Muscle group(s):Entire abdominal wall
Phase/modality:Static stabilisation, strength, endurance
Equipment:None
Purpose
❑ To increase awareness, strength and endurance of the entire abdominal wall. ❑ To provide a primary stabilisation
mechanism for the lumbar spine.
Starting position
Client is lying supine, in neutral spine alignment, with knees bent and feet flat on floor.
Correct performance
❑ Client braces or ‘stiffens’ the muscles of the trunk and holds for a few seconds, before releasing.
❑ The therapist should be aware of the use of mental imagery to aid the patient. This may include instructions about tightening other muscles in the body and applying the same technique to the torso; asking the client to imagine they are about to be hit in the torso; asking the client to cough and notice the stiffness that it produces in the torso.
❑ Careful observation should be made to ensure the client is maintaining neutral spine alignment throughout the exercise.
Progressions
Progression can occur in a number of stages: ❑ GRADING THE CONTRACTION – the
client is taught to brace the abdominal muscles to different intensities of contraction (100 per cent, 90 per cent, down to 10 per cent). This teaches the client to use the correct intensity of brace when required.
❑ INCREASING CONTRACTION TIME – once ability to contract is achieved, the client can then increase holding times up to 8 seconds maximum. Endurance can be further enhanced by increasing the
number of repetitions. It is important that the client is instructed in the proper breathing technique while holding contractions.
❑ POSITIONAL CONTRACTIONS – the client is instructed to maintain
contractions in a number of body positions, including prone lying, side- lying, four-point kneeling, two-point kneeling, sitting (stability ball) and standing.
138 Corrective Exercise: A Practical Approach
(a)
(b)
❑ EXTREMITY MOVEMENT – the final stage of progression is to maintain the abdominal brace while performing upper and lower extremity movement. These movements are usually performed in a number of positions (as above) and involve moving arms and legs in controlled and precise movement patterns. The aims at this stage are significantly to challenge lumbar stability and spine position using body weight. This provides a useful foundation for further functional and load-bearing movements.
Oblique sling
Muscle group(s):Obliques
Phase/modality:Static stabilisation, strength
Equipment:None
Purpose
❑ To enhance awareness of the internal and external oblique force couple, as used in trunk rotation.
❑ To improve the functioning of the obliques, particularly in patients with unilateral rotational dysfunction.
❑ To increase the strength of the obliques.
Starting position
Client is lying supine, in neutral spine alignment, with knees bent and feet flat on floor. One hand should be placed over the right external oblique and the other hand over the left internal oblique.
Correct performance
❑ Client begins to draw the hands closer to one another by focusing on co-contracting the opposite internal and external
oblique. To aid this process initially, a small compensatory movement of the shoulder and the opposite hip is allowed.
139 Corrective exercise for the trunk
Clinical perspective
There is an important difference between abdominal hollowing and abdominal bracing and their contribution to spinal stability. While abdominal hollowing is an important exercise for motor re-education in low back pain patients, the act of
hollowing does not ensure optimal stability for the spine.
Abdominal bracing is more effective at enhancing spine stability as it activates all three layers of the abdominal wall. This is achieved through two mechanisms. First, during bracing, the criss-cross structure of the obliques is fully utilised to provide stiffness for the trunk; second, the abdominal muscles are more effective stabilisers of the trunk when they have a wider base, that is, when the abdomen is not hollowed. In this way, an abdominal brace provides maximal lumbar stability through co-contraction of all the
abdominal muscles. This can prove to be more energy-efficient, as high levels of co- contraction in bracing are rarely required during daily functional activities.
In practice, individuals rarely have complete inactivity of the deep abdominal, except in some cases of abdominal
surgery, chronic sedentary lifestyles and pathological muscle weakness/wasting. Many low back pain patients exhibit some ability to contract the deep abdominals, and, with this in mind, corrective exercise should be progressive. Once deep
abdominal contraction has been restored, the bracing mechanism should be taught as the primary means of spinal stabilisation and implemented further in all functional activities.
❑ The position is held for a few seconds before releasing. It is then repeated several times before changing sides.
Progressions
OBLIQUE CURL – Once the client has gained awareness of the obliques, they can then proceed to adding rotational spine movements. In this exercise the fingertips are placed by the sides of the head and the client curls the trunk diagonally towards the
opposite hip, before returning and repeating to the other side. To facilitate integrated use of the internal and external oblique, the client should be instructed to lift the shoulder rather than the elbow, with a simultaneous lift from the opposite hip.
Note:If the client has rotational dysfunction, such as that present in scoliosis, it may be necessary to perform the oblique sling or curl unilaterally, as part of an overall corrective exercise programme. In this instance, muscle strength testing is a prerequisite.