Core Control & Lumbar stabilization
The Core & The Abdominals
There are global and local core muscles. The global muscles include the rectus abdominis (our “six pack”), the external and internal abdominal obliques. These muscles help control external loads and spinal orientation. The local muscles include the transverse abdominis, multifidus, diaphragm, and the pelvic floor muscles. These muscles are deeper and smaller than the global ones and they contract in anticipation of movement, contributing to spine and pelvic stability. Our focus will be on the deep core muscles.
The transverse abdominis (TsA) is the deepest layer of our core muscles, extending from the transverse process of the lumbar vertebrae to the pelvis and all the way around. Its job is to com-press abdominal contents, in doing so it gene-rates pressure in the abdominal cavity and stabilizes the pelvis and spine. Studies have found that weakness or lack of control of this muscle leads to back pain.
oThe multifidi span the entire length of the spine and are particularly developed in the lumbar region, hence their importance in managing back pain. These muscles travel from the trans-verse process of a spinal segment to the spinous process of a segment above.
Their most important role is to maintain good segmental spine stability. The pelvic floor muscles (inferiorly), and the diaphragm (superiorly), provide the additional spinal stability needed to maintain our spine in a neutral zone and reduce our chances of developing back pain.
Spinal stabilization therapy programs, such as the one outlined in this brochure, have been observed to be effective in reducing back pain, disability, medication intake, and recurrence rates. The local core muscles, due to their location, help protect our spine in a three-dimensional and cylindrical fashion when they work together. The following exercises help you begin building a strong and stable foundation, and start to alleviate your pain.
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Unlocking the Inner Core
The transverse abdominis (TsA) is the deepest layer of our core muscles, extending from the ribs to the pelvis and all the way around to the thoracolumbar fascia. Any anatomy book will tell you that its job is to compress abdominal contents. In doing so, it generates pressure in the abdominal cavity and stabilizes the pelvis and spine. Studies indicate that injury or weakness in this muscle and the multifidus causes back pain.
If the TsA is thin or weak, strengthening it will improve its thickness and contractility, which has been shown to decrease low back pain. To really work the TsA, you must understand how to recruit the muscle. First, lay on a flat, firm surface and find your ASIS (pictured above). Next, slide your fingers in, just off the bone. Gently use your abdominals to pull your belly button back towards your spine. You may feel your muscles tightening under your fingers. If you do, Congrats!
That is your TsA. If you don't, try pulling your belly button in more and either cough, laugh, or make a buzzing or humming sound and you should feel the muscle engage. If you are still having difficulty doing all of the above, then try slowly flattening your lower back against the surface you are lying on.
Once you have engaged the TsA, work on your endurance by taking deep breaths without losing the tone you've created. Although challenging, this exercise provides a solid foundation to any core strengthening program.
For more information see: M.Y. Eom: "Effects of Bridging Exercise on Different Support Surfaces on the Transverse Abdominis"
For more information see: T. Flynn: "Appropriate use of Diagnostic Imaging in Low Back Pain- A Reminder that Unnecessary Imaging may do as Much Harm as Good".