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L.A. Sports and Spine, 10474 Santa Monica Building, #202 Los Angeles, CA 90025, USA
Hutton, 1985). Better and safer abdominal exer- pain. Researchers at Yale University have shown
cises exist which will be described in this series of that a specific motor control signature of delayed
papers. agonist-antagonistic muscle activation predicts
which asymptomatic people will later develop low
back pain (LBP) (Cholewicki et al., 2005). In
Are specific patterns of muscle particular, what was found was longer muscle
co-activation necessary? response latencies to perturbation in the ‘‘at risk’’
group than those in healthy control subjects.
Whether the goal is preventive, injury recovery, Marras et al. (2005) have reported that there is a
rehabilitation, or performance enhancement good different pattern of antagonist muscle co-activation
‘‘core’’ fitness is a must. Muscles stabilize joints by (kinematic ability) in LBP individuals than in
stiffening like rigging on a ship (Fig. 1). According asymptomatics. Patients were found to have great-
er spine load and greater kinematic compromise
$
This paper may be photocopied for educational use.
during lifting tasks. Altered kinematics were
Tel.: +1 310 470 2909; fax: +1 310 470 3286. strongly related to spine load, being able to predict
E-mail address: cldc@flash.net 87% of the variability in compression, 61% in
1360-8592/$ - see front matter & 2007 Elsevier Ltd. All rights reserved.
doi:10.1016/j.jbmt.2007.04.007
ARTICLE IN PRESS
A modern approach to abdominal training 195
Normal respiration
unexpected perturbations (Cresswell et al., 1994; McGill et al. (1995) recommends that patients AB
Lavender et al., 1989; Marras et al., 1987; Stokes during both phases of respiration rather than only
et al., 2000; Wilder et al., 1996). during exhalation. Typical gym training advice to
This can be achieved by having a patient perform exhale with exertion does not make sense in sports
a dead bug or bird dog and then ‘‘brace’’. While the or work demands since stability must be ensured as
patient performs an AB the clinician offers slow and endurance challenges are faced.
then quick perturbations in different planes while
asking the patient to maintain their posture. The Sternal crunch
patient can pretend they are about to be pushed or
hit and they will ‘‘automatically’ brace (see Fig. 2). A novel approach to achieving stronger co-activa-
tion of all abdominal wall muscles is to observe the
Neutral spine posture position of the anterior chest wall (Kolar, 2007).
A cephalad position which can be thought of as an
The second criteria for spine stability is maintai- ‘‘inhalation’’ position is inhibitory of the normal
nance of a ‘‘neutral spine’’ or normal lumbar diaghragmatic function. It is noted that the
lordosis. Many patients perform posterior pelvic thoraco–lumbar (T/L) junction is hyperlordotic
tilts which actually places the lumbo-sacral spine in and the diaphragm is oblique in this position (see
flexion and thus can potentially harm the disc via Fig. 3). Ideally, a caudal anterior chest position is
ARTICLE IN PRESS
A modern approach to abdominal training 197
Practice-based problem
Won’t the sternal crunch remove the lumbar
two articles in this series will review more detail Kavcic, N., Grenier, S., McGill, S.M., 2004. Determining the
about the basics of assessment and training of the stabilizing role of individual torso muscles during rehabilita-
abdominal wall. tion exercises. Spine 29, 1254–1265.
Kolar, P., 2007. Facilitation of agonist–antagonist co-activation
by reflex stimulation methods. In: Liebenson, C. (Ed.), Re-
habilitation of the Spine: A Practitioner’s Manual. Lippincott/
Williams and Wilkins, Philadelphia.
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Self-Management: Clinician Section
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