Trigger Point Overview - Rectus Abdominis
Rectus Abdominis Trigger Points - Dr. Jonathan Kuttner
Latin rectus, straight; abdominis, of the belly/stomach
The rectus abdominis is divided by tendinous bands into three or four bellies, each sheathed in aponeurotic fibers from the lateral abdominal muscles.
These fibers converge centrally to form the linea alba. Situated anterior to the lower part of the rectus abdominis is a frequently absent muscle called the pyramidalis, which arises from the pubic crest and inserts into the linea alba. It tenses the linea alba, for reasons unknown.
Rectus Abdominis Trigger Points
Origin
Pubic crest and symphysis pubis (front of pubic bone).
Insertion
Anterior surface of xiphoid process. 5th, 6th, and 7th costal cartilages.
Action
Flexes lumbar spine. Depresses rib cage. Stabilizes pelvis during walking.
Antagonist: erector spinae.
Nerve
Ventral rami of thoracic nerves, T5–T12.
Basic Functional Movement
Pyramidalis
Points for dysmenorrhoea
McBurney’s point
Example: initiating getting out of a low chair.
Referred Pain Patterns
Upper fibers: horizontal mid-back pain; heartburn and indigestion. Lower fibers: pain between pubis and umbilicus, causing dysmenorrhea.
Lateral fibers: pseudoappendicitis; McBurney’s point.
Indications
Heartburn, colic, dysmenorrhea, nausea, vomiting, sense of being full, horizontal back pain, lower crossed pattern, rib pain, testicular pain, diaphragm and breathing issues.
Causes
Direct trauma, postural, visceroptosis (commonly from overexertion during sports), poor sit-up technique, prolonged cross- legged sitting, coughing, emotional stress, may be related to back pain, post-surgical (abdominal).
Differential Diagnosis
Visceral pathology including: renal, hepatic, pancreatic, diverticular disease, colitis, appendicitis, hiatus hernia, peritoneal disease—pelvic in ammatory disease, ovarian, bladder. Appendicitis. Gynecological disease. Umbilical/incisional— hernia. Latissimus dorsi.
Connections
Transversus abdominis, internal oblique, external oblique, pyramidalis.
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