A Modern Approach to Abdominal Training

This week, I wanted to share an interesting article from my friend Craig Liebenson.  he was gracious enough to share this series of articles with me from the Journal of Bodywork and Movement Therapies.  I share these types of articles because I always enjoy them.  Dr. Liebenson tends to produce articles that serve as quick little clinical pearls, like the past article I posted on the missing link in protecting against back pain.

This is the first of a three part series on Dr. Liebenson’s Modern Approach to Abdominal Training.  In this first article, Dr. Liebenson discusses a few fundamental concepts necessary to optimize motor control during abdominal stabilization training.  Specifically, the abdominal brace, neutral spine posture, normal respiration, and the sternal crunch.

A Modern Approach to Abdominal Training

 

Read the entire series on A Modern Approach to Abdominal Training:

10 replies
  1. Anonymous
    Anonymous says:

    I was wondering if you know if the Janda AB test is performed with a que to initiate an AB before the sacral push or if the push is in a relaxed state to test initiation/reaction time? Also do you have a better explanation of the sternal crunch?

    Thanks
    Scott

  2. Anonymous
    Anonymous says:

    Craig,

    I like your article overall, but dislike the way you summarized one study. According to Stuge et al. (2004), "One group received physical therapy with a focus on specific stabilizing exercises. The other group received individualized physical therapy without specific stabilizing exercises." As a 2nd year DPT student, I am somewhat offended that on page 2 you describe the findings as "…stabilizing exercises were superior to traditional physical therapy for pelvic girdle pain after pregnancy." The study was conducted by physical therapists, using solely physical therapy interventions with/without stabilization and I think the way you portray it is the authors are comparing physical therapy to non-physical therapy. Stabilization has been used by PTs for some time now. No where in the article does Stuge et al label anything as "traditional physical therapy" so I am not sure who coined that term and how it was defined. As we all know, some think physical therapy equates to modalities which is completely false. I just think it is important to make that point. Otherwise, I enjoyed reading.
    John

  3. Craig Liebenson, D.C.
    Craig Liebenson, D.C. says:

    Julie,
    You stated an astute question, "I was a little confused that the source of pain ie spinal compressive loads due to co-contractions also provide the spinal stability we are generaly seeking in an exercise program.". This is from Granata & Marras (2000) who found that co-contractions increase spine compression load (by 440N), but increase spine stability even more (2925N).

    At 1st blush it is confusing. But, the the spine requires muscle co-activity in order to be stabilized. Of course, there is always a price to pay so there is some compression from the co-activation. However, there is a net gain in stability.

    In the 1st of a different 3 part series on Spinal Stabilization also published in Journal of Bodywork and Movement Therapies(2004)8,80–84 I mention Crisco & Panjabi's ('92) work on this subject – "The spinal column devoid of its musculature has been found to buckle at a load of only 90N (about 20lb) at L5. However, during routine activities, loads 20 times this are encountered on a routine basis."

    I hope this helps.
    Craig
    If you think about the spinal column without muscles it is unstable

  4. Craig Liebenson, D.C.
    Craig Liebenson, D.C. says:

    Jodi,
    Thanks for your comments. You mentioned you did not follow the – soft tissue antagonistic/agonistic explanantion of "low back pain" –
    If you were referring to this "Researchers at YaleUniversity haveshown
    that a specific motor control signature of delayed agonist-antagonistic muscle activation predicts which asymptomatic people will later develop low back pain (LBP) (Cholewicki et al., 2005). What was reported was that it was not so much individual muscles being slow to engage but 3 specific things of the entire 360 degree ring of muscles –
    1. delayed firing
    2. overactivation
    3. delayed relaxation

    Your other thought that the paper did not adequately addressing the underlying anatomical structures. I agree. The paper was really focused on the muscle as a source of functional instability. If you are referring to joint dysfunction that is vital I agree. Loss of lumbar lordosis is one such joint dysfunction. Segmental issues as tested by Delitto, Fritz, et al. SI dysfunction. And, perhaps the biggest one of all – loss of hip hyperextension mobility.

    Thanks,
    Craig

  5. Craig Liebenson, D.C.
    Craig Liebenson, D.C. says:

    Mike,
    I will respond shortly. I was due to teaching in Denmark this weekend. Needless to say many hours at the airport & Copenhagen closed til at least Sat for air traffic.
    Craig

  6. Paul Weiss
    Paul Weiss says:

    Thank you for posting this article and giving us a forum to discuss it.

    I think we have to be careful with interpreting the results of the study by Koumantakis, et al. as referenced in this paper. In this study, patients were excluded if they had "signs and symptoms of instability (radiological diagnosis of spondylolysis or spondylolisthesis corresponding to a symptomatic spinal level; "catching," "locking," "giving way," or "a feeling of instability" in one direction or multiple directions of spinal movements)"

    These are the types of patients one may expect to respond to "specific spinal stabilization exercises", as shown in O'Sullivan's paper and in a paper describing a clinical prediction rule for which patients would respond to this training. I think that study would have been more interesting if it focused on those who were exlcuded as above.

  7. Julie, MPT
    Julie, MPT says:

    I agree with Jodie in that I was a little confused that the source of pain ie spinal compressive loads due to co-contractions also provide the spinal stability we are generaly seeking in an exercise program.

    I also hesitate to state that you are not engaging the transverse abdominus as you are not actually flexing the trunk (rectus abdominus' chief action). Since I stopped having patients perform true posterior pelvic tilts approximately 3 years ago and focused more on TA, I have achieved faster results with my patients.

  8. jb
    jb says:

    Interesting commentary and nice review of relevant literature. I like the less is more philosophy with this exercise protocol. He lost me a bit with the soft tissue antagonistic/agonistic explanantion of "low back pain", and poorly discusses the integrity of the underlying anatomical structures as a cause of instability causing the altered muscular kinematic recruitment.

    Since you brought it up, could they look at the SLR for hip patients to try to get that exercise off the standard therex list next?

    Mike, always good stuff to review. Thanks for your work.

    Best,
    Jodie

  9. Steve Pittari
    Steve Pittari says:

    Mike great article we look forward to the next two. We are working with the Bioengineering department at Binghamton University accessing muscle balance. Most of the work has been focused on the antagonistic muscle surrounding the knee. We are looking to indentify the key stabilizers or antagonists of the lower back so that we could eventually do the same there as well.

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