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Why rectus abdominis is not proximal muscle?


I am thinking this picture which shows proximal muscles.

Why for instance pectoralis major, subclavius and rectus abdominalis are not included in proximal muscles?


It's not clear what "proximal" means in this context. It's not a standard use of that anatomical term in English. I'd also say that the figure on the left actually does show the pectoralis major.

The author of this figure might be trying to show the muscles that cross the proximal joints in the upper and lower limbs. For example:

Upper limb

  • Pectoralis major
  • Biceps brachii
  • Triceps brachii
  • Latissimus dorsi

Lower limb

  • Adductors (brevis, longus, magnus)
  • Rectus femoris
  • Semimembranosus, semitendinosus, biceps femoris (long head)
  • Gluteals (maximus, medius, minimus)

Muscles that do not cross the shoulder or hip are not included. This explains the lack of rectus abdominis or subclavius. Though it is not clear to me which the paired muscles in the posterior view are running craniocaudally from the thorax to the gluteal region.


The Rectus Abdominis—Our “Cinderella Muscle”

I’m a girl who loves fashion. I’m such a Cinderella [ Figure 9-1 ] — I love to put on a great dress and heels. It’s fun!

—Maria Bello, American actress and writer, from Norristown, Pennsylvania.

N OT A LWAYS M INOR S TRAINS

It was just a minor strain. Nothing serious.

The Washington Nationals’ Ryan Zimmerman’s rectus abdominis tweak during 2011 spring training wasn’t supposed to be anything it all. Until it was.

While diving back into second base during the first week of the regular season, Zimmerman did more than just aggravate the area. He tore it up. After a month of treatment and some rest, Zimmerman was still in enough pain that in mid-May of that year, surgeons repaired the tear. 1

Figure 9-2. (A) Artist’s depiction of the rectus abdominis muscle. (B) Prominent rectus abdominis in a male model.

Most people know the rectus abdominis as the muscle group that comprises the 6-pack (Figure 9-2). Athletes like to have nice abs, but they would rather have a collection of rectus abdominis muscles that allows them to lunge, spike, dive, pull, and perform a menu of other important functions that involve extending the body. Zimmerman returned to action and has enjoyed good health since. But there is no guarantee someone who plays baseball’s hot corner and is constantly diving to stop hard-hit balls will be pain-free forever.

And he has plenty of company.

He had torn the muscle from the pubic plate (ie, the cover of the pubic baseball see Figures 8-4 and 8-5). The muscle had twanged upward, and the bleeding end caused a big, proximal hematoma.

Yes, most rectus abdominis strains have no bad consequences. But you had better keep your eyes open for the more serious injuries. Put up your antennae for anything unusual or if pain lasts more than a few days. These injuries can be serious and debilitating. With precise diagnosis and treatment, nearly all are highly fixable (Figure 9-3).

From our clinical practice, we have quite a number of other illustrative cases from whom we could have chosen to lead off this chapter. Dramatic cases of the rectus abdominis ripping off the pubic bone affect various types of athletes and everyday folks, from bull riders to P90X beginners. You may have seen the famous ESPN video of the wonderful role model in baseball Nomar Garciaparra falling to his knees in pain while sprinting out of the batter’s box, or know about a star for Manchester United who suddenly reeled to the ground in pain at a key time in the match. Or perhaps you heard about Jack Sock, the American tennis prodigy with the huge serve, who had such troubles with his abdomen early in his career.

You probably don’t know about the young woman from Philadelphia who tore off her abdominal muscle picking up 2 cases of beer, or the 20 soldiers with badly wrenched rectus abdominis muscles after a sit-up contest at a US Army base. We have a lot of such stories. The point is that abdominal muscle injuries happen every day in athletics and routine life. Some of them get better and some of them don’t.

So, what might the folks with severe injuries have in common predisposing them to such problems? One main thing: they work their abdomens out way too hard. They might do this voluntarily (eg, novice exercise enthusiasts getting back into shape, pitchers doing inverted sit-ups in off-season workouts) or they might be in situations in life where they have to work their abdomens too hard (eg, volleyball players, dancers, divers). Beyond a doubt, the same repetitive forces to the rectus abdominis muscles may have a serious toll often, they cause enough wear-and-tear to predispose you to something bad.

Figure 9-3. Rectus abdominis hematoma from pubic plate injury. The muscle of this major league third baseman had torn off the plate 6 weeks previously and the proximal muscle stump bled into the substance of the muscle. (A) Coronal stir image of a well-organized hematoma several inches above the plate. (B) T2 sagittal image showing the tract to the same hematoma from where the muscle ripped off the plate.

You can probably easily guess what sports or what specific positions within sports would make someone most vulnerable to isolated rectus abdominis avulsions. Think about it? The rectus abdominis primarily flexes the abdomen with the chest.

Pick sports or positions that involve a lot of flexion and extension. You’ve got it—tennis players with big serves, third basemen, rowers, bull-riders… The list goes on. Of course, you can get these tears in most sports. The point is that certain activities make you more susceptible to these specific injuries. And when it comes to abs, most people who try to stay in shape mistreat them. The soldiers mentioned previously are supreme examples.

We like to call the rectus abdominis the “Cinderella muscle” because it is regarded as so beautiful yet wicked stepsisters love to abuse it.

W HAT ’ S O BVIOUS A BOUT T HIS M USCLE

The rectus abdominis is probably the most important of our core muscles.

It may not be the strongest. But it is so important for balance and athleticism. It connects the upper body to the lower body, it directs the mechanism that harnesses our core power and even seems to have a direct connection to the brain. It is beautiful, humble, and underappreciated. While the world may recognize its beauty, it may not appreciate its graciousness or importance. That’s why the world regularly abuses the rectus abdominis muscle.

Figure 9-3 exhibits some subtle details about the rectus abdominis muscle. At the top end, it intermingles with the rib cage. On the sides, it merges with the obliques, and at the bottom, it joins with the pubic plate, which attaches to the pubic bone and rest of the harness. It forms the top part of the harness.

Think of the rectus abdominis as having 3 parts:


  1. The top part where it merges with the ribs
  2. The middle part, which becomes hugely important in some sports (eg, diving, tennis, gymnastics)
  3. The bottom part, a key part, the connector to the thighs

In most but not all sports, the bottom part puts in the most work. Think about soccer and American football. On the other hand, rowing works more the top part.

It was upon the untimely death of this good man, however, that the stepmother’s true nature was revealed: cold, cruel, and bitterly jealous of Cinderella’s charm and beauty, she was grimly determined to forward the interests of her own two awkward daughters. Thus, as time went by, the chateau fell into disrepair, for the family fortunes were squandered upon the vain and selfish stepsisters while Cinderella was abused, humiliated, and finally forced to become a servant in her own house. And yet, through it all, Cinderella remained ever gentle and kind, for with each dawn she found new hope that someday her dreams of happiness would come true.

—Giambattista Basile, Pentamerone (1634) and Grimms’ Fairy Tales (1812)

The word Cinderella has, by analogy, come to mean one whose attributes were unrecognized, and who unexpectedly achieves recognition or success after a period of neglect. So it is for the rectus abdominis muscle. It is time for that muscle to shine. Of course, Cinderella was beautiful, but we are talking about the way she was abused. If that abuse continued, she would eventually lose her beauty. Fortunately, she became recognized for her strengths—and was saved.

Of course, we all know the rectus abdominis is beautiful. “Six-pack abs” dominate the fitness culture—“30 Days to 6-Pack Abs,” “The 6 Best Exercises for 6-Pack Abs,” blah, blah, blah. 2 Look at Figure 9-2B. Beautiful? Yes. Subject to abuse? For sure.

Look a little closer and notice that the 6-pack doesn’t really start until about the level of the belly button. Do you think that is by chance? Note the absence of folds below the belly button. There are purposes for these subtleties of our anatomy. We don’t know all the reasons for the subtleties yet, but we are learning a lot of important stuff. The likely reason for the relative absence of folds below the umbilicus probably has something to do with this being the top part of the core’s harness. Think about what happens in a sit-up. You use the lower half of the abdomen more the lower your upper body gets to the floor. You need that part of the abdomen to flatten out. As you reach the top of the sit-up, your head and chest bend so much more, creating an anatomic “need” for folds.

The rectus abdominis muscle has many subtleties. Few people appreciate them. For that matter, few people appreciate the muscle as a whole we abuse it.

This story is about the Cinderella muscle of the core. It is important. It is gracious. We must treat it gently and with respect. Otherwise, we will lose it. Just like the first moral of the story Cinderella : think of beauty as a treasure but graciousness as priceless. Without it, nothing is possible with it, one can do anything.

The fitness world focuses on 6-pack abs, making these sit-up muscles more beautiful. The world believes the more sit-ups one does, the more rectus abdominis exercises one does, the more beautiful these abs become. What the world does not recognize is all the wear and tear all this work causes and the injuries to which this subjects this muscle. The fitness world—personal fitness instructors, the sports world, even the military—does not come close to grasping how much damage this continual abuse causes.

The massive number of sit-ups recommended by “fitness experts,” the ab exercise machines out there, fitness magazines with all the pictures, they all feed a culture of lust, greed, ignorance, and abuse of this muscle. If you come away with one theme from this book, come away with this theme: Lust may be okay, so long as you protect the rectus abdominis muscle.

We must protect our Cinderella.

The rectus abdominis muscle belongs to no medical specialty. If one had to identify a medical specialist that “owns” or knows most about this muscle, it would be the general surgeon. But the general surgeon’s knowledge base concerning this muscle is shallow. For years, surgeons only viewed it as part of the abdominal wall that holds in the guts. They debated such “important” things as whether it is better to cut across it transversely or vertically, and of course, that great medical mystery was never solved.

General surgeons never talked about the importance or function of this muscle in terms of fitness or health. The general surgeon considers the muscle with respect to the occurrence of certain types of hernias, defined as protrusions through the abdominal wall. They pay attention to the occasional tumors that occur here, particularly ones that need to be cut out, like desmoids and the more aggressive sarcomas. The fact remains: General surgeons, and basically all medical specialists for that matter, think of the rectus abdominis muscle merely as one of the muscles that keeps the insides of the belly from falling out. That’s it.

So, you’ve already heard the Cinderella story. Think of the rectus abdominis muscle as amazing, that it does so, so much and that it is so, so beautiful. And that we still have so much more to learn about it.

Anatomically, the muscle is quite variable—sometimes having 2 heads in its distal aspect and sometimes 3, and sometimes associated distally with another muscle called the pyramidalis (see Figure 7-13). The rectus abdominis joins with the ribs in complex ways. It does such subtle things as house certain intercostal sensory nerve branches that can cause great pain. The muscle provides astonishing coil and spring that fits well for jumping, extending, and flexing. Think of its function for divers, gymnasts, and ballet dancers.

The muscle is so important in the harness mechanism. It provides some strength, but not nearly as much for which it is given credit, but directs the power from all the muscle adjacent to it, like the side and back muscles. It harnesses the strength from those muscles so that we use it efficiently. In a sense, it also provides both the bridle and the harness for control of this strength. This muscle is super important for the harness/“pubic joint” concept. It is also the great communicator for the core to the brain in matters of athletic activity. Think about it. If you are sprinting hard and want to suddenly shift to the right or left, what muscles does your brain first ask to tense up first? No doubt it is the rectus abdominis, and then the brain asks it to coordinate with the rest of the harness mechanism and the adductors. MRIs show that the rectus abdominis also quickly atrophies in response to injury or nonuse. The latter fact provides added testimony and circumstantial evidence for how much we ordinarily use this muscle and how truly important it is.

Add to this knowledge base that this muscle is easily injured from overuse or too much force, usually from abdominal hyper-extension or thigh hyper-abduction.

Because of its intimate relationship to the pubic bone and thighs, we have seen multiple problems related to the rectus abdominis muscle. Most commonly, the problems occur in association with adjacent bony and muscular structures. For now, let’s consider some of the syndromes that we have identified that are just relatively isolated to the rectus abdominis muscle.

We see this so commonly now on the side of primary injury. The presumption is that the lack of connection to the pubic plate or pain, or both, leads to avoidance of using the muscle. Atrophy is a regular finding with mesh used in hernia repairs. Somehow, the mesh fibroses and fixates the underlying or overlying muscle rendering it less mobile or functional. There is debate about whether the dominant or nondominant side houses the bigger rectus abdominis in upper extremity–dominant sports, such as baseball or tennis. One paper attests to the nondominant side being bigger in tennis players. 3 We have seen dramatic differences in rectus abdominis size in athletes, but in a much more unpredictable fashion than that paper would suggest. And in our clinical experience, the dominant side seems to be larger, except when there is an injury (Figure 9-4).

Figure 9-4. Rectus abdominis atrophy in a 24-year-old professional soccer player with right adductor pain. We speculate that abdominal detachment was the primary event leading to pubic plate separation and adductor injury. This fat-sensitive MRI image shows atrophy and fatty replacement of the right lower rectus abdominis muscle.


Rectus abdominis muscle tear diagnosed with sonography and its conservative management

This is a rare case of a post-traumatic rectus abdominis muscle tear in an adolescent female diagnosed by ultrasonography (US). Conservative management is also described.

Methods

A 14-year-old female presented to a chiropractic clinic with extreme pain and tenderness in the right lower quadrant (RLQ) after post-plyometric power kneel box jumps. Movement aggravated her pain and she demonstrated active abdominal guarding with RLQ palpation. Ultrasonography revealed a subacute Grade 2 right rectus abdominis muscle tear, without evidence of hyperemia or a hematoma. Following the diagnosis of a right rectus abdominis muscle tear, she was treated with spinal manipulation and a course of musculoskeletal rehabilitation directed at truncal stabilization.

Results

After treatment, the patient was able to return to play 5 week post-injury without any pain or discomfort. A follow-up US at 3 months provided evidence of muscle healing without complications.

Conclusion

This case demonstrates the diagnosis of a rare rectus abdominis muscle tear managed conservatively. To our knowledge, less than a dozen cases are reported using US in the evaluation and diagnosis of a rectus abdominis tear.


Anatomical and mechanical relationship between the proximal attachment of adductor longus and the distal rectus sheath †

This article was published online on 14 June 2012. P.J. Barker's affiliation was provided incorrectly and has been updated. This notice is included in the online and print versions to indicate that both have been corrected.

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Abstract

The objectives of this study were to investigate the anatomical relationship between the proximal adductor longus (AL) and rectus abdominis muscles and to determine whether unilateral loading of AL results in strain transmission across the anterior pubic symphysis to the contralateral distal rectus sheath. Bilateral dissections were conducted on 10 embalmed cadavers. Strain transfer across the pubic symphysis was examined on seven of these cadavers. An AL contraction was simulated by applying a controlled load in the direction of its proximal tendinous fibers, and the resultant strain in the contralateral distal rectus sheath was measured using a foil-type surface mounted microstrain gage. Adductor longus attached to the antero-inferior aspect of the pubis. In 18 of the 20 limbs, the proximal attachment of AL was tendinous on its superficial surface and muscular on its deep surface. The proximal AL tendon was found in most instances to have secondary communications with structures such as the contralateral distal rectus sheath, pubic symphysis anterior capsule, ilio-inguinal ligament, and contralateral proximal AL tendon. Despite these consistent anatomical observations, strain measured in the contralateral distal rectus sheath upon unilateral loading of the proximal AL varied considerably between cadavers. Measured strain had an average ± 1SD of 0.23 ± 0.43%. The proximal attachment of AL contributes to an anatomical pathway across the anterior pubic symphysis that is likely required to withstand the transmission of large forces during multidirectional athletic activities. This anatomical relationship may be a relevant factor in explaining the apparent vulnerability of the AL and rectus abdominis attachments to injury. Clin. Anat. 2013. © 2012 Wiley Periodicals, Inc.


What bone is the rectus abdominis attached to?

The rectus abdominis muscle is attached superiorly to the xiphoid process of sternum and costal margins of 5th, 6th and 7th ribs (principally the fibers of the 5th rib).

Secondly, where is the rectus abdominis muscle located? The rectus abdominis muscle is located in the front of the body, beginning at the pubic bone and ending at the sternum. It is located inside the abdominal region.

Also know, what bones do the abdominal muscles attach to?

Internal Abdominal Oblique The muscle fibres radiate superomedially and insert into the inferior borders of the lower three ribs and their costal cartilages, the xiphoid process, the linea alba and the symphysis pubis.

What part of the hip and what part of the sternum does the rectus abdominis attach to?

The proximal attachments are the pubic crest and the pubic symphysis. It attaches distally at the costal cartilages of ribs 5-7 and the xiphoid process of the sternum. The rectus abdominis muscle is contained in the rectus sheath, which consists of the aponeuroses of the lateral abdominal muscles.


  1. Term Paper on the Meaning of Human Muscles
  2. Term Paper on the Types of Human Muscles
  3. Term Paper on the Parts of Human Muscles
  4. Term Paper on the Fascicular Architecture of Human Muscles
  5. Term Paper on the Nomenclature of Human Muscles

Term Paper # 1. Meaning of Human Muscles:

Muscle is a contractile tissue and primarily designed for movements.

It resembles a mouse with their tendons representing the tail. All muscles are developed from mesoderm, except – arrector pilorum, muscles of iris and myoepithelial cells of salivary, sweat and lacrimal glands which are derived from ectoderm.

Term Paper # 2. Types of Human Muscles:

Muscles have three types:

Below the characters of above three muscles have been described:

I. Skeletal Muscles (Striped, Striated, Somatic and Voluntary Muscles):

i. Skeletal muscles are most abundant and found attached to skeleton.

ii. They exhibit cross-striations under microscope.

iii. These are supplied by somatic nerves (cerebro spinal) and are under voluntary control.

iv. They response quickly to stimuli and is also being capable of rapid contractions and get fatigued easily.

v. It helps in adjusting the individual to external environment.

vi. These are under highest nervous control of cerebral cortex.

vii. In skeletal muscle, each muscle fibre is multinucleated cylindrical cell containing groups of myofibrils made up of myosin, actin, and trapomyosin – myofilaments – are actual centractile elements.

Example- Muscles of limbs and body wall.

II. Smooth Muscles (Plain, Unstriped, Non-Straited, Visceral and Involuntary Muscles):

i. These muscles often surround the viscera.

ii. They do not exhibit cross-striations under microscope.

iii. These are supplied by autonomic nerves and are not under voluntary control (sympathetic).

iv. They respond slowly to stimuli, being capable of sustained contraction and do not fatigue easily.

v. They also provides motor power for digestion, circu­lation, secretion and excretion.

vi. These are less dependent on nervous control, capable of contracting spontaneously, automatically and often rhythmically.

vii. In smooth muscles, each muscle fibre is an elongated, spindle shaped cell, with a single nucleus placed centrally. Myofibrils show longitudinal striations, e.g., muscles of blood vessels and G.I.T., G.U.T., arrectorpili muscles of skin.

i. It forms myocardium of the heart.

ii. They are intermediate in structure, being striated and involuntary.

iii. These are meant for automatic and rhythmic contractions.

iv. In cardiac muscles. each muscle fibre has a centrally placed single nucleus.

v. In these muscles, fibres branch and anastomose with neighbouring fibres at inter-calated discs (opposed cell membranes).

vi. It’s Cross-striations are less prominent than skeletal muscles.

i. Myoepithelial cells are basic muscular cell belonging to smooth muscle type.

ii. Myoepithelial cells are present at bases of secretary acini of sweat gland and help in expulsion of secretion from acini.

Term Paper # 3. Parts of Human Muscles:

i. Origin – Proximal and fixed.

ii. Insertion – Moving and distal.

i. Fleshy part – contractile – belly.

ii. Fibrous part – non-contractile – tendon, aponeurosis etc.

Structure of Skeletal Muscle:

I. Contractile Tissue – Myofibrils:

Term Paper # 4. Fascicular Architecture of Human Muscles:

Arrangement of muscle fibres varies according to direction, force and range of movement at a joint.

I. Parallel – Fasciculi:

II. Oblique – Fasciculi:

ii. Flexor pollicis longus

III. Spiral or Twisted Fasciculi:

ii. Sternocleidomastoid (cruciate)

Term Paper # 5. Nomenclature of Human Muscles:

Depends on number of ways, e.g.:

i. According to shape, e.g., Trapezius, rhomboideus etc.

ii. According to number of heads of origin, e.g., Biceps, quadriceps, triceps, digastric.

iii. According to gross structure, e.g., Semi-tendinosus, semi-membranosus etc.

iv. According to location, e.g., Temporalis, supraspinatous, intercostals etc.

v. According to attachments, e.g., Stylohyoid, cricothyroid etc.

vi. According to function, e.g., Adductor longus, flexor-carpi ulnaris etc.

vii. According to direction of fibres, e.g., Rectus abdominis, obliquus abdominis, transversus etc.

Blood Supply of Skeletal Muscles:

Derived from neighbouring arteries. Arteries, veins and nerves pierce the muscle at a point known as neurovascular hilum.

Accompany blood vessels and drain into neighbouring lymph nodes.

When a muscle contracts it shortens by 1/3 (30%) of its belly length and brings about a movement.

i. Prime movers- Bring about desired movement (Agonists).

ii. Antagonists- (opponents) – oppose the prime movers.

iii. Fixators- Which stabilize the proximal joints of a limb so that desired movement at the distal joint may occur on a fixed base.

iv. Synergists- When prime movers cross more than one joint, the undesired actions at the proximal joints are prevented by certain muscles known as synergists.

i. Paralysis- Loss of motor power is paralysis.

ii. Muscular spasm- Are quite painful and localized spasm caused by a muscle pull generalized spasm – occurs in tetanus and epilepsy.

iii. Disused atrophy and hypertrophy- Due to excessive use of muscles.

iv. Regeneration of skeletal muscle- Is limited, in large damage – no regeneration.


Why Do Women Strive for Abdominal Perfection?

“Why is the abdominal region the most popular and sought after in terms of perfection for women?” asks a journalist in her email to me. A quick look at some of the most recent magazine covers verifies that ‘Ab workouts’ feature prominently. For example, Shape magazine helps readers to ‘Up Your Ab Game,’ Fitness provides a four step guide to ‘Sculpt Sexy Abs’ for the ‘Ultimate Mid-Section,’ and Women’s Health offers a fast ‘sane plan’ for ‘Tight Butt, Toned Arms and Flat Abs.’ Why is it, indeed, that abdominal workouts are of so much interest?

Women can, of course, exercise their abdominals for various reasons, but one way to think of ab exercises’ popularity is to consider the biology of the body (the abdominals), the psychology of exercise choices, and our cultural context for bodily ideals as co-contributors in the quest for abdominal perfection. Let’s first look at the biological body.

From an anatomical point of view, we have three layers of abdominal muscles. Only the superficial layer, rectus abdominis, is visible and is often referred to as ‘the six-pack.’ Like all muscles, rectus abdominis moves bones to enable our bodies to move in space. The upper end of this muscle is attached to the ribcage and the lower level to the pelvic bone. When rectus abdominis contracts it tilts both the ribcage and the pelvic bone forward. Different forms of 'sit-ups' or ‘crunches’ are typical exercises that strengthen the rectus abdominis. To exercise this muscle most effectively, both the upper body (as in a sit-up) and the pelvis (and legs) need to be lifted off the floor: this action engages both ends of the rectus abdominis muscle.

The other two abdominal layers serve different functions and also act as 'stabilizers' - they are the ones that, in addition to the rectus abdominis, should be included in any 'core' training program (like Pilates). However, they are not as visible as the rectus abdominis. The external obliques are located on the side and front of the abdomen and underneath these are the internal obliques. They are attached to the side of the ribcage and on the side of the pelvic bone. These muscles tilt the upper body sideways (laterally) and also help rotate the upper body when it tilts forwards. Sit-ups where you cross your body sideways or towards the opposite knee typically strengthen the obliques.

The deepest level of the abdominals is the transversus abdominis. It is almost like a ‘corset’ that embraces the body’s mid-section from the back (the aponeurosis – a type of fascia) to the front (the rectus abdominis sheath) and from the lower ribs to the pelvic bone. The transversus is often considered a muscle that stabilizes the body instead of moving certain bones to create visible movement. Most of the time, engaging the transversus means having to use the other layers of abdominals too. For example, a Pilates exercise called ‘the 100’ that includes ‘anchoring’ the pelvis on the ground (pressing the pelvis bones and lower spine on the mat), lifting the knees and feet as well as the upper body off the ground should engage all three layers of abdominals. As the transversus (and all the abdominals) is attached to the ribcage, moving it by breathing will further help work it.

It is clear that all our abdominals have a specific anatomical function, but the magazine workouts seldom point to these functions (tilting, stabilizing) on their covers. Let’s take a look at some online ab workouts to see what it takes to get the promised ‘ultimate midsection.’

Shape magazine that specializes in women’s fitness offers plenty of abdominal exercise choices. These workouts have moved beyond simple crunches to favor complex multi joint exercises such as various types of planks, burpees, variations of Pilates inspired teasers, or standing up abdominal exercises. Many of these exercises demand a significant amount of strength, mobility, and skill. Many emphasize using the core and the different abdominal muscles. All promise a flat and sexy stomach, many promise it fast, some promise specifically ‘to melt belly fat.’

This is where the cultural knowledge intertwines with the biological body to direct our exercise choices. Although improved strength and a better functioning body can result from these abdominal workouts, the magazines primarily promise visible changes towards the ultimate ‘sexy’ looking body: toning, flattening, or melting any extra fat around the abdominal area. While the visible upper layer, the rectus abdominis, is needed for the sexy, ‘six-pack’ look, the other two layers, hidden underneath the rectus, are often involved in quite complex ‘core exercises’ needed to deliver visible body transformation – the best ‘compression’ for the flat looking stomach.

Exercising for a better-looking body is not exactly news. Since the late 1980s, feminist researchers have argued that the ideal feminine body sells women's magazines. In their seminal work from more than two decades ago, Sandra Barky (1988) and Susan Bordo (1992) exposed the (very) thin, toned (not muscular), and youthful feminine ideal body as narrowly defined. Most women, they continued, have not been born with such bodies, but continually work toward this impossible ideal. Paradoxically, the areas where we naturally store fat (under arms, abdominals, pelvis, thighs) are the areas targeted to be lean. For women, the abdominals are among the most difficult muscles to sculpt to the correct lean and toned shape. Bordo (1992) even argued that women grow up despising their feminine form, because the ideal feminine shape in this society resembles that of a young boy: wide shoulders, tight muscles, narrow hips.

My early research (Markula, 1995) also showed that women exercised mainly for the thin and toned body. While not wanting to look muscular, they longed for the ideal shape of the magazine models who they, rather paradoxically, also found unrealistic and even unhealthy. They listed the abdominals among ‘the problem’ spots where extra fat gathers. Similar to the current online workouts, they presumed that ab exercises would reduce any fat stored around their abdominal area. Here again, the cultural quest for the sexy looking body interferes with the biological body: physiologically, such ‘spot reduction’ is not possible because fat is metabolized in a general manner, not in a particular spot, when exercising (see also my earlier 'Spot Reduction' August, 2014). This means that an exerciser needs to also lose fat by dieting to uncover the muscle tone.

More recent research finds that the same body ideal with the same problems spots brings women to exercise classes. While the participants, first and foremost, want to lose weight the ‘stomach’ continues to be the number one problem area that needs to be reduced to the correct flatness by exercising (Chikinda, 2014).

With all of this in mind, I suggest to the journalist that because obtaining the ideal body, displayed in the magazines, is so impossible, we always seem to be in need of more abdominal exercises and diet advice from the magazines. She is not convinced.

It is a common misnomer, she argues, that the magazines shape the body ideal. They merely mirror their readers’ ideals, she continued. The magazine editors and staff do not believe that women should be thin or have great abs, it is the women who seem to want six-packs. In addition, she went to say, market research shows that it is the readers who want ab exercises on the covers and the magazines merely want to serve their readers.

This is where the psychological factors directing exercise choices enter the quest for abdominal perfection. It is clear that we have plenty of exercise choices, but why choose to work the abs? When women have plenty of different abdominal exercises for different purposes to choose from, why do they choose the ones that promise a flat and sexy looking stomach fast instead of those designed to improve our sideways tilt?

At the most basic level, psychologists call our willingness to act toward some goal, motivation. Motivation is further characterized by choice, effort, and persistence. To be motivated to exercise our abdominals, we obviously need to choose to it for it to become a particular goal (i.e., for a sexy looking mid-section), then put effort into performing those exercises, and finally we must continue or persist in doing those exercises over a significant amount of time like weeks and months.

Many exercise psychologists add that our exercise choices are related to individual’s self-efficacy: the confidence we have in our ability to successfully perform particular exercises. If we believe that we can successfully complete a series of abdominal exercises, we are motivated to choose and persist with these exercises. This also means that we are unlikely to continue with an ab workout that is too demanding, difficult, or that we cannot complete. While self-efficacy can improve our motivation to exercise, it does not alone explain why we choose to workout particular body parts more than others.

Several psychological theories (e.g., the theory of reasoned action, the theory of planned behavior) account for the influence of significant others on our intensions. For example, if all of the women around us exercise their abs, we also start thinking it is important. Based on these theories, the expectation of exercising one’s abs, however, derives from social norms defining acceptable femininity. Social cognitive theorists add that their immediate social and physical environment mediates individuals’ behavioral choices. For example, a woman’s individual choice to exercise her abs can also be directed by her environment where there is strong social support for such a choice. Seeing relatable peers model the desired behavior, like in an exercise class, is particularly effective in this regard. Based on this theory, readers of women’s exercise and health magazines should be able to relate to the magazines’ models and their tight abs to be motivated to read (and do) whatever exercise advice the magazines are selling.

More recent psychological theories, such as the socio-ecological model, recognize that external factors influence behavior as much as individual choice. For example, social influences like the ideal fit body shapes individual women’s beliefs of what type of exercise counts. Therefore, the social, environmental, and individual factors all shape behavior and effect our motivation in a number of dynamic and complex ways. This means that while individual women read articles on how to get the perfect abs, their ideas of such perfection come from their social environment, including, of course, images of so-called fit women portrayed in the media. Therefore, recent explanations of exercise behavior from psychologists have begun to account for the importance of global, cultural, and social environment factors in addition to individual’s preferences (Linke, Robinson & Pekmezi, 2013).

It seems like the reasons why women might seek abdominal perfection are, indeed, multi-layered (pardon the pun). The biological, psychological, and cultural ideas of the body become intertwined to support this quest. But is this a necessary quest for women to pursue? Do we really need tightly toned abdominals as sported by the fitness magazine models? Most of us do not need a six-pack or strong rectus abdominis to repeatedly tilt our ribcage and pelvic bone forward whereas we do need the support of the transversus to sit-up straight. So would we strive for flat and tight abs without the magazines’ images to ‘motivate’ us? What do you think, readers, how strongly does the image of the ideal body shape your desire for abdominal perfection? If we had more diverse women’s bodies represented on these magazines would we define abdominal perfection differently?

Bartky, S. L. (1988). Foucault, femininity, and the modernization of patriarchy. In I. Diamond & L. Quinby (Eds.), Feminism and Foucault: Reflection on resistance (pp. 61-86). Boston, MA: Northeastern University Press.

Bordo, S. (1992). Unbearable weight: Feminism, Western culture, and the body. Berkley, CA: University of California Press.

Chikinda, J. (2014). The body, health and exercise: A Foucauldian-feminist analysis of fitness instructor knowledges. Unpublished masters capping project. University of Alberta, Canada.

Linke, S. E., Robinson, C. J., & Pekmezi, D. (2013). Applying psychological theories to promote healthy lifestyles. American Journal of Lifestyle Medicine, 1-11.

Markula, P. (1995). Firm but shapely, fit but sexy, strong but thin: The postmodern aerobicizing female bodies. Sociology of Sport Journal, 12, 424-453.


The uppermost or superficial layer of your abdomen contains the skin, subcutaneous tissue, two layers of fascia (Scarpa’s fascia and Camper’s fascia), and also connective tissue. This part of the tummy gives structure and protection to your internal organs. Nerves, lymphatics, and blood vessels are also present throughout.

Abdominal skin

Skin quality is an important indicator of health and youthfulness. Strong, healthy abdominal skin is firm and elastic. Unfortunately, it is rather easy to stretch the skin on your belly. The older you get, the easier it is to damage the skin because mature skin does not bounce back as easily as it once did.

Gaining weight or having a baby can also take a toll on skin. As the body stretches to accommodate either underlying fat or a growing fetus, it can weaken the skin structure dramatically. The skin may develop a loose, sagging appearance, creases, and folds. Stretch marks are another common problem.

Stretched skin does not always shrink back to how it was before. Rather than seeing a nice, trim tummy after losing weight or having a baby, the skin can seem to simply hang loose from the tummy. Women with multiple pregnancies and patients who have undergone bariatric or gastric bypass surgery are most at risk. People over age 30 are also affected because skin produces progressively less collagen and elastin as the body ages. 1,5

There are many ways to treat skin aging and stretch marks. Lots of over-the-counter beauty products, home remedies, and prescriptions promise to make the skin appear youthful. However, when you have damaged abdominal skin, there are usually other underlying problems that need to be addressed as well. Plastic surgery can help improve the appearance of abdominal skin, remove fat, and repair stretched or torn abdominal muscles at the same time.

It is important to mention that cosmetic surgery does not change the biology of the skin. If your skin is aged, inelastic, or lacking collagen, a tummy tuck won’t magically make your skin inherently youthful again. No surgeon can promise that with body contouring surgery.

However, a tummy tuck can help your skin appear younger since the skin is pulled nice and taut when the incision is closed with sutures. This gives the skin a firmer appearance, even though the skin is not structurally different than it was before surgery. Abdominoplasty may also remove some stretch marks on the tummy when the skin is trimmed.

Subcutaneous tissue

The layer just below the skin is called subcutaneous tissue. It is also known as the hypodermis. From regulating body temperature to blood flow, this tissue serves many important functions. It is made up of fat and connective tissue. Blood vessels and nerves run through this layer, which acts as a passageway for blood flow between the upper layers of skin and underlying muscle.

Camper’s fascia

Below the skin are two layers of superficial fascia. The Camper’s fascia is the first layer. The fascia of Camper contains mostly areolar tissue, which is made of elastic and smooth connective fibers with a minimal amount of fat.

Areolar tissue

There are six types of connective tissue in the human body. Areolar tissue is a loose connective tissue made from a meshwork of collagen fibers and elastic tissue. One function of areolar tissue is to connect the skin to the muscles below. Areolar tissue helps give the abdomen structure so that everything stays in its proper place. It also stores some fat and helps insulate the body.

Adipose tissue (fat)

Fat, or adipose tissue, is a special kind of connective tissue made of adipocytes. The purpose of these cells is to store energy from food. Food fuels adipose tissue with calories, which gives us energy. That’s why when you workout, you burn fat. Yet even when you sit still or sleep, your body is always burning calories. Whether you are digesting food, breathing, or blinking your eyes, the human body is always doing something that requires energy. Adipose tissue also cushions and insulates the body.

Too much subcutaneous fat can leave your tummy soft and pudgy. When we think of getting a tummy tuck with liposuction or VASER liposculpture, it’s often this layer of connective tissue that we want to address. Pregnancy, aging, medications, eating too many high-calorie foods without working out, and even your body’s unique biochemistry can lead to a buildup of adipose tissue.

The tummy is often the first place people gain weight. Lipo-abdominoplasty surgery is an excellent way to remove belly fat, even the stubborn kind that exercise and diet alone don’t seem to help.

Scarpa fascia

The Scarpa fascia is located beneath the Camper’s fascia in your abdomen. It is a thick, membraneous layer on the anterior abdominal wall.

The Scarpa fascia is a very important part of successful tummy tuck surgery. This is the structure that gets sutured closed in abdominoplasty. It is very strong and tough, so it can support a lot of tension. That allows your surgeon to get a nice, taut closure of the incision without compromising skin vascularity. 2

The way your surgeon dissects in or around the Scarpa fascia can mean the difference between a surgery with or without drains. Most patients find drains to be a real pain. Drains are rather inconvenient and cumbersome. By operating carefully in and around the scarpa fascia, a tummy tuck without drains is possible. Unfortunately, some tummy tuck surgeons today still use drains because they are not trained on the latest techniques. You can save yourself the hassle of having to use drains by choosing a surgeon who knows how to perform drainless abdominoplasty.

Preserving the Scarpa fascia is important during abdominoplasty to give patients the best results. By dissecting superficially and taking care to avoid damaging the blood supply to the Scarpa’s fascia, Doctor Bernard Beldholm can avoid using drains entirely. This means an easier recovery for his patients.


4 Answers 4

  • Global muscles produce movement.
  • Local muscles prevent movement.

For examples of over-developed rectus abdominis you can look towards the sport of super-heavyweight powerlifting/strongman where many have extremely large rectus abdominis to stop their body folding in two

The rectus abdominis generates spinal flexion. A physical barrier like a large stomach may create a physical barrier to stop movement but it doesn't matter if it's fat or a "six pack" that's blocking the movement. There's no relation to muscle function

The reason this was such a good question is that the rectus is considered a global muscle and not consider a part of the innercore.

Failure to stabilize the spine isn't ONLY due to weakness. Altered neuromuscular firing patterns produce the same result.

If you're more powerful global muscles are firing before your deep stabilizers this results in large force being applied to an unstablized spinal column.

This is why the trA is so important. It is activated first before movement in any direction. Unlike your quadratus lumborum which is only active during sagittal plane movements.

Have a strong core is essential in anything you do while standing up. Your rectus abdominis are a big part of this.

For example, is there any "heavy lifting" or exercise significantly helped by a specifically strong rectus (not transverse!) abdominis?

Yes, your rectus abdominis will help stabilize your body while doing things like deadlifts, squats, bend-over rows, military press, push-ups, if you do these movements will standing (apart from the push-ups). Even if you do bicep curls while standing, your core is working to keep your body erect.

Note: I'm not saying rectus abdominis is the only muscle that is stabilizing your body, your entire core does this. I'm saying rectus abdominis is a part of this and therefore making it stronger will help in anything that requires your core to stabilize your body during heavy lifting or any daily activitie.

It looks like the rectus abdominis plays a role in posture and contributes a bit towards increasing intra-abdominal pressure (IAP).

Posture is more dynamic and complicated than people give it credit for. Technically every muscle in your body plays some role in posture.

Also, it is used for trunk/lumbar flexion as well.

Of course, it does that but priority of training that is likely low.

I'd say the torso is more for transfer of force from the upper body to lower body and vice versa. Secondary or tertiary function is stability, or anti-rotation (could be considered the same thing). As opposed to lumbar flexion, which is at best a tertiary or quaternary (fourth) consideration.

Frankly few people are that weak at lumbar flexion. And if you can do more than 8 reps of something, you're no longer training strength, you're training muscular endurance. Doing 30-40 crunches becomes a waste of time because the threshold of adaptation is way too low and it takes to long to get a training effect at the expense of spinal flexion cycles.

However, what benefit is there to having a particularly "strong" rectus abdominis? By strong, I mean significantly beyond whatever may be required for basic mere things like posture and the occasional sit-up (or crunch).

  1. Hypertrophy -- If that's what you want, then loaded lumbar flexion (cable crunches, loaded crunches) is somewhat of a requirement in a

Yes, none of those examples seem 'specific' to rectus abdominis in terms of isolation, but you can't isolate muscles anyway. This is a myth, you can only favour muscles in a kinetic chain. All muscles work in some kind of kinetic chain. Even in a crunch, your hip flexors, TVA, pelvic floor and your obliques are involved.

The RA is involved heavily in all of those torso exercises.

I understand IAP can be quite helpful for lifting and handling heavy weights, but it seems it's the transverse abdominis that's much more important for that.

I'd argue that internal obliques and your diaphragm are more important than TVA for most people for strong IAP. Breathing and bracing drills improve IPA significantly better than TVA specific drills (vacuum/sucking in). In many ways, TVA specific training is the opposite of creating good IPA. TVA specific work is overrated and based on generally outdated research.

For example, is there any "heavy lifting" or exercise significantly helped by a specifically strong rectus (not transverse!) abdominis? I'm not referring to some contrived "weighted sit-up" or crunch exercise here.

Yes. The chin up immediately comes to mind as you have to control extension. Anyone good at them will typically have considerable RA strength. There is a piece of research or two, that showed chin ups yield significantly more RA activation than any crunch variation (even loaded ones if I recall).

Of course, given that you can't truly isolate one muscle and that all muscles work in some kind of kinetic chain. It's silly to really focus too much attention on any one muscle.


Conclusions

The value of MR imaging for the clinical work-up of athletic pubalgia increases with the radiologist’s familiarity with and recognition of injury patterns in the anatomic structures surrounding the pubic symphysis. As the pathophysiology and anatomy of the pubic region come to be better understood, so too does the MR imaging appearance of common groin injuries in athletes who participate in sports with quick side-to-side movements, twisting and extension at the waist, and rapid acceleration and deceleration. Unenhanced MR imaging with a dedicated protocol for evaluating athletic pubalgia allows the diagnosis of subtle pathologic changes, identification of the structures involved, and determination of the extent of injuries in patients with activity-induced groin pain. The recommended MR imaging protocol for assessing the possible sources of referred groin pain includes both small-field-of-view high-resolution studies detailing the pubic symphysis and large-field-of-view pelvic surveys. Knowledge of the characteristic patterns of clinical and imaging findings in the various injuries that may produce athletic pubalgia, including primary injury of the rectus abdominis–adductor aponeurosis, allows the radiologist to accurately and precisely characterize the pathologic process and to help guide the referring clinician toward an appropriate treatment plan.