Therapist Notes – Rectus Abdominus and Pyramidalis

Effective relief starts with an understanding of the anatomy.

About the coloring of the illustrations…

This muscle fits into thick sheaths of connective tissue. Learn more in this post about the anatomy of the rectus abdominus.

Integrative Craniosacral Releases

Sagittal suture restrictions are classically known from Applied Kinesiology as a governing the rectus abdominus. Test to localize the sutural restriction before and after treatment.

Frontomax and Frontonasal techniques govern the pubic symphysis. Test to the pubic symphysis before and after the technique to verify proper release.

Pelvic balancing provides longer-lasting results so that direct treatment is easier, more effective, and longer-lasting.

Each therapist has their own method of pelvic balancing. I prefer craniostructural work with SOT blocking but also use METs, strain-counter strain, and some NMT techniques. Use the pelvic balancing approach that works best for your particular bodywork approach.

Classical Neuromuscular Approach

From the Structural Overview in Neuromuscular Assessment Guides:

The rectus abdominus has a strong relationship with pelvic tilt and the tone of psoas major. They are, in most cases, antagonists. As this muscle becomes short and strong, the lumbar curve is lost, and the upper bellies of psoas major usually become taut to protect the lumbar vertebrae. As this muscle becomes long, the abdomen distends, and, depending on the tone of the obliques, psoas changes tone.

Rectus abdominus is often involved in low back pain but is overlooked as treatment is focused on muscles that are closer to the pain. It both refers into the low back and is involved in postural distortions that perpetuate trigger points in the low back. Abdominal trigger points and visceral issues are hard to separate. It can be challenging to determine whether the tone of abdominal muscles is governed by intestinal disturbance or vice versa.

This superficial abdominal muscle is more difficult to treat than most muscles. Its attachments near the pubic bone often tense because for various reasons. Its bellies do not have a solid foundation under them for deep glides. The practitioner needs to balance pressure and speed for effective release. Visceral issues, like adhesions and aortic aneurysms, create additional concerns for pressing into the abdomen.

NMA-rectus-abdominus

From the Clinic Notes in Neuromuscular Assessment Guides:

This is a classic routine for releasing the rectus abdominus through neuromuscular massage. Releasing the superficial abdominal muscles also allows easier access to the deep abdominal muscles. This protocol relaxes and stores proper tone to the rectus abdominus.

Make sure that the entire core, including pelvic balancing is addressed for lasting changes. Shortened obliques or a displaced pubic symphysis can perpetuate this problem.



This site is undergoing changes. Starting in early 2020, we began changing the format of the posts to include more extensive self-care, illustrations, therapist notes, anatomy, and protocols. We’d love your feedback. We are adding posts and converting the old posts as quickly as time permits.


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Tony Preston has a practice in Atlanta, Georgia where he sees clients. He has written and taught about anatomy, trigger points and cranial therapies since the mid-90s.

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