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| Abdominal muscle: anterior & lateral (Ref: https://fitnessvolt.com/) |
Low back pain rehabilitation from physiotherapists in patients with low back pain must provide efficient and safe exercises which will enhance stability of the vertebral column. Various exercises are used to restore the abdominal muscles function in the management of low back pain including other musculoskeletal disorders.
The key target muscles for low back pain exercise consists of the paravertebral, abdominal muscles, the pelvic musculature, and the diaphragm. All of them work together to support spine alignment and absorb load to spine structures. Individuals with low back pain undergo dysfunction in co - activation between the group of paravertebral muscles and the group of abdominal muscles which focus on the lateral abdominal muscles.
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| Major core stabilizer muscle group (Ref: https://ssphysio.com.au/) |
The lateral abdominal muscles including transversus abdominis (TrA), internal oblique (IO), and external oblique (EO) provide stability to the trunk in different functional activities. They were classified into the lateral or outward abdominal muscles because of their locality. The muscle fibers are outward of the torso that connect to fascia on abdominal and back regions.
The efficacy of lateral abdominal exercises have been established in acute and chronic LBP patients. The Appropriate rehabilitation program seems to provide recovery within 6 weeks. If not, it is possible to recur within 1 year. In case they cannot recover from the acute LBP, they will turn to the chronic LBP condition.
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| Lateral abdominal muscle left to right: EO - IO - TrA (Ref: https://www.sciencephoto.com/) |
The first basic 10 of 20 therapeutic strengthening exercises to activate lateral abdominal muscle for low back pain (Remark: If you feel severe pain and any numbness, I would like to recommend you to stop exercising and observe the symptoms. And consult your physiotherapists or doctors.)
Each exercise needs 10 - 15 reps with 3 sets for 3 - 5 days a week. (Remark: Keep breathing during exercise for more efficiency because the diaphragm is a member of core stabilizer muscle).
Exercise #1: Abdominal brace: Flatten the abdominal belly by squeezing the muscle slightly that is not by force inhale. Anyhow, you have to keep breathing normal during exercise. This exercise can apply in walking, standing, sitting, etc.
Exercise #2: Stand trunk rotation with band: rotate upper body only, not include leg, knee, and ankle.
Exercise #3: Dynamic side plank with knee bending: Lying down on the exercise side with set the torso and thighs on the straight line. Bending both knees to increase base of support and decrease the lever. Lift torso - pelvic - thigh up and down slowly with maintain the straight line by lateral torso and hip muscles.
Exercise #4: Static side plank with knee bending: Lying down on the exercise side with set the torso and thighs on the straight line. Bending both knees to increase base of support and decrease the lever. Lift torso - pelvic - thigh up and hold 10 - 60 seconds following physiotherapist recommendation with maintain the straight line by lateral torso and hip muscles.
Exercise #5: Dynamic side plank: Lying down on the exercise side with set the torso and thighs on the straight line. Lift torso - pelvic - knee joint up and down slowly with maintain the straight line by lateral torso and hip muscles.
Exercise #6: Static side plank: Lying down on the exercise side with set the torso and thighs on the straight line. Lift torso - pelvic - knee joint up and hold for 10 - 60 seconds following physiotherapist recommendation with maintain the straight line by lateral torso and hip muscles.
Exercise #7: Prone plank with knee support: This plank is supported by both elbows and knees to decrease load and lever. Keep flatten abdominal belly and spine that look like you make triangle space under the body. Do not arch back or drop pelvic or lift pelvic high. Hold for 10 - 60 seconds following physiotherapist recommendation.
Exercise #8: Basic prone plank: This plank is supported by both elbows and toes. Keep flatten abdominal belly and spine that look like you make triangle space under the body. Do not arch back or drop pelvic or lift pelvic high. Hold for 10 - 60 seconds following physiotherapist recommendation.
Exercise #9: High hip abduction: Lying on the side which the target side is up. Set torso and thighs in straight line and do not let pelvic rotate, especially rotate backward. Lift target leg up & down slowly with maintain straight line and pelvic is neutral.
Exercise #10: Lateral leg swing: Swing both legs side way slowly by torso muscles. The range of swing is shoulder wide or further slightly.
Strengthening exercises are often prescribed to promote stability. Many of the exercises designed with strengthening in mind require the torso musculature to produce specific movements against gravity or other externally applied resistance. However, the lumbar stabilizers need to have a very low level of contraction about 2 - 3 % of their maximum voluntary contraction capacity.
They are mainly composed of type I fiber compared to rectus abdominis which mainly consists of type II fiber. It is shown that the type II fibers will show greater shrink in size compared to type I fiber when they are opposed to atrophic situations although the loss of actual fibers themselves is similar for type I and type II.
It is my reason to design an easy exercise for my patients. I have planned more repetitions in some exercises for some cases 10 - 20 reps a hour during the day that total 100 - 200 reps a day.
The factor of lateral abdominal muscles size is not only muscle fibers type but also age and gender. The mass of transverse abdominis muscle may be maintained by this small amount of contraction regardless of the age. Age was significantly correlated with IO, EO, and RA muscle thickness. Males seemed to have significantly thicker abdominal muscles than females and also BMI was positively associated with muscle thickness in RA and EO.
My low back pain exercises program was designed by the muscle function. The EO consists of anterior fibers and lateral fibers. The anterior fibers flex the vertebral column when acting bilaterally. Acting unilaterally with the anterior fibers of the opposite IO can rotate the vertebral column, bring the thorax forward, or the pelvic backward (when the pelvic is flexed). For example, with the pelvis fixed, the right EO rotates the thorax counterclockwise, and the left EO rotates clockwise. That can say, the vertebral column will rotate to the opposite side of EO. Whereas, lateral fibers of EO result the same movement but add on tilting the pelvis posteriorly.
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| Heel tap workout (Ref: https://www.hevyapp.com/) |
The IO is the intermediate layer between EO and TrA. Their function flexes the vertebral column when acting bilaterally that same the EO. They work unilaterally with opposite EO anterior fibers to rotate the vertebral column that will rotate to the same side of IO. Moreover, they can bring the thorax backward or the pelvis forward (when the thorax is fixed). The lateral fibers of IO act to bend the torso laterally.
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| Layer of lateral abdominal group: EO (outer), IO (middle), and TrA (Inner) (Ref: https://human-movement.com/) |
The TrA is the deepest layer of the lateral abdominal group. It has been of particular interest to many physiotherapists as a core stability muscle due to its anatomy. It acts like a girdle to flatten 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 torso bending that it acts to bend the torso forward for compressing the viscera and stabilizing the linea alba. If it gets weak, the posture will permit a bulging of the anterior abdominal wall that may induce increased lordosis. And it has the potential to be bulging laterally as well.
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| Lateral abdominal weakness and fat (Ref: https://www.pooyingnaka.com/) |
The EO and IO contribute torso forward bending and rotation but lateral bending is moved by IO only. TrA makes the belly flatten and bend forward. Therefore, the exercise poses were designed in forward flexion, lateral flexion, and rotation that except extension.
Reference:
https://core.ac.uk/download/pdf/227985494.pdf
https://www.sciencedirect.com/science/article/pii/S0004951414605146
http://www.pnfchi.com/fotos/literatura/1233770497.pdf
https://d-nb.info/1114223050/34
Kendall FP., et al. Muscles testing and function. Fourth edition. Williams & Wiikins. USA.
1993.
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