Abdominal Bracing Exercises and Back Pain
Monday, December 28, 2009 at 7:24AMOne of the primary goals for core exercises, especially as they relate to back pain is the ability to establish and maintain a “braced” core. This “braced” core is accomplished by maintaining a mild contraction or tension of the abdominal wall. Stuart McGill, a reknowned investigator in the field of exercise science refers to this muscle stiffening and terms it “abdominal bracing.” (Arch Phys Med Rehabil. 2007 Jan;88(1):54-62.)
Controversy and Abdominal Bracing:
Stuart McGill has taught for some time a technique for abdominal bracing that involves “full abdominal co-contraction.”
For a time, a group of Australian researches and physiotherapists taught a technique called “abdominal hallowing” in an effort to have people engage specific muscles of the abdominal wall (transversus abdominus). (Richardson et al. 1999) (Picture)
However, newer research from McGill has demonstrated that:
The brace technique improved stability by 32%, with a 15% increase in lumbar compression. The transversus abdominis contributed .14% of stability to the brace pattern with a less than 0.1% decrease in compression… There seems to be no mechanical rationale for using an abdominal hollow, or the transversus abdominis, to enhance stability. Bracing creates patterns that better enhance stability. (Arch Phys Med Rehabil. 2007 Jan;88(1):54-62.)
There are two important lessons to be learned from this study. First, the brace technique is definitively superior to the abdominal hollowing technique in terms of delivering stability to the lumbar spine. Second, the stiffening of the abdominal wall delivered by McGill’s abdominal bracing technique is dramatically successful in its potential to improve lumbar stability (32% improvement). It is for this reason that all the discussion related to abdominal bracing is relevant.
Teaching Abdominal Bracing:
The basic goal of abdominal bracing exercises is to stiffen the abdominal wall with a mild isometric co-contraction of all the muscles around the core. With this co-contraction of muscles there should be no movement in the spine or pelvis and the abdominal wall is neither sucked in nor pushed out. The muscles involved in this co-contraction include the transverse abdominis, internal and external obliques, rectus abdominis, quadratus lumborum, erector spinae, and multifidi.
This exercise, though, is sometimes easier said than done.
McGill (Low Back Disorders. 2007) suggests that the idea of abdominal bracing be introduced by having a person first stiffen one joint, such as the elbow, by simultaneously contracting the flexors and extensors. The person stiffens the joint without any movement occurring at the joint and palpates the joint to feel what is happening. This can be practiced at other joints to allow a person to get a feel for this bracing idea. Then, the drill is moved to focus on the core/torso region and the person uses the same technique to achieve the bracing effect. This is usually done first in a supine position where a person can find a neutral spine position and then activate a brace so to speak. (Picture)
One way to practice this bracing technique is to perform the “Curl-Up” as described by McGill. I reference this exercise in my journal post Back Pain: Generalities and My Favorite Back Exercises (http://backexercisedoctor.squarespace.com/journal/2008/7/17/back-pain-generalities-and-my-favorite-back-exercises.html) To do the exercise one leg is bent, the other remains relaxed and lays flat on the floor. The hands are placed anywhere that seems comfortable (not necessarily behind the head). Fix your eyes on a spot on the ceiling directly above you. Tighten your stomach. Hold the contraction and lift your shoulder blades off the floor while maintaining your focus on the spot on the ceiling. Hold for 3-10 seconds and repeat three times. Switch leg positions, placing one down and the other up and repeat.
Then, as a person gets a better feel for the technique an instructor can teach the participant to maintain the abdominal brace during functional movement situations (such as we do every day in real life). (Picture)
[Pictures are forthcoming]
Reader Comments (1)
What are the exercises best for it? And well, probably can cost you less and easy to do.