physiotherapy with 14 abdominal muscles stretching for back pain

 

(Ref: https://thefitnessmaverick.com/ab-crunches/)

            The abdominal muscles include the rectus abdominis, external oblique abdominis, internal oblique abdominis, and transversus abdominis. These muscles play a role in trunk motion, posture, labor, vomiting, dejection, and respiration. Activity of the abdominal muscles is not generally observed during respiration at rest; however, these are activated during exercise and expiratory effort.

Abdominal muscles family anatomy
(Ref: https://basicmedicalkey.com/)

            Abdominal muscle shortness can deviate body posture. The deviated body posture

of the torso is able to be mixed between forward bending and side bending and rotation. I

will demonstrate the basic torso posture deviation in each direction.

(1) Bilateral shortness of anterior fibers of external and internal oblique muscles

causes the thorax to be depressed anteriorly contributing to flexion of the vertebral column.

In standing, this will be seen as a tendency toward kyphosis and depressed chest that is

increased forward flexion of thoracic spine. So, we can see the  increased forward flexion of

thoracic spine or kyphosis in a kyphosis - lordosis posture that due to the lateral portions of

the internal oblique are shortened, and the lateral portions of the external oblique are

elongated. These same findings occur in a sway - back posture with anterior deviation of

the pelvis and posterior deviation of the thorax.

Kyphosis - lordosis posture
(Ref: https://www.pinterest.com/)

Sway back posture
(Ref: http://www.oregonexercisetherapy.com/)

(2) Cross - sectional shortness of external oblique on one side and internal oblique

on the other causes rotation and lateral deviation of the vertebral column. Shortness

of left external oblique and right internal oblique, as seen in advanced cases of right

thoracic, left lumbar scoliosis, causes rotation of the thorax forward on the left.

Torsion scoliosis
(Ref: https://www.physio-pedia.com/Scoliosis)

(3) Unilateral shortness of lateral fibers of external oblique and internal oblique on

the same side causes approximating of the iliac crest and thorax laterally resulting

in C - curve convex toward the opposite side. Shortness of the lateral fibers of the

right internal and external obliques may be seen in a left C - curve.

C - curve scoliosis
(Ref: https://www.mitchmedical.us/muscles/info-wcb.html)

            (4) Rectus abdominis muscle which connects between chest and pelvis has been

mentioned about elongated and weakness of anterior abdominal muscles on pelvic anterior

tilt and normal thoracic spine curve in military - type posture. On the other hand, there is

potential to be shortness or strength of anterior abdominal muscles that happen in

flat - back posture, does pelvis posterior tilt and no significant thoracic spine curve changes.

I cannot conclude that anterior abdominal muscles affect thoracic and pelvis posture.

 

Flat back posture including pelvis posterior tilt
(Ref: http://www.oregonexercisetherapy.com/)

Military - type posture
(Ref: https://quizlet.com/) 

            In my physiotherapy experience in patients with low back pain, I have seen abnormal

spinal curves e.g. hyperlordosis, hypolordosis, and scoliosis. I have given massage and

stretching as a part of all treatment in postural changes. 

For example, some patients with low back pain and posterior pelvic tile demonstrated hypolordotic lumbar curve. I found a spasm of QL muscle that cannot be improved by
massage and stretching. Additionally, I found weakness in the lower back and groin
muscles. So, I gave massages and stretches anterolateral abdominal wall muscle,
and strengthening for the lower back and hip flexor muscles group.  

        14 stretche poses to improve flexibility of abdominal wall muscles. The principle

to stretch this muscle is the same as the others: stretch to the point where “tightness with

pain” or “noticeable tension without pain” will hold at the point for 30 seconds of 3 - 5

reputations following demonstrated VIDEO. 

Exercise #1: Basic Cobra stretch: During stretching needs to keep pelvic on the floor.

Exercise #2: Modified Cobra stretch: During stretching needs to keep pelvic on the floor.

Exercise #3: Basic Cobra with lateral bending stretch: During stretching needs to keep

pelvic on the floor.

Exercise #4: Modified Cobra with lateral bending stretch: During stretching needs to keep

pelvic on the floor.

Exercise #5: Basic cat stretch: Do pelvic anterior tilt and drop spine toward floor.

Exercise #6: Modified Camel stretch: Keep torso backward bending that not mean lean backward. You can apply pillow or yoga block or foam roller if you are not flexible enough.

Exercise #7: Modified Gate - Latch stretch: Do anterior pelvic tilt and torso backward bending before bend to side way and maintain all motion until finish.

Exercise #8: Seat anterior pelvic tilt stretch: Do anterior pelvic tilt and torso backward bending for stretching.

Exercise #9: Seat lateral bending stretch: Do anterior pelvic tilt and torso backward bending before bend to side way and maintain all motion until finish.

Exercise #10: Seat torso rotation stretch.

Exercise #11: Stand torso backward bending stretch: Do anterior pelvic tilt and torso backward bending for stretching.

Exercise #12: Stand torso backward bending with lateral bending stretch: Do anterior pelvic tilt and torso backward bending before bend to side way and maintain all motion until finish.

Exercise #13: Stand torso backward bending with rotate stretch: Do anterior pelvic tilt and torso backward bending before rotate torso and maintain all motion until finish.

Exercise #14: Stand hip circle.

Each abdominal muscle member is separated into layers. Rectus abdominis muscles
which we know as six pack and external oblique muscles which are outward to eleven
line, are the outermost layer that we can see by visual. If the external oblique muscles
and its aponeurosis were removed by dissections, we would see the internal oblique
muscles that we cannot see by visual because the external obliques muscles cover it
fully. The transversus abdominis muscles are the innermost of the anterolateral
abdominal wall. We cannot see muscle shape by visual but we can see its function
by abdominal draw - in maneuver. 

Layer of anterolateral abdominal muscles
(Ref: https://musculoskeletalkey.com/)

(1) Rectus abdominis

Origin: pubic crest and symphysis.

Insertion: costal cartilages of 5th, 6th, and 7th ribs, and xiphoid process of sternum.

Direction of fibers: vertical

Action:flexes the vertebral column by approximating the thorax and pelvis anteriorly. With

the pelvis flexed, the thorax will move toward the pelvis; with the thorax fixed, the pelvis

will move toward the thorax.

Weakness: a weakness of this muscle results in a decrease in the ability to flex the

vertebral column. In the supine position, the ability to tilt the pelvis posteriorly or to

approximate the thorax toward the pelvis is decreased, making it difficult to raise the head

and upper trunk. In order for anterior neck flexors to raise the head from a supine position,

it is essential that anterior abdominal muscles, particularly the rectus abdominis, fix the

thorax. With marked weakness of abdominal muscles an individual may not be able to

raise the head even though neck flexors are strong. In the erect position, weakness of this

muscle permits an anterior pelvic tilt and a lordotic posture (increase anterior convexity of

the lumbar spine).

Rectus abdominis muscle
(Ref: https://www.yoganatomy.com/)

(2) External oblique, anterior fibers

Origin: external surface of rib five through eight interdigitating with serratus anterior.

Insertion: into a board, flat aponeurosis, terminating in the lines alba, a tendinous raphe

which extends from the xiphoid.

Direction of fibers: the fibers extend obliquely downward and medialward with the

uppermost fibers more medialward.

Action: acting bilaterally, the anterior fibers flex the vertebral column approximating the

thorax and pelvis anteriorly, support and compress the abdominal viscera, depress the

thorax, and assist in respiration. Acting unilaterally with the anterior fibers of the internal

oblique on the opposite side, the anterior fibers of the external oblique rotate the vertebral

column, bringing the thorax forward (when the pelvis is fixed), or the pelvis backward

(when the pelvis is fixed). For example, with the pelvis fixed, the right external oblique

rotates the thorax counterclockwise, and the left external oblique rotates the thorax

clockwise.

External abdominal oblique
(Ref: https://learnmuscles.com/)

(3) External oblique, lateral fibers

Origin: external surface of ninth rib, interdigitating with serratus anterior; and external
surfaces of 10th, 11th and 12th ribs, interdigitating with latissimus dorsi.
Insertion: as the inguinal ligament, into anterior superior spine and pubic tubercle, and into
the external lip of anterior one half of iliac crest.
Direction of fibers: fibers extend obliquely downward and medialward, more downward than the anterior fibers.
Action: acting bilaterally, the lateral fibers of the external oblique flex the vertebral column,

with major influence on the lumbar spine, tilting the pelvis posteriorly. Acting unilaterally

with the lateral fibers of the internal oblique on the same side, these fibers of the external

oblique laterally flex the vertebral column, approximating the thorax and iliac crest. These

external oblique fibers also act with the internal oblique on the opposite side to rotate the

vertebral column. The external oblique, in its action on the thorax, is comparable to the

sternocleidomastoid in its action on the head.

Surface anatomy of external abdominal oblique
(Ref: https://biologydictionary.net/)

(4) Internal oblique, lower anterior fibers

Origin: lateral two thirds of inguinal ligament, and shirt attachment on iliac crest near anterior

superior spine.

Insertion: with transversus abdominis into crest of pubis, medial part of pectineal line, and into linea

alba by means of an aponeurosis.

Direction of fibers: fibers extend transversely across lower abdominal.

Action: the lower anterior fibers compress and support the lower abdominal viscera in conjunction

with the transversus abdominis.

(5) Internal oblique, upper anterior fibers

Origin: anterior one thirds of intermediate line of iliac crest.

Insertion: linea alba by means of aponeurosis.

Direction of fibers: fibers extend obliquely medialward and upward.

Action: acting bilaterally, the upper anterior fibers the vertebral column, approximating the

thorax and pelvis anteriorly, support and compress the abdominal viscera, depress the

thorax, and assist in respiration. Acting unilaterally, in conjunction with the anterior fibers

of the external oblique on the opposite side, the upper anterior fibers of the internal oblique

rotate the vertebral column, bringing the thorax backward (when the pelvis is fixed), or

the pelvis forward (when the thorax is fixed). For example, the right internal oblique rotates

the thorax clockwise, and the left internal oblique rotates the thorax counterclockwise on

a fixed pelvis.

Internal abdominal oblique muscle
(Ref: https://learnmuscles.com/)

(6) Internal oblique, lateral fibers

Origin: middle one thirds of intermediate line of iliac crest, and thoracolumbar fascia.

Insertion: inferior borders of 10th, 11th, and 12th ribs and linea alba by means of

aponeurosis.

Direction of fibers: fibers extend obliquely upward and medialward, more upward than the anterior fibers.

Action: acting bilaterally, the lateral fibers flex the vertebral column, approximating the

thorax and pelvis anteriorly, and depress the thorax. Acting unilaterally with the lateral

fibers of the external oblique on the same side, these fibers of the internal oblique laterally

flex the vertebral column, approximating the thorax and pelvis. These fibers also act with

the external oblique on the opposite side to rotate the vertebral column. 

(7) Transversus abdominis (TrA)

Origin: inner surfaces of cartilages of lower six ribs, interdigitating with the diaphragm;

thoracolumbar fascia; anterior three fourths of internal lip of iliac crest; and lateral one third

of inguinal ligament.

Insertion: linea alba by means of a board aponeurosis, pubic crest and pecten pubis.

Direction of fibers: transverse 

Action: acts like a girdle to flatten the abdominal wall and compress the abdominal viscera;

the upper portion helps to decrease the infrasternal angle of the ribs as in expiration. This

muscle has no action in lateral trunk flexion except that it acts to compress the viscera and

stabilize the linea alba, thereby permitting better action by anterior trunk muscles.

Weakness: permits a bulging of the anterior abdominal wall, thereby indirectly tending to

affect an increase in lordosis. During flexion in the supine position, and hyperextension of

the trunk in the prone position, there tends to be a bulging laterally if the transversus

abdominis is weak.

Transversus abdominis muscle
(Ref: https://learnmuscles.com/)

        Transversus abdominis has been of particular interest to many physiotherapists as

a core stability muscle due to its anatomy. The influence of lumbar stability on poor posture

versus upright posture has also been studied. It has been reported that there is a significant

decrease in activity of the internal oblique and multifidus muscles in poor sitting and

standing postures. 

The present study was an investigation into the changes in TrA thickness in commonly

adopted poor postures (sway-back standing and slouched sitting) compared to equivalent

neutral spine postures. The results show a significant thickening of TrA in both lumbo-pelvic

neutral erect standing and sitting postures compared to sway-back standing and slouched

sitting. TrA thickness has been shown to be correlated with muscular activity. Therefore,

the observed increase in thickness of TrA in erect standing compared to the sway-backed

position suggests that there is more TrA activity in erect standing. This increase in activity

may help to stabilize the spine. 

For healthy abdominal muscles, we need to maintain good standing and sitting

posture, stretching, and strengthening. 

Reference: 

https://www.researchgate.net/publication/24428336_Effects_of_posture_on_the_thickness_

of_transversus_abdominis_in_pain-free_subjects 

Kendall FP., et al. Muscles testing and function. Fourth edition. Williams & Wiikins. USA.

1993.