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Rectus Abdominis and Pyramidalis Audio

Integrated functional anatomy of the rectus abdominis and pyramidalis. Attachments, nerves, palpation, joint actions, arthrokinematics, fascia, triggerpoints, and behavior in postural dysfunction. Examples of common core exercises, mobility, stretches, and strengthening exercises for the abs/core muscles.

Rectus Abdominis and Pyramidalis

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This course describes the anatomy and integrated function of the rectus abdominis and pyramidalis muscle (a.k.a. the abdominal muscle, abdominis muscle, abs, rectus muscle, 6-pack muscles, or six-pack muscle). The rectus abdominis originates on the pubic symphysis and inserts on the costal cartilages of the fifth through seventh ribs and the xiphoid process of the sternum. The pyramidalis originates on the ramus of the pubis and inserts into the linea alba, but the pyramidalis is absent in about 20% of the population. The rectus abdominis is composed of a fairly even distribution of type I muscle fibers and type II muscle fibers; however, a larger proportion of type II fibers is more common. The rectus abdominis and pyramidalis cross the torso and pelvis, influencing motion of the pelvis, thoracic spine, lumbar spine, and ribs. The rectus abdominis is the primary lumbar flexor, will contribute to a posterior pelvic tilt, and potentially lateral flexion of the spine. This course also describes the role of the rectus abdominis muscle in facet joint arthrokinematics, fascial integration (integration of abdominal wall muscles), postural dysfunction, and subsystem integration. Sports medicine professionals (personal trainers, fitness instructors, physical therapists, massage therapists, chiropractors, occupational therapists, athletic trainers, etc.) must be aware of the integrated function of the rectus abdominis for the detailed analysis of human movement, and the development of sophisticated exercise programs and therapeutic (rehabilitation) interventions. Further, this course is essential knowledge for future courses discussing injury prevention and physical rehabilitation (e.g. “weak core,” abdominal wall pain, diastasis recti, hip flexor strain, sports hernias, groin injury, anterior pubic ligament injury, low back pain), the synergistic function of the rectus abdominis and pyramidalis (e.g. lumbar flexion with the external obliques, internal obliques, and psoas), and rectus abdominis muscle specific exercises and techniques for enhancing sports performance (e.g. ensuring ideal rectus abdominis length for optimal core stability, strength, power, hypertrophy, etc.).

Brookbush Institute’s most recommended techniques for the Rectus Abdominis (see videos below):

Anterior Oblique Subsystem Integration Step-Up to Chest Press

The rectus abdominis muscle running from the ribcage to the pelvis

 Course Description: Rectus Abdominis and Pyramidalis

 c.1400, from Old French rectifier, literally “to make straight” (14c.), from Late Latin rectificare “make right,” from Latin rectus “straight” (see 

 (adj.1)) + root of facere “to make” (see 

 1540s, “belly fat,” from Latin abdomen “belly,” which is of unknown origin, perhaps from abdere “conceal,” with a sense of “concealment of the viscera,” or else “what is concealed” by proper dress. (

"the straight muscle that conceals the abdominal viscera"

 - 1550s (earlier in Latin form piramis, late 14c.), from French pyramide (Old French piramide "obelisk, stela," 12c.), from Latin pyramides, plural of pyramis "one of the pyramids of Egypt," from Greek pyramis (plural pyramides) "a pyramid," apparently an alteration of Egyptian pimar "pyramid." Financial sense is from 1911. Related: Pyramidal. (

 suffix forming adjectives from nouns or other adjectives, "of, like, related to, pertaining to," Middle English -al, -el, from French or directly from Latin -alis (see 

Cadaver dissection of the pyramidalis and rectus abdominis muscles

Pyramidalis (being traced with surgical tool in image) - https://academic.amc.edu/martino/grossanatomy/site/medical/lab%20manual/gastrointestinal/Dissections/Anterior%20Abd%20Wall/Anterior%20Abd%20Wall%2034.html

Introduction to the Rectus Abdominis and Pyramidalis

Origin: The tendons of each individual rectus abdominis attach to the pubic crest; however, fibers from the two tendons cross and interlace over the pubic symphysis (8, 11).

Insertion: Costal cartilages of the fifth through seventh ribs and xiphoid process of the sternum (8, 11).

Nerve: Segmentally innervated from the 7 - 11th intercostal nerves, arising from the ventral rami of the corresponding spinal nerves with a potential contribution from T5-T6 and/or T12 (8, 11).

Origin: Anterior surface of the ramus of the pubis (11).

Insertion: Linea alba halfway between the pubis and umbilicus (this muscle lies within the anterior rectus sheath) (11).

Nerve: Innervated by a branch of the 12th intercostal nerve, arising from the ventral rami of the corresponding spinal nerve (8)

This muscle is typically absent in 17 - 25% of the population (8).

The rectus sheath showing the connection of the rectus abdominis, obliques, transverse abdominis and linea alba

Rectus Sheath - By Henry Vandyke Carter - Henry Gray (1918) Anatomy of the Human Body (See "Book" section below)Bartleby.com: Gray's Anatomy, Plate 399, Public Domain, https://commons.wikimedia.org/w/index.php?curid=561473

Attachments & Innervation: Rectus Abdominis and Pyramidalis

The rectus abdominis is fairly superficial, lying just beneath the skin, adipose tissue, and a fairly complex fascial sheath. The rectus sheath envelopes the rectus abdominis anteriorly and posteriorly. From the costal cartilage to the arcuate line (the level of the umbilicus), the anterior sheath is comprised of a continuation of the 

 fascia while the posterior sheath is comprised of a continuation of the 

 and transverse abdominis fascia. Below the level of the arcuate line, the posterior sheath does not continue, and the fascia of the 

, and transverse abdominis (lateral abdominal muscles) continue anteriorly to the rectus abdominis. The pyramidalis actually lies within the anterior rectus sheath, from the pubis to approximately half the distance to the umbilicus. The fascial sheaths converge at the linea alba, where they continue into identical fascial tissue on the opposite side. The linea alba, running down the midline of the abdomen, between the two rectus abdominis muscles, is itself a thickening created by the crossing of the fibers of the fascial sheaths (3). The rectus abdominis is separated into segments by transverse connective tissue inscriptions which fuse the anterior rectus sheath, and are thought to reinforce the rectus abdominis, resisting distension and aiding in the muscle's ability to eccentrically decelerate extension, and transfer force between lateral abdominal muscles (17, 19). In an older study of 115 cadavers, it was noted that the number of transverse inscriptions is variable in humans, ranging from 1 - 4 (20). The lateral borders of the rectus abdominis are separated from the lateral abdominal muscles by a narrow border that may be palpated (the semilunar lines) where the layers fascia converge before separating again to create the rectus sheath.

Posterior to the rectus abominis lies the peritoneum and viscera. Although this may seem fairly obvious, an understanding of the relative location and anatomy of that viscera is essential before pressure is applied to the rectus abdominis for therapeutic or exercise purposes.

The insertion of the rectus abdominis on the costal cartilage is a continuation of the anterior rectus sheath, is superficial to the ribs and external intercostals, and runs continuous with the pectoral fascia and some inferior, deep fibers of the 

. The origin of the rectus abominis is a complex network emanating from two distinct tendons; fascial slips cross and invest in the pubic symphysis, just superior to the tendon of the 

. Several texts have made inferences about the continuity between the rectus abdominis and adductor tendons and their ability to transmit force between the two muscle groups. This will be discussed further under "Subsystems" and "Fascia Integration" (3, 6, 17).

The transverse abdominis and rectus abdominis sheath 

Transverse Abdominis and Rectus Abdominis Sheath -
By modified by Uwe Gille - Gray397.png, Public Domain, https://commons.wikimedia.org/w/index.php?curid=2601348

Where are the Rectus Abdominis and Pyramidalis Located?

The palpations below have been placed in an order that makes locating each individual muscle a bit easier.

This muscle is visible in athletic, lean individuals. If a student with a visible rectus abdominis is willing to volunteer, using them as a model to teach this technique may be advised. In some lean individuals the rectus abdominis, transverse inscriptions, and semilunar lines are all visible upon contraction of the rectus abdominis.

With your partner in a supine position, locate the xiphoid process (notch at the bottom of the sternum) and pubis (bony shelf, just above the genitals).

Place your hands between these landmarks. Start by sinking your hands gently through the skin and adipose tissue to find the groove created by the linea alba running vertically at the midline between the two rectus abdominis muscles.

Have your partner crunch (lift their upper back off the table) and you should feel the rectus abdominis contract around your fingers.

Start exploring the vertical rectus abdominis fibers, and try to locate the transverse inscriptions.

Trace the rectus abdominis inferiorly and try to identify the two thick tendons that invest into the pubis.

Trace the lateral borders of the rectus abdominis and try to identify the semilunar lines.

It may be possible to feel a few fascicles of this muscle attached to the linea alba just superior to the pubis. If they can be palpated they should feel distinct from the rectus abdominis, which is primarily tendon at this point. A small gap between the muscle fibers of the pyramidalis on the linea alba and the rectus abdominis tendon may be felt.

Sidney Wilson with visible rectus abdominis, linea alba, transverse inscriptions, and semilunar lines

Sidney Wilson - www.SidneyWilson.com
Rectus abdomonis, linea alba, transverse inscriptions and semilunar lines visible.

Palpating the Rectus Abdominis and Pyramidalis

Spine: Primary flexor of the lumbar and thoracic spine, unilaterally (one side) the rectus abdominis may contribute to lateral flexion (8, 11).

Despite having a larger moment arm, the trunk flexors generally have a lower capacity to generate force and have less endurance than the lumbar extensors (21, 22). This is due in large part to the larger mass of the lumbar extensors and their more vertical fiber arrangement.

Pelvis: Will contribute to a posterior pelvic tilt.

Intra-abdominal Pressure: This muscle is active during bracing and very forceful exhalation (for example, coughing), but is not active during "drawing in" or other less vigorous functional tasks (16).

Linea Alba: Increases tension and rigidity of the linea alba.

The rectus abdominis, external obliques, internal obliques, transverse abdominis, and linea alba

Abdominal Fascia - By Henry Vandyke Carter - Henry Gray (1918) Anatomy of the Human Body (See "Book" section below)Bartleby.com: Gray's Anatomy, Plate 392, Public Domain, https://commons.wikimedia.org/w/index.php?curid=287550

 Stabilization of the lumbar spine, thorax, and pubic symphysis.

Isometrically this muscle "fixes" the torso and ribcage allowing other musculature that anchor on the rib cage and spine to produce force more efficiently.

Eccentric deceleration of lumbar extension

Eccentric deceleration of anterior tilting of the pelvis

These functions are of particular importance in preventing hyperextension and excessive reduction of the neural foramina.

The rectus abdominis is mildly active from stance phase to push-off during gait - likely to maintain a neutral pelvis during hip extension (eccentrically decelerating an anterior pelvic tilt). The rectus abdominis is also slightly active during the swing phase of gait, countering the force generated by the hip flexors (3)

Lumbar Flexion: The rectus abdominis is the primary flexor of the lumbar spine, acting synergistically with the 

The "drawing-in" action of the transverse abdominis may enhance the efficiency of the rectus abdominis by aligning fibers vertically (in the sagittal plane) between the pubis and ribcage, increasing force production by enhancing length/tension relationships. As opposed to, the rectus abdominis working in a lengthened position around a distended viscera.

Psoas - Synergist or Antagonist: When the hip and pelvis are fixed, the psoas may contribute to lumbar flexion (3). However, the psoas originates on the anterior aspect of the lumbar spine and is a strong hip flexor. When the pelvis and hip are not fixed and the pelvis may tilt freely, the psoas will create an anterior force on the lumbar spine during hip flexion, contributing to an anterior pelvic tilt and an increasing in the lumbar lordosis (extension). In short, when the pelvis is fixed the psoas is a synergist, when the pelvis is not fixed it is an antagonist.

The rectus abdominis, internal obliques, and TVA insertion into the pubis

Complex insertion of the Rectus Abdominis, Internal Obliques and Transverse Abdominis - By Henry Vandyke Carter - Henry Gray (1918) Anatomy of the Human Body (See "Book" section below)Bartleby.com: Gray's Anatomy, Plate 398, Public Domain, https://commons.wikimedia.org/w/index.php?curid=561471

The superficial rectus abdominis muscle running vertically on the torso

Arthrokinematics

Rectus Abdominis and Pyramidalis Muscle Actions

My Fascial Hypothesis: Large fascial sheaths not only play a role in the transmission of mechanical force but may also play a role in dictating the function of muscular synergies. This is likely caused by reducing or increasing tone of invested musculature via reflex arcs formed between mechanoreceptors embedded in the connective tissue and the attached musculature. In this way, my view of fascia differs slightly from noted expert on the subject Tom Myers. I think of these large fascial sheaths (specifically the thoracolumbar fascia, iliotibial band, and abdominal fascial sheath) as nature's "motherboard." A place for mechanical information to be communicated to the nervous system for more efficient recruitment of the muscular system. Despite having a slightly different philosophy it does not change the fact that fascia plays an important communicative role in the human body and we have Tom Myers to thank for his work.

Image of the fascial system of the body connecting muscles

Hyperkyphosis and forward head position of the torso and head

Fascial Integration of the Rectus Abdominis

The external obliques and anterior adductors in the anterior oblique subsystem

Muscle attachments on the anterior pelvis, femur, and lumbar spine

Relationship between the adductor muscles, rectus abdominis, and external obliques

Subsystems

Fascial Integration

The rectus abdominis has been noted as long and under-active and/or short and over-active depending on the dysfunction, by several texts and clinicians (1. 2, 3, 6, 7, 13, 17). Further, as a prime mover of lumbar flexion, this muscle is often targeted during resistance training and core conditioning routines. The rectus abdominis is one of the few muscles that may adopt an increase or decrease in relative length and activity. The only way to ensure effective exercise/technique selection is movement assessment. Over-activity and adaptive shortening does create a practical issue, as release of the rectus abdominis is difficult and self-administered techniques are unlikely to be effective or recommended based on potential disruption of the abdominal viscera. Stretching the rectus abdominis may be problematic for those with lumbar spine pain. Generally, recommendations for addressing rectus abdominis activity and length, include whether or not rectus abdominis and 

 integration exercises should be performed.

 the rectus abdominis does not play a direct role in 

; however, is often short/over-active. This can be explained mechanically, via the rectus abdominis' ability to contribute to a thoracic kyphosis and the correlation between an increased thoracic kyphosis and shoulder pain (24). It can also be explained relative to motor control, in which changes in length/tension relationships and altered spine/pelvis position, resulting in inhibition of the 

 and synergistic dominance of the rectus abdominis and 

 (13, 17). The latter can be demonstrated using an 

. If the individual being assessed exhibits the sign "

" with the spine neutral or exhibits an "

", it is often the case that the over-activity of the rectus abdominis is balanced by, or over-powered by the over-activity of the latissimus dorsi which have been lengthened by the arm position. However, if the 

overhead squat is performed "with modification"

, and the hands are down, the individual will often collapse forward into 

lumbar flexion or an excessive forward lean

, it may be recommended to reduce or eliminate spinal flexion and 

 integration exercise until the dysfunction is corrected.

Lumbo Pelvic Hip Complex Dysfunction (LPHCD)

the rectus abdominis is often long and under-active contributing to an 

 (1, 2, 6, 7). Although crunches alone are not likely to be effective, they are not contra-indicated for this population. Addressing short/over-active structures with 

 prior to activation, integration, and conditioning, and addressing the under-activity of all anterior trunk muscles (

 the rectus abdominis is often lengthened on one side relative to the other (longer on the side of the anteriorly rotated innominate). Release techniques for the relatively short side may prove to be beneficial, and it is not practical to try to isolate and activate the longer side. Addressing the length of this muscle by addressing stiffness in the sacroiliac joint, lumbar spine, and pubic symphysis and correcting the relative tilt of each innominate is a more effective strategy. It is not uncommon, for correction of SIJD to result in the client/patient adopting a dysfunctional, but symmetrical anterior pelvic tilt. This is an improvement and would be treated as 

 the rectus abdominis does not play a direct role; however, may be affected by changes in pelvic position. In a similar scenario to that described in 

, changes in length/tension relationships and altered spine/pelvis position, resulting in inhibition of the 

 (13, 17). This can be demonstrated using an 

, in those exhibiting LLD. If the individual being assessed exhibits the sign "

", it is often the case that the lean is due to a lack of dorsiflexion and attempt to maintain the center-of-mass over the base of support - with no change in rectus abdominis or 

overhead squat assessment is performed "with modification"

, and a block is put under the heels, and the 

 is still present then over-activity of the rectus abdominis or 

 may be assumed. In those exhibiting this set of signs, it may be recommended to reduce or eliminate spinal flexion and 

, the rectus abdominis is likely given too much attention, particularly in strength training program with the intent of isolating this muscle. The rectus abdominis has been noted as long and under-active and/or short and over-active depending on the dysfunction, although over-activity tends to be more common. Release of the rectus abdominis is difficult, and self-administered techniques are unlikely to be effective (or recommended based on the potential disruption of the abdominal viscera). Stretching the rectus abdominis may be problematic for those with lumbar spine pain. Generally, recommendations for addressing rectus abdominis activity and length, include whether or not rectus abdominis and 

 integration exercises should be performed. If trigger points are to be an issue it is best to refer out to a manual therapist with experience treating abdominal musculature.

Diastasis Recti - Exercise may reduce the chance of this occurring ante- and post-natal by 35%, and reduce width in those affected (32)

Signs of Altered Length/Tension and Tone:

 Short/Over-active on side of dysfunction

Postural Dysfunction and the Rectus Abdominis and Pyramidalis

Pain is a terrible predictor of dysfunction, but it is a clue – the structure or area perceived as painful is being affected by the dysfunction. Further, palpation and location of trigger points may provide evidence that these muscles have adopted a less than optimal length, and tone has been adversely affected, even when the patient/client complaint is not directly related to the rectus abdominis complex. .

Trigger points in the rectus abdominis can cause visceral-like symptoms and can be easily masked by visceral dysfunction (8). It is easy to mistake one for the other; careful assessment and referral to a physician should be considered when a clear delineation cannot be made between visceral dysfunction and trigger points in the abdomen. 

Upper rectus abdominis trigger points are generally found just below the level of the xiphoid process and refer pain horizontally around the torso to the mid-back.

Lower rectus abdominis trigger points, near the pubis and musculotendinous junction, may refer pain horizontally in a band that wraps around to cover the lower back and sacrum.

Periumbilical (around the belly button) rectus abdominis trigger points produce a variety of symptoms, similar to visceral pain and dysfunction. This may include nausea, vomiting, intestinal and rectal colic, pain in the genitals, and potentially dysmenorrhea (8).

Common trigger points and referral pain patterns of the rectus abdominis

Rectus Abdominis Trigger Points
David G. Simons, Janet Travell, Lois S. Simons, Travell & Simmons’ Myofascial Pain and Dysfunction, The Trigger Point Manual, Volume 1. Upper Half of Body: Second Edition, Pg. 944© 1999 Williams and Wilkens

The pyramidalis may refer pain along the linea alba between the pubis and umbilicus (8).

Common trigger points and referral pain patterns of the pyramidalis

Pyramidalis trigger points and referral pain pattern, and a rectus abdominis trigger point purported to result in dysmenorrhea - David G. Simons, Janet Travell, Lois S. Simons, Travell & Simmons’ Myofascial Pain and Dysfunction, The Trigger Point Manual, Volume 1. Upper Half of Body: Second Edition,© 1999 Williams and Wilkens

Rectus Abdominis Trigger Points and Referral Pain Patterns

Despite being segmentally innervated, all relevant studies demonstrate that the rectus abdominis is recruited as a single muscle during motion and stabilization of the spine, hips, and pelvis (25 - 33). One study demonstrated, that only one activity resulted in separate recruitment of the upper and lower portions of the rectus abdominis. The activity was the stomach roll in belly dancing (34). Note that the lumbar spine and pelvis do not move during a stomach roll.

There is a physics issue with the concept of targeting the lower rectus abdominis. If the inferior portion rectus abdominis contracts and the upper rectus abdominis does not contract at the same intensity, the lower fibers would stretch/lengthen the upper fibers, and the whole muscle would not change length. This would result in no motion occurring at the pelvis or ribcage.

What would happen if the upper and lower portions of the rectus abdominis contracted at different intensities? This is obvious for practitioners working with spinal cord patients. There is a test in which an examiner asks a patient with a thoracic spinal cord injury to "crunch" or raise their head against resistance. In this exam, called the "Beevor's Sign", the umbilicus will be drawn toward the upper rectus abdominis fibers still innervated by the nerves above the spinal cord lesion. This results in a visual example of the upper section of the rectus abdominis contracting, stretching the non-contracting lower portion of the rectus abdominis, resulting in movement of the umbilicus (belly button), but no motion of the rib cage or pelvis. Clinically, this may provide insight into the level of thoracic spinal cord lesions.

Rectus Abdominis and Pyramidalis

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