Making Your Back Muscles and Abdominals Work for You
Steve Daisey MPT, CSCS

The past 10 years has seen tremendous research (1-5) surface that has helped us better understand just how the muscles surrounding the lower back are supposed to work.

For years, it was thought that strong abdominal muscles helped the back. This was only partially true. The abdominal muscles we think of (the "six pack") are really only a small part of the equation.

In particular, a muscle called the Transversus abdominis (TA), which lies underneath the "six-pack" plays the major role in stabilization of the lower back. The TA looks interestingly like a back belt, wrapping around the front to the back from one side of the spine to the other. The function of this muscle is reactionary and preparatory. Its job is to contract and stiffen the spine just before we move. At the same time, a muscle called the deep multifidus (located along the midline of the spine) also contracts to stiffen the spine.

Research (3-5) has shown that many people who are not in pain, but have a history of lower back problems, cannot effectively contract the TA and multifidus. When those people reach overhead, or get out of chair, or twist, these muscles are either delayed in contracting, or they do not contract at all.

When these deep core muscles do not stiffen the spine, more stress is placed on the disc, the facet joints, and the outer muscles (the paraspinal muscles, the six-pack). It is critical therefore to learn how to use these muscles correctly.

The following are two very basic exercises I typically start with when a patient presents with an inability to contract the TA and multifidus. Be forewarned - it generally takes 2 or 3 one-on-one treatment sessions just to teach someone how to contract these muscles. While it is fine to try them, someone should be present to give you feedback in case you are doing them wrong, as that will only feed into over-dominance of the outer muscles.

Transversus Abdominis Contraction
It is probably best to try this in standing initially, as it is easier to feel and perform. Stand upright with good posture. Place the tips of your fingers 2" on either side of your navel. Now, slide them down over your lower abdomen, about one inch BELOW your navel. This is the best place to feel a contraction of the transversus abdominis muscle.

Now try to imagine drawing in the lower abdominal area. Or imagine drawing the skin under your fingers inward. This is not the same as sucking in your stomach. You should feel a tension increase under your fingers and then a pulling-in of the skin away from your fingers. If your fingers/thumbs are pushed out, you are contracting the outer muscles.

Nothing else should move. You should not have to hold your breath or puff out your chest. You may even feel the muscle shake a bit once you correctly contract it.

Once you are performing this correctly, (and someone who understands how it should feel has confirmed it), you can begin to train yourself to contract it in other positions - sidelying, lying on your back, on your hands-and-knees, as well as performing it simultaneously with other movements. This forms the basis for a total exercise program for the abdominals and back. Again, this should be supervised by a professional.

Multifidus Contraction
These are the deepest muscles running along the spine and are critical to stabilizing and de-stressing the spine during movement. They work in tandem with the TA.

On all fours, get your back straight as shown. Next, draw in the TA and only the TA. Again, this is not sucking in the gut. Now simply unweight one of your knees. Do not raise it off the ground. Just take the weight off. You should feel a contraction in the deep muscles of the back.

REFERENCES:
1. Hides J, et. al: An MRI investigation into the function of the transversus abdominis muscle during "drawing-in" of the abdominal wall. Spine. 2006 Mar 15;31(6):E175-8.
2. Richardson CA, et. al: Lumbo-pelvic joint protection against antigravity forces: motor control and segmental stiffness assessed with magnetic resonance imaging. J Gravit Physiol. 2004 Jul;11(2):P119-22.
3. Richardson CA, et al: The relation between the transversus abdominis muscles, sacroiliac joint mechanics, and low back pain. Spine. 2002 Feb 15;27(4):399-405.
4. Hodges PW: Changes in motor planning of feedforward postural responses of the trunk muscles in low back pain. Exp Brain Res. 2001 Nov;141(2):261-6.
5. Hodges PW, Richardson CA: Delayed postural contraction of transversus abdominis in low back pain associated with movement of the lower limb. J Spinal Disord. 1998 Feb;11(1):46-56.

DISCLAIMER:
The information presented on DaiseyPT.com is provided for educational purposes only and is not intended to be a substitute for professional medical or physical therapy advice. You should not use the information on this web site for diagnosing or treating a medical or health condition. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider.

The exercises presented in these articles pose risks if performed incorrectly or if performed by persons who may be inappropriate for them. They are provided for informational purposes only and to provide education and insight into a particular interest. Daisey Physical Therapy & Sports Medicine Inc. does not recommend performing them without a complete history and examination as well as professional instruction. Daisey Physical Therapy & Sports Medicine assumes no liability for any injury that may occur by attempting the exercises presented here.