • Name: Transverse Abdominis (TVA)

  • Area: Located in the deep abdominal wall, running horizontally from the thoracolumbar fascia, ribs, and pelvis to the linea alba.

Indications

Transverse abdominis trigger points may contribute to:

  • Pain in the Lower Abdomen or Lower Back (Mistaken for Hernia Pain or Digestive Issues)

  • Pain That Extends to the SI Joint and Pelvis (Can Mimic SI Joint Dysfunction or Hip Flexor Strain)

  • Weakness in Core Activation (Difficulty with Balance, Lifting, or Core Exercises)

  • Pain or Discomfort That Worsens with Coughing, Laughing, or Deep Breathing

  • Lower Back or Abdominal Tightness That Restricts Spinal Mobility

  • Pelvic Instability or a Feeling of "Core Weakness" During Movement

Pain from this muscle is often mistaken for digestive disorders, SI joint dysfunction, or abdominal strain.

Muscle Action

  • Compresses the Abdominal Contents: Acts like a "corset" to support posture and protect the spine.

  • Stabilizes the Lumbar Spine and Pelvis: Works with other core muscles to maintain trunk control.

  • Supports Breathing Mechanics: Assists in exhalation and diaphragmatic function.

The TVA is crucial for core function, spinal alignment, and overall postural stability.

Signs and Symptoms

Individuals with transverse abdominis trigger points often report:

  • Pain in the Lower Abdomen and Lower Back That Feels Like a "Deep Ache" or "Pressure"

  • Weakness in Core Stability (Difficulty Holding a Plank or Engaging the Core During Movements)

  • Pain or Discomfort That Worsens with Prolonged Sitting or Standing

  • A "Hollow" or "Weak" Feeling in the Abdominal Wall (Common in Postpartum Individuals and Those with Core Dysfunction)

  • Tightness or Stiffness in the Lower Abdomen That Restricts Breathing or Spinal Mobility

  • Pelvic Instability That Feels Like the Hips Are "Shifting" During Walking or Exercise

Pain worsens with poor posture, prolonged sitting, or excessive core engagement.

Perpetuating Factors

Common causes of transverse abdominis trigger points include:

  • Weak Core or Poor Core Activation (Common in Sedentary Individuals and Postpartum Recovery)

  • Overuse in Core Exercises Without Proper Engagement (Can Lead to Muscle Imbalances and Weakness)

  • Prolonged Sitting or Poor Posture (Can Lead to Core Inactivity and Lower Back Dysfunction)

  • Diaphragmatic Dysfunction (Shallow Breathing Can Overuse the TVA for Stability, Leading to Tension and Tightness)

  • Pregnancy or Abdominal Surgery (Can Lead to Core Weakness, Muscle Separation, or Diastasis Recti)

Trigger Point Referral Pattern

Trigger points in the TVA refer pain to:

  • The lower abdomen and lumbar spine (Can Mimic Hernia Pain or Core Weakness)

  • The SI joint and pelvis (Mistaken for Hip Flexor or Pelvic Floor Dysfunction)

  • The lower ribs and diaphragm area (Can Resemble Breathing Dysfunction or Digestive Issues)

Pain from this muscle is often confused with hernias, pelvic floor dysfunction, or lumbar instability.

Differential Diagnosis

TVA trigger points may be mistaken for:

  • Hernias (Pain or Pressure in the Lower Abdomen, Often Worsens with Straining or Lifting)

  • SI Joint Dysfunction (Pelvic Pain That Worsens with Walking or Standing on One Leg)

  • Lower Back Pain or Disc Issues (Pain That Radiates to the Lower Abdomen or Hips, Worsens with Sitting or Bending)

  • Diaphragm Dysfunction (Pain in the Lower Ribs and Abdominal Wall, Can Affect Breathing Mechanics)

  • Postpartum Core Dysfunction (Core Weakness, Pelvic Instability, and Diastasis Recti Symptoms)

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

Associated Trigger Points

TVA trigger points often co-exist with:

  • Rectus Abdominis (Upper and Lower Core Pain, Affects Spinal Stability and Postural Control)

  • Internal and External Obliques (Side Abdominal and Rib Pain, Affects Trunk Stability and Rotation)

  • Quadratus Lumborum (Lower Back and Pelvic Pain, Contributes to Core Weakness and Postural Imbalances)

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

Anatomy and Innervation

Muscle Origin Insertion Innervation
Transverse Abdominis Thoracolumbar fascia, iliac crest, lower ribs, inguinal ligament Linea alba, pubic crest Lower intercostal nerves (T7–T12), iliohypogastric and ilioinguinal nerves (L1)

The TVA is innervated by the lower intercostal nerves and iliohypogastric/ilioinguinal nerves, which also control abdominal function, spinal stability, and breathing mechanics.

Patient Examination

A comprehensive examination should include:

  • Palpation: Identify tender nodules along the lower abdomen, lower ribs, and pelvic region.

  • Resisted Core Activation Testing: Assess pain and weakness when performing core engagement exercises.

  • Postural and Breathing Assessment: Look for shallow breathing, pelvic misalignment, or excessive abdominal tension.

  • Pelvic and Lower Back Stability Testing: Rule out SI joint dysfunction, hip imbalances, or postural dysfunction.

Corrective Actions

Dry Needling

  • Dry needling can release trigger points in the TVA, reducing core tightness and improving trunk stability.

Manual Therapy

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

  • Myofascial Release: Helps improve circulation and reduce muscle tension in the abdominal wall.

Stretching

  • Diaphragmatic Breathing Exercises: Helps release tension in the TVA and promote deep core activation.

  • Seated Twisting Stretch: Encourages core flexibility and rib mobility.

Strengthening Exercises

  • Dead Bugs (Controlled Core Activation): Helps engage the TVA for spinal support and stability.

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

  • Glute Bridges: Helps counteract anterior pelvic tilt and improve lower back stability.

Postural and Lifestyle Adjustments

  • Avoid Prolonged Slouching (Maintain Proper Sitting Posture to Prevent Core Weakness)

  • Ensure Proper Breathing Mechanics (Encourages Full Rib Expansion and Reduces Excessive Abdominal Tension)

  • Use Proper Lifting Techniques (Prevents Excessive Strain on the TVA and Lower Back)

Conclusion

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