Much has been made of the Transverse abdominis (TrA) muscle since valuable research from Queensland University* demonstrated its weakness and delayed action in people with lower back pain. This research has led to confusion in its application in the therapeutic world.
Despite having no symptoms of ‘true instability’ it was assumed that weakness of the core muscles somehow made a spine 'unstable' and this was the cause of much back pain. By contrast, it was believed a good core stability exercise program of lower abs strengthening would both relieve back pain and prevent injury.
The idea that strengthening exercises for core stability could overcome TrA weakness and delay led to the flourishing industry of Pilates and core stability training programmes. They tried to devise exercise regimes designed to specifically isolate and strengthen transversus. This was always a strange and somewhat naïve mission, since it is simply not possible to work a single muscle in isolation. It is cloud-cuckoo land to think you can specifically ‘switch on’ TrA in advance and hope to integrate this unique action into highly complex and co-ordinated activity.
When patients ask me should they switch on TrA before doing any kind of abdominal workout, my standard reply is: “This is like asking me shall I switch on the diaphragm before I take a breath!”.
Transversus fibres wrap around the belly horizontally and are most effective at holding the lower belly in
Professor Eyal Lederman in his paper ‘The Myth of Core Stability’ tells us: ‘The division of the trunk into core and global muscle system is a reductionist fantasy, which serves only to promote the core stability (industry)’.
I believe that too much in the way of TrA strengthening for core stability involves excessive stiffening of the abdominal area. Subjects rigorously cinch in their belly to brace their spine, just as much for low load activities, such as picking up a sock, as for high load such as picking up a heavy pail of water. This excessive bracing over-compresses the lumbar spinal segments, as per its job description.
I believe the premeditation also engenders a lack of fluency and too much thinking about the back before moving that makes the back less free - and more painfully rigid - as time goes by.
Too much thinking about what should or shouldn't be switched on disconbobulates patients and makes them too wary of automatic movement
transversus abdominis fibres insert into a diagonal lattice
either side of the spine
Any lower abs exercises should incorporate all three layers of abdominal musculature at the one time, without trying to single any one out. In my experience, forced transverse abdominis strengthening can cause increased pain, in backs that are already painful.
Pretty well everyone walking around on two pins needs a stronger set of abdominal muscles. So yes, transverse abdominis certainly needs strengthening. But no more so than its just-as-important partners, the internal and external oblique muscles and rectus abdominis.
A lot of the core stability classes involve slowly repetitive, non-functional exercises such as kneeling on all fours and lifting the arms and legs without allowing the trunk to move. This type of ‘formal’ exercising is very unnatural and bears no relation to everyday functional activity.
Lederman puts it a little more succinctly:
‘It is believed that low velocity exercise performed laying or kneeling on all fours would help normalise motor control which would include timing dysfunction (of TrA).This kind of training is unlikely to help reset timing differences. It is like aspiring to play the piano faster by exercising with finger weights, or doing slow push ups. To overcome the timing problem the proponents of core stability came up with a solution - teach everyone to continuously contract the TrA or to tense/brace the core muscle. By continuously contracting it would overcome the need to worry about onset timing.’
I propose that transversus abdominis muscle is very probably weak in the first instance because it has switched off as a pain-relieving, automatic reflex. This is not an elective, cerebrally pre-meditated action. It is to spare the lumbar segments excessive compression – and thus to reduce pain coming from one (or more) of the spinal links. I agree, it is indeed fantasy to think that vigorously exercising a muscle can over-ride its instinct to reflexively inhibit.
And furthermore, I think we totally confuse the picture by
giving patients all sorts of complicated strengthening exercises for core
stability, with different cues about when and how to recruit a
weak-and-late TrA. I believe this especially when we have it on
authority** that that the most effective transverse abdominis
strengthening exercise is simply drawing in the abdomen.
The best formal lower abs exercise in my opinion is ‘reverse curl-ups’. But in terms of recruiting TrA it functionally, all you need to do is pull in your tummy hard (‘like a greyhound’) whenever you go to bend over, be it to pick up your toothbrush or multiple bags of shopping.
Of course, it should go without saying, that this will not work either if you don’t draw up the pelvic floor at the same time. It’s no use pulling the tummy in if you leave one flank of the internal compartment of the abdominal cavity out of the equation.
For any physiotherapists reading this and interested in doing my Masterclasses (now available on webinar for the Theory component (see here) you will see that ‘The Pitfalls of Core Stability Training’ is Lecture 18 in Stage 4.
We all need to have a strongly effective abdominal wall - and pelvic floor - to support the lumbar spine and make bending safe.
Read more in-depth information about The Best Abs Exercises for lower backs, to be sure you're on the right track.
It seems a shame to be doing harm when you're exercising with the best intent. You need to know why.
Read here about The Worst Abs Exercises, and why. Too many fitness regimes include the three cardinal sins (abs exercises I mean).
When you have a bad back, it's important to get the exercises just right. Here is a detailed rundown of the three (just 3!) important and highly effective lower abs strengthening exercises.
Read more about 'The Best Exercises for the Lower Abs'
** Urquhart et al.
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