Abdominal Bracing – A Modern Approach to Abdominal Training Part 2

image A few weeks back I posted a great article by Craig Liebenson on a Modern Approach to Abdominal Training.  The post received some interesting questions and Craig was kind enough to answer them well.  I always love the dialogue that occurs after these types of posts.

In part I, Craig laid the groundwork for many important topics in this series including the abdominal brace, neutral spine posture, normal respiration, and the sternal crunch.  Part II discussed facilitating the abdominal brace.  This in itself is a very important fundamental concept.  if you are familiar with Dr. McGill’s work, this is a key component to low back rehabilitation and injury prevention.  Think of the abdominal brace as the beginning, the one component of abdominal training the your patients and clients need to master before getting fancy with more aggressive core work.

Let me know what you think of the article and if you have any questions for Craig feel free to post a comment.

8 replies
  1. Paul Weiss
    Paul Weiss says:

    Walt,

    In the article, it states that the indication for these exercises are "low back pain". It does not give any suggestion as to a subgroup of patients who would respond to the recommended treatment. I find that as a shortcoming.

    The exercises described are not of the TrA/multifidus/motor control training paradigm, and the author clearly differentiates between the abdominal brace and abdominal drawing in.

  2. Walt Lingerfelt, DPT
    Walt Lingerfelt, DPT says:

    Obviously the progression would be different based upon what other impairments the individual may be experiencing; however, usually once the pt. can successfully demonstrate they are able to perform the "brace" or "hollowing" manuevers correctly, I'll incorporate arm movements while the brace (or hollow is held, then maybe leg movements, then maybe both. I try to move outside the saggital plane the better the pt. can perform the above. More advanced exercises might include standing downward trunk rotations w/ a theraband or have the pt. kneeling performing a similar rotational pattern. I'm keeping this a little short, but the basic concepts are pretty simplistic- "stiffen" the spine w/ contraction of the deep stabilizers then challenge w/ multidirectional arm and trunk movement. And to Paul…certainly not advocating a one- dimensional approach to LBP. I'm just discussing a progression for the subgroup of patients who would respond to faster TrA, multifidus, etc. firing, which in the literature seems to be many LBP patients, but certainly not everyone.

  3. Walt Lingerfelt, DPT
    Walt Lingerfelt, DPT says:

    Obviously the progression would be different based upon what other impairments the individual may be experiencing; however, usually once the pt. can successfully demonstrate they are able to perform the "brace" or "hollowing" manuevers correctly, I'll incorporate arm movements while the brace (or hollow is held, then maybe leg movements, then maybe both. I try to move outside the saggital plane the better the pt. can perform the above. More advanced exercises might include standing downward trunk rotations w/ a theraband or have the pt. kneeling performing a similar rotational pattern. I'm keeping this a little short, but the basic concepts are pretty simplistic- "stiffen" the spine w/ contraction of the deep stabilizers then challange w/ multidirectional arm and trunk movement. And to Paul…certainly not advocating a one- dimensional approach to LBP. I'm just discussing a progression for the subgroup of patients who would respond to faster TrA, multifidus, etc. firing, which in the literature seems to be many LBP patients, but certaintly not everyone.

  4. Paul Weiss
    Paul Weiss says:

    The abdominal bracing method described seems to reinforce abnormal motor control. In people with low back pain, transversus abdominis loses its independent motor program and the external obliques become overactive. "Pushing the muscles out" would seem to reinforce that abnormal pattern.

    Also, I don't think that any one exercise method can be recommended for all with low back pain. Clinical prediction rules and subgroups of low back pain patients are being identified to determine who is most suitable for a given treatment. Clearer indications for a given program should be identified rather than simply "low back pain".

  5. Carson Boddicker
    Carson Boddicker says:

    Walt,

    I had similar qualms with the deadbug exercises in the past, but recently I've had good success by shortening the lever arm significantly and progressing it from 1 limb short lever to two limb short lever and back to 1 limb regular lever. That said, I'm not working with athletes in pain.

    I'd be interested to see your progression as well.

    Best regards,
    Carson Boddicker

  6. Walt Lingerfelt, DPT
    Walt Lingerfelt, DPT says:

    Definitely not new material, but does hit on a few good points Stuart McGill reiterates in his Low Back Disorders text. I'm not really a fan of the dead bug exercises as pointed above. Easy to lose a neutral spine position (for most w/ LBP) and most likely are loading the erector spinae on both sides at the same time, which to me, may contribute to more shear forces at the lower segments if not throughout the thx regions. I usually progress the abd. brace making sure that functional, diagonal, and rotational movements occur simultaneously.

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