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Rectus Abdominis: Abdominal Pain

The rectus abdominis muscle is the muscle of six-pack abs. The muscle attaches to the pubis bone going up the middle of the abdomen to connect to the sternum and upper ribs.

Dysfunction with the rectus abdominis can cause a host of symptoms, including pain around the sternum, lower abdomen, and bands of pain across the middle and lower back. The muscle can also contribute to heartburn, indigestion, and feeling bloated. Are you having UTI symptoms or problems with incontinence? Trigger points in the rectus abdominis and other abdominal muscles may cause and contribute to your woes.

Where Is The Rectus Abdominis Muscle?

Image of the rectus abdominis muscle

The rectus abdominis muscle attaches to the bottom of the pelvis (pubis bone) traveling up to connect to the breast bone (xiphoid process of the sternum) and the 5th, 6th, and 7th ribs.

For detailed anatomy information: Rectus Abdominis Anatomy Page.

What Does The Rectus Abdominis Do?

  • Flexion of the spine (bending over)
  • Assists with breathing
  • Supports and protects the internal organs
Image of a woman demonstrating flexion of the spine

Interesting Facts:

  • The rectus abdominis muscle extends from ribs below the breasts to the top of the pubic bone without attaching to bone. The horizontal bands of connective tissue called tendinous intersections help the muscle maintain structure and proper length.
  • It is the muscle that gives the appearance of six-pack abs.
  • The abdominal muscles can cause a range of symptoms that can be worrisome and mimic other medical conditions such as appendicitis, gallbladder disease, irritable bowel syndrome, colitis, endometriosis, and urinary incontinence. Lingering or sudden onset abdominal pain should be checked out by a physician.

Rectus Abdominis Pain Symptoms

Image showing the rectus abdominis pain pattern.

The rectus abdominis and other abdominal muscles help support and protect our internal organs. The ab muscles also aid with breathing and movements. Because of the various functions of the trunk muscles, they can refer pain throughout the abdominal and low back area.

A common pain pattern that points to rectus abdominal involvement is bands of pain that run under the shoulder blades and across the hips.

The rectus abdominis can also cause pain around the sternum and an area of pain in the lower abdomen.

Trigger points in the rectus abdominis can also cause symptoms and pain that mimics medical conditions. A trigger point in the upper portion of the muscle can contribute to heartburn and indigestion. Trigger points in the middle and lower portion of the muscle can contribute to feeling bloating, pain in the urinary tract, and testicular pain in men.

NOTE: Because the body's trunk contains our vital organs, it is important to consult your doctor to rule out a serious medical cause for your symptoms.

The symptoms:

  • Pain that runs horizontally across the mid-back under the shoulder blade
  • Pain that runs horizontally across the low back and or top of the hips
  • Pain around the sternum between the breasts (not shown)
  • Pain in the low abdomen
  • Feeling bloated
  • Heartburn and indigestion
  • UTI symptoms
  • Bladder incontinence
  • Testicular pain

Other muscles, including the rectus abdominis, contribute to these conditions

Muscles With Similar Pain Patterns

What Causes Rectus Abdominis Muscle Pain?

In today's world, the number one contributor to pain caused by the rectus abdominis is being overweight and being out of shape. Poor posture and sitting too much are close seconds. These weaken the abdominis rectus muscle causing pain and other symptoms. These conditions can contribute to shallow breathing, heartburn, and constipation which can also cause the development of trigger points in the muscle, adding to pain and discomfort. It becomes a vicious cycle.

Childbirth, abdominal surgery and the resulting scars will cause trigger points to develop throughout the abdominal area. Many people find that their pain is reduced once the trigger points are deactivated.

Other causes: 

  • Over-exercising muscles (sit-ups and leg-ups)
  • Shallow breathing
  • Chronic coughing and sneezing
  • Childbirth
  • Abdominal surgery
  • Scars from abdominal surgery
  • Chronic Constipation
  • Sitting for long periods of time
  • Carrying a heavy backpack

Satellite trigger points associated with the rectus abdominis:

Trigger points in the rectus abdominis muscle will cause TrPs to develop in other muscles. These are known as satellite trigger points. You will need to check these muscles for additional TrPs.

What Are Trigger Points?

Text image defining trigger points
Illustration of a trigger point.

Rectus Abdominis Muscle Trigger Point Treatment


Warning: Do not ignore ongoing pain in the trunk as it houses our internal organs. If you are experiencing sharp, sudden onset pain, constant pain, or discomfort, you should see your doctor rule out medical conditions.

Massage and trigger point treatment of the rectus abdominis is easy to learn. However, you should not begin pushing and prodding in the abdominals without guidance, as you can bruise and affect the area's internal organs, nerves, and blood vessels.

If you do not have experience treating trigger points, find a massage therapist, physical therapist, or chiropractor trained in trigger point therapy. A professional will show you how to find and treat specific trigger points and satellite trigger points that need treatment.

The Trigger Point Therapy Workbook is highly recommended for those who would like to learn how to treat trigger points. The book explains the cause of trigger points, how to find them, and treatment options. It lists all muscles that develop trigger points, where they are located, and how to treat and deactivate the painful nodules.

How Long Before I Feel A Reduction In Pain?

Fortunately, most rectus abdominis trigger points resolve quickly. After just a few treatments, most people notice pain reduction and more effortless movement. If you are not seeing any improvement after a few days of self-treatment, you need to search for possible satellite trigger points in the muscles listed below.

Products We Use and Recommend For Rectus Abdominal Pain

There are cheaper braces, but none better.

If you have low back pain or need abdominal support, the Professional's Choice Back Brace will help reduce your pain and stiffness. The waist wrap and 2 side straps are easily adjusted and provide support compression to the low back and abdomen. It is the only low back brace TWD recommends. It works!

Image of an adjustable standing desk.

Sitting at a desk all day? Consider using a standing desk which allows you to alternate standing and sitting.

How To Avoid Development of Trigger Points In The Rectus Abdominis

  • If you have a rounded shoulder posture where your shoulders roll forward or forward head posture where you carry your head with your chin jutted forward, you may want to consider a posture corrector to help retrain your muscles into the correct posture.
  • We know sitting for extended periods every day negatively affects our bodies and health. However, sitting all day is the norm if you work at a desk. Consider purchasing a standing desk and alternate sitting and standing throughout the day.
  • We all have a habit of slumping when we sit. A lumbar support will remind you not to slouch and support your back, which will help with abdominal pain.
  • Are you a shallow breather? Does your chest or abs expand to take in air when you inhale? It should be the abdominals. Practice inhaling deep into the stomach and slowly exhaling until it becomes a habit.
  • Sneezing and coughing require the use of many of the abdominal muscles. If you have allergies or other medical conditions that make you cough and sneeze, talk to your doctor about medications or other remedies that can help.
  • Constipation affects all the abdomen, low back, and pelvic muscles. If you tend to have frequent constipation, talk to your doctor about dietary changes and other methods to help bring relief.
  • If you have abdominal scars from surgery, massage is the best treatment to treat the restrictions that form in the scar area. Massage will reduce your pain and tightness and increase your mobility.
  • Pay attention when doing targeted abdominal exercises. More is not always better. Don't overdo it!


Clay, J. H., Allen, L., Pounds, D. (2015). Clay & Pounds' Basic Clinical Massage Therapy: Integrating Anatomy and Treatment (3rd ed.). Philadelphia, PA: Lippincott Williams & Wilkins

Davies, C,. Davies, A., (2013). The Trigger Point Therapy Workbook: Your Self-Treatmend Guide For Pain Relief (3rd ed.). Oakland, CA: New Harbinger Publications

Finando, D., Finando, S. , (2005). Trigger Point Therapy for Myofascial Pain: The Practice of Informed Touch (1st ed.) Rochester, VT: Healing Arts Press.

Muscolino, J., (2016) Kinesiology: The Skeletal System and Muscle Function (3rd ed.). Maryland Heights, Missouri: Mosby.

Image Credit: Depositphotos