A guide for massage therapists, manual therapists, and rehabilitation professionals

The rectus abdominis is one of those muscles that clients know by name but rarely understand in function.

People think “six-pack,” aesthetics, core strength, or gym workouts. But for us as manual and rehabilitation therapists, the rectus abdominis is a central player in functional stability, postural balance, breathing mechanics, organ support, and movement efficiency. When something goes wrong here, the ripple effect can be enormous. And yet, because the muscle sits on the anterior surface and is associated with the “front” of the body rather than the musculoskeletal back or hips, it’s surprisingly easy for practitioners to overlook its involvement in many pain patterns.

Over the years, I’ve found that rectus abdominis dysfunction presents in subtle, often deceptive ways. Clients will describe stomach tension, vague abdominal discomfort, a feeling of gripping around the midsection, difficulty breathing deeply, or a persistent ache that seems to move unpredictably between the ribs, sternum, low back, and pelvis. Many believe the issue is digestive because the discomfort sits so close to the visceral space. Others feel weak through their midsection despite hours spent on abdominal workouts. More than a few are convinced it’s “back trouble” that never quite resolves. And more often than not, rectus abdominis tension or trigger points are part of the picture.

This article takes a deep dive into the anatomy of the rectus abdominis, its functional relationships, common dysfunctions and injuries, and the role that massage therapy and trigger point work can play in restoring comfort and stability. The goal is to help you see this familiar muscle with new eyes and to recognize its importance in whole-body balance.

The Anatomy: A Long Vertical Column With Complex Responsibilities

The rectus abdominis runs vertically from the pubic bone up to the ribs and sternum. Structurally, it is a paired muscle separated by the linea alba, with tendinous intersections that give it the characteristic segmented appearance. These intersections, however, serve functional roles, helping distribute force and maintain tension across the abdominal wall.

The muscle originates from the pubic crest and pubic symphysis and inserts into the costal cartilages of ribs 5 to 7 and the xiphoid process. It is enclosed within the rectus sheath, a fascial envelope formed by the aponeuroses of the external oblique, internal oblique, and transversus abdominis. This sheath is not simply a container—it influences movement, tension patterns, and the ease with which the rectus can contract and relax.

Innervation comes from the lower intercostal nerves (T7 to T12), which explains why rectus trigger points sometimes refer upward toward the ribs and why patients can feel discomfort along the thoracic region even when the source is anterior.

Functionally, we tend to oversimplify. Yes, the rectus flexes the spine. But that’s only one part of the story. It regulates pelvic tilt, depresses the ribs, supports breathing (particularly forced expiration), helps maintain abdominal pressure for stability, and works in concert with deeper core muscles to stabilize the trunk during dynamic movement. When the rectus works well, it provides a sense of strength and steadiness through the centreline of the body.

Why This Muscle Matters So Much More Than Clients Realise

For therapists, the rectus abdominis is often a key player in broader movement dysfunction. A tender rectus can contribute to low back ache, thoracic stiffness, hip imbalance, pelvic tilt issues, and even breathing problems. When hypertonic or laden with trigger points, it can restrict spinal mobility and create the feeling of being “locked” in the centre of the body. And when weak or under-active, it can force the obliques, hip flexors, or deep spinal stabilizers to take on more than their fair share of load.

A hallmark of rectus dysfunction is the sheer variety of symptoms it can cause. Some clients describe a band of pressure across the abdomen. Some complain of aching near the sternum that they worry might be cardiac or gastric. Others feel gripping around the midsection while walking, or fatigue when standing for long periods. A surprising number describe discomfort around the umbilicus that they can’t trace to food or digestion. In many cases, the rectus abdominis is quietly involved.

Functional Relationships: How the Rectus Interacts With Its Neighbours

No muscle works in isolation, and this is especially true of the abdominal wall. The rectus abdominis is part of a dynamic system that includes the obliques, transversus abdominis, diaphragm, pelvic floor, spinal extensors, and hip flexors. When one component becomes imbalanced, the whole system compensates.

The transversus abdominis acts as a deep stabilizer, creating tension like a corset. If TA is under-active, the rectus often steps in as a global stabilizer, working harder than intended. Over time, this creates lingering tension, fatigue, and the potential for trigger points.

The obliques manage rotation and diagonal stability. If they weaken or become inhibited, the rectus can dominate trunk movement, which is why so many clients who perform endless sit-ups develop poor rotational mobility.

The diaphragm is an intimate partner. Shallow breathers often brace their abdominal wall, maintaining a state of subtle rigidity that never truly relaxes. Over weeks or months, this pattern becomes a contributing factor to abdominal tightness, referred pain, or positional discomfort.

Pelvic tilt is another point of connection. Because the rectus assists in posterior pelvic tilt, clients who have shortened rectus fibres may appear flat-backed or locked into a posteriorly rotated pelvis. Conversely, if the rectus is inhibited, anterior pelvic tilt can worsen.

The hip flexors, particularly psoas and rectus femoris, have a reciprocal relationship with the rectus abdominis. When one becomes overactive or shortened, the other often adapts in a compensatory pattern. Addressing both can dramatically enhance outcomes.

Common Injuries and Dysfunctions Affecting the Rectus Abdominis

Although rectus injuries are well-documented in athletic populations, the average person also experiences rectus-related dysfunction more often than they realize. From chronic poor posture to high stress levels, modern life provides plenty of opportunities for this muscle to become irritated, overstretched, or exhausted.

Rectus strains are especially common in activities requiring sudden flexion or rotation—sports like gymnastics, sprinting, tennis, and football. A strain usually presents as sharp or tearing discomfort aggravated by coughing, laughing, or rising from a horizontal position. Even mild strains can deepen into persistent guarding if not treated.

Overtraining is another source of trouble. Clients who perform repetitive sit-ups, crunches, or weighted abdominal exercises without balancing their core routine may develop hypertonicity, shortened fibres, or irritation at the tendinous intersections. This commonly appears as localized tenderness along the vertical lines of the rectus or discomfort during trunk extension.

Surgical history matters, too. C-sections, hernia repairs, laparoscopic incisions, or any abdominal surgery can alter fascial structure and create restrictions that impact the rectus. Scar tissue can limit glide, create asymmetrical tension, or produce protective bracing patterns that persist long after healing.

Diastasis recti, although most associated with pregnancy, can occur in men and women due to chronic pressure, poor lifting mechanics, or poor abdominal strategy. For therapists, working around diastasis requires sensitivity, awareness, and interdisciplinary support when necessary.

Breathing dysfunction is another underrated contributor. Stress-induced shallow breathing, habitual bracing, or chronic anxiety can keep the abdominal wall in a semi-contracted state, which over time becomes a habitual holding pattern.

Finally, the proximity of the rectus abdominis to internal organs can cause clients to misinterpret muscular discomfort as visceral. Understanding referral patterns can prevent unnecessary worry for the person on your table.

Trigger Points in the Rectus Abdominis

Trigger points in the rectus are some of the most interesting and confusing in the body because their referral patterns often mimic digestive or visceral discomfort. Clients may describe cramping around the umbilicus, aching near the ribs, or pain that wraps around to the back, yet medical examinations frequently find nothing. The muscle sits close to the visceral cavity, and the CNS sometimes interprets trigger point referrals as organ-related discomfort.

Trigger points can develop anywhere along the vertical fibres, but they commonly appear near the costal margins, beside the navel, and near the pubic region. They may form in clusters along the tendinous intersections or present unilaterally if a client habitually rotates or bends toward one side.

The referral patterns vary, but they often radiate upward toward the ribs and lower sternum, downward into the pelvis or groin, or directly across the abdomen in a band-like pattern. Many clients will say the discomfort “feels deep,” which can be unnerving for those unfamiliar with muscular referral.

Trigger points are most likely to develop when the muscle is overloaded, held in a shortened state, recovering from strain, restricted by scar tissue, or operating as a compensatory stabilizer in cases of poor breath mechanics or weak core partners. Even prolonged coughing during respiratory illness can overload this muscle enough to trigger local dysfunction.

Trigger Point Therapy and Manual Approaches

Treating the rectus abdominis requires skill, sensitivity, and excellent communication. Clients often feel exposed receiving abdominal work, so creating a sense of safety is crucial. Once trust is established, however, the rectus responds beautifully to thoughtful, well-paced manual therapy.

Direct pressure and release are highly effective here, but the pressure must be controlled. Broad contact with the fingertips or palm works well for superficial scanning, while deeper fibres respond to slow, gradual compression along the vertical lines. Because the nerve supply comes from the intercostals, working along the costal margin often relieves surprisingly wide areas of discomfort.

Myofascial work around the rectus sheath can be transformative. Fascial restrictions often limit the muscle’s ability to lengthen or glide, creating chronic tightness. Skin rolling, gentle fascial spreading, and slow cross-fibre work can restore mobility and improve comfort without causing guarding.

Breath-assisted work is especially powerful. Encouraging the client to take slow, deep breaths—particularly emphasizing the exhale—helps reduce abdominal holding patterns and allows deeper access without discomfort. Many clients don’t realize how tightly they brace day-to-day until you help them experience a more relaxed abdominal wall.

Stripping along the length of the rectus helps identify hidden trigger points while promoting circulation. Working just off the midline can reveal lines of tension that contribute to posture problems or pelvic imbalance.

Positional release is occasionally helpful, especially in clients who guard or feel anxious about direct pressure. By placing the client in slight trunk flexion, tension reduces across the rectangle fibres, allowing gentler access.

Although not the primary tool, stretching the rectus—when appropriate—can support trigger point therapy. Simple back extension mobilizations can be effective if introduced gradually and safely, particularly when combined with strengthening the deeper stabilizers.

Rehabilitation Considerations and Movement Strategies

Trigger point therapy is powerful, but long-term change comes from addressing the functional factors that created the problem in the first place. Rehabilitation for rectus abdominis dysfunction should consider posture, breathing, movement habits, core balance, and overall lifestyle.

Breath retraining is one of the most impactful interventions. Teaching clients the difference between abdominal bracing and healthy diaphragmatic breathing can dramatically reduce chronic abdominal tension. Many clients are astonished by how much lighter and more mobile their midsection feels once they stop bracing out of habit.

Postural awareness is another area worth exploring. Clients who slump compress the abdominal wall, while those who stand in overextended or sway-back positions may overstretch and fatigue it. Simple, accessible postural cues can help restore a more functional balance.

Strengthening the deep stabilizers, particularly the transversus abdominis, is key. Exercises such as controlled dead-bug variations, gentle core engagement drills, and light pelvic tilts can help retrain coordination and reduce reliance on the rectus for tasks best handled by deeper layers.

Mobilizing the thoracic spine can also reduce abdominal overwork. When the thorax moves freely, the rectus no longer compensates for lost upper trunk mobility. Thoracic extension drills, rotation patterns, or supported mobility movements can be extremely helpful.

Finally, addressing the hips and pelvis—particularly the hip flexors and glutes—helps balance the demands placed on the rectus during daily activity. A well-coordinated posterior chain reduces anterior loading and helps distribute forces more evenly across the abdominal wall.

Conclusion: A Muscle With Unexpected Influence

The rectus abdominis may be a familiar muscle in conversations about fitness, but clinically, it is far more complex and influential than most clients ever realize. Whether overworked, underactive, restricted by scar tissue, or tense due to stress or posture, this muscle has a remarkable ability to affect comfort, breathing, movement, and overall body balance.

For therapists, treating the rectus requires sensitivity, clear communication, and a willingness to explore abdominal work with skill and confidence. When approached thoughtfully, trigger point therapy, myofascial techniques, breath-assisted release, and movement retraining can bring exceptional relief and restore functional harmony across the core.

A responsive, balanced rectus abdominis doesn’t just look good—it supports the entire structural integrity of the torso, encourages better breathing and movement, and helps clients feel stronger and more at ease in their bodies. And in clinical practice, that makes it a muscle well worth understanding in depth and treating with respect.