Physiotherapy with (second) 10 of 20 lateral abdominal basic exercises for low back pain (ep.2)

Side abdominal exercise
(Ref: https://excelfitindia.com/)

    The lateral abdominal muscles including transversus abdominis (TrA), internal oblique (IO), and external oblique (EO). All of the trunk muscles are considered to be important for the restoration of normal function and progression involves strategies for re-education of the whole muscle system.

Refer to the recent topic which talks about lateral abdominal and spine movement that indicated multi - muscle in one movement. Torso rotation is associated between the same IO side and opposite EO side. Torso side bending acts by the same side of IO and EO and TrA. Torso forward bending such as sit up is moved by EO anterior fibers, TrA, and rectus abdominis. Abdominal flattening is developed by TrA and EO. 

Side bending exercise
(Ref: http://www.jasestuart.com/)

The second 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 or significant weakness, I would like to recommend you to stop exercising and observe the symptoms. And consult your physiotherapist 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 muscles.)

Exercise #11: Heel tap

Exercise #12: Quadrup spider

Exercise #13: Spider

Exercise #14: Lower torso rotate

Exercise #15: Upper torso rotate (Russian twist)

Exercise #16: Basic crunch

Exercise #17: Lateral crunch

Exercise #18: Rotation crunch

Exercise #19: Cross crunch

Exercise #20: Easy starfish crunch

 

A contemporary approach for LBP involves recruitment of TrA which contributes to lumbo-sacral stability by its role in intra-abdominal pressure, creating tension of thoraco-lumbar fascia, and compression of sacroiliac joints. It produces little force for trunk flexion, extension and lateral flexion. Despite its involvement in rotation of the trunk, it has only a small lever arm to produce rotational movement. 

These exercise approaches need minimal activity about 2% - 3% of maximum voluntary contraction of the superficial abdominal muscles in the early stages of rehabilitation. To stimulate TrA activity based on evidence based practice  contributes to spinal control and dysfunction of this muscle occurs in people with LBP.

Intra - abdominal pressure support low back spine
(Ref: https://www.performancehealthcarepdx.com/)

The recruitment of TrA is emphasized initially as abdominal hollowing (AH) maneuver or abdominal bracing has been presented as an activity which exercises the TrA muscle in an isolated fashion. It recruits OE with less activity of upper TrA, lower OI and RA. The technique involves inward movement of the lower abdominal wall without movement of the spine or pelvis.

  In order to control the contraction of TrA during this maneuver, palpation of its tendon medial to anterior superior iliac spine, and also Pressure Biofeedback (PBF) have been used. The efficacy of this method has been established in randomized control trials with acute and chronic LBP patients.

Surface anatomy of core stabilizer muscle palpation at
her index and middle finger where are above iliac crest.
(Ref: https://depositphotos.com/)

The 'curl-up' exercise in supine used to strengthen the abdominals, especially rectus abdominis, is a good example of this type of strengthening exercise. Producing a force or torque which can be used for specific movements is only one aspect of muscle function. It is similar to McGill that uses it to strengthen the EO majorly.   

The pelvic tilting is likely to produce greater activity of middle OI relative to upper TrA and RA.  

One musculature mechanism which involves stability is the production of tension in the lumbar dorsal fascia. Upper fascicles of TrA that attach to the rib cage are horizontal, and middle and lower fascicles that fuse with the thoracolumbar fascia and the iliac crest are inferomedial. Fibers of upper TrA are also active with the opposite direction of trunk rotation to lower and middle fibers, and activity of lower and upper fibers of OI vary during posterior pelvic tilting.

Left to right: TrA - IO - EO - Thoracolumbar fascia
(Ref: https://www.crossroadsphysiotherapy.com/)

            The lumbar dorsal fascia is a noncontractile structure which provides considerable support to the lumbar area. Its contribution to stability is increased through the influence of muscle attachments.  Tension in the fascia can be increased by contraction of the internal obliques and transverse abdominals which attach to the middle layer of the fascia. Tension is also increased between the middle and posterior layers of the fascia by the contraction of the paraspinal muscles. Although the lumbar dorsal fascia provides local protection fur the lumbar spine, it appears that increasing intra-abdominal pressure(IAP) could provide a more general mechanism for protection of the whole spine.

Ideal posture (Left) & Lower cross syndrome (Right)
(Ref: https://evergreenclinic.ca/)

Many muscles worked in synergistic groups and appeared to be specifically involved in mechanisms designed to stabilize, protect the lumbar spine and control neutral posture. For example, weakness of OE causes sway back posture which is thoracic behind the pelvic. Or Hyper lumbar lordosis posture because of TrA weakness. 

You can watch more VIDEO on https://yimphysionearme.blogspot.com/2022/09/physiotherapy-with-9-of-18-basic.html and https://yimphysionearme.blogspot.com/2022/09/the-second-physiotherapy-with-9-of-18.html 

 

 

 

Reference: 

https://core.ac.uk/download/pdf/227985494.pdf 

 

https://www.researchgate.net/publication/23480146_Altered_response_of_the_anterolateral_abdominal_muscles_to_simulated_weight-bearing_in_subjects_with_low_back_pain

 

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.  

Physiotherapy with 6 tips to stretch iliopsoas muscle

Ref: https://www.rowperfect.co.uk/

     

        Hip flexion or anterior hip bending was caused by hip flexor muscles contraction. A group of hip flexor muscles consist of iliopsoas, sartorius, tensor fascia lata, and rectus femoris which work as prime - mover, and, pectineus, adductor longus, adductor brevis, and the most anterior fibers of the adductor magnus and the gluteus (medius and minimus) which work as accessory muscle. 

My experience in the physiotherapy clinic, I have seen tightness in some or all of the hip flexor muscles in patients with IT band syndrome, groin pain, and low back pain. One muscle which differs from others is “iliopsoas” because its origins connect to the spine. 

“To stretch the tightness of iliopsoas is used in my physiotherapy session to improve the symptoms often.” 

6 options to stretch iliopsoas muscle

Exercise #1: Standard half kneeling stretch where the target muscle is on the rear leg. The pose need keep back straight with shift pelvic in front that no need to arch the back.

Exercise #2: Supine leg off the side bed

Exercise #3: Basic Thomas stretch that the target muscle is straight leg

Exercise #4: Advance Thomas stretch that the target muscle is off bed

Exercise #5: Upward - Facing dog pose. The pose need elevation of pelvic.

Exercise #6: Chair stand posterior pelvic tilt

    The iliopsoas is the most powerful of the hip flexors. The function of iliopsoas such as sit up, elevate leg, leg swing during walking, control sitting balance, and control lordotic curve of lumbar spine. 

Ref: https://womencycles.com/blog/

  

    Iliopsoas is a compound muscle which consists of the psoas major and iliacus. The psoas major is placed lateral to the vertebral column. It corresponding intervertebral discs of the last thoracic and all the lumbar vertebrae that originates at  the 12th thoracic vertebrae until to the vertebral body of the lateral surface of the 5th lumbar vertebrae and extends to the transverse process of the lumbar vertebrae 1st to 5th, and, the superior two-thirds of the bony iliac fossa and the iliolumbar and ventral sacroiliac ligaments. It goes down and palpable just deep to the inguinal ligament, where it lies bordered by the sartorius muscle laterally and the femoral artery medially, and, finally attaches to the femur lesser trochanter and the linea aspera medial. 

Ref: https://www.optimaphysio.com/

The iliacus has several points of origin; it starts with the iliac crest, anterior inferior iliac spine, iliolumbar ligament, and anterior sacroiliac ligament. And eventually attaches to femur lesser trochanter and linea aspera medial that seem to be the same tendon of psoas major. 

Ref: https://www.osteopathyny.com/

While sitting or standing, the iliopsoas is constantly active and plays an important role in stabilizing the pelvis and lumbar region along with the erector spinae and quadratus lumborum. Hence shortening or straining of the iliopsoas can cause excessive pelvic anterior tilt or increased spine extension during hip joint motion, thereby acting as a risk factor for low back pain. A shortening of the iliopsoas muscle can result in anterior pelvic tilt and trunk extension. Finally, it is leading to low back pain.

Ref: https://www.pinterest.com/

            Shortening of the iliopsoas muscle was found to be the primary cause of lumbar hyperlordosis and excessive anterior pelvic tilt. This abnormal alignment may inhibit the function of the Transversus Abdominis (TrA). Back muscle guarding from lumbar hyperlordosis resulted from the shortening of the iliopsoas muscle. This is impaired circulation by muscle guarding, leading to increased pain (pain-spasm-pain model). 

Back pain and improved excessive lumbar lordosis angle can be reduced by lengthening the iliopsoas muscle and increasing TrA activation capacity.

The principle of muscle stretching is simple: 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 in one muscle as demonstrated VIDEO. 

Reference: 

https://www.orthopaedicmedicineonline.com/downloads/pdf/B9780702031458000843_web.pdf 

https://www.jptrs.org/journal/view.html?doi=10.14474/ptrs.2021.10.2.225 

https://www.thaiscience.info/journals/Article/JMAT/10971199.pdf