Transversus Abdominus and Its Role in Lumbar Spinal Stabilization

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Transversus Abdominus and Its Role in Lumbar Spinal Stabilization

Transversus Abdominus and its Role in Lumbar Spinal Stabilization 

Spinal stability is dependent upon three sub-systems: the active or contractile system, the passive or non-contractile system and the neural control system. (Panjabi, 1992). If dysfunction is present in any one or a combination of these sub-systems, the stabilizing capacity of the spine will be compromised and painful movement more likely to occur. While all muscles contribute to spinal stability and movement, some are better suited than others to provide dynamic stability. In the lumbar spine (L/S), the deeper muscles, close to the axis of joint motion, with a predominance of Type I muscle fibers, have proven more effective as stabilizers than the larger, more superficially located lumbar spinal muscles.

Research has shown that: 1) people with low back pain (LBP) present with atrophy and altered activation of the deep spinal muscles when compared with persons without LBP (Hodges et al., 1996; Hides et al., 1994) and 2) the deep spinal muscles play a key role in developing inter-segmental motion stiffness which translates into improved dynamic control of the spine (Hodges et al., 2003).

Transversus Abdominus (TA) is an important dynamic stabilizer of the L/S. TA is able to directly increase intra-abdominal pressure which converts the trunk into a more solid cylinder. This reduces compression and shear forces acting on the L/S and transmits them over a wider area (Twomey & Taylor, 1987). TAs attachment to the thoracolumbar fascia further increases its ability to stabilize the L/S.

The success of specific spinal stabilization training for TA and other deep muscles lies in: 1) teaching clients to activate the dysfunctional muscle in isolation of other muscles; 2) effectively retraining slow twitch muscle fiber function through isometric contractions (low loads, sustained hold times); 3) repetition: to aid motor reprogramming; 4) teaching co-contraction of the target muscle, first with other deep muscles, then the global muscle network and 5) training carryover for physical and functional tasks of increasing levels of difficulty.

“Exercises that target the deep abdominal muscles with minimal external loading in the spine have been shown to be effective in increasing lumbar stability, thus treating and preventing the recurrence of LBP.” (Teyhen et al., 2008; Axler & McGill, 1997).

The physiotherapists at Corona Station Physical Therapy recognize the importance of specific exercise prescription and a properly executed home exercise program to ensure optimal rehabilitation results. Time is spent educating the client as to the importance of the exercises they are given, while frequent review ensures proper exercise technique and allows for appropriate progressions. We believe it pays to be picky! For more information, please contact us at the clinic by phone or email and ask to speak to one of our physiotherapists.

Low Back Pain

Low Back Pain

One of the main developments in treating lower back pain has been the understanding that the abdominal muscle group plays an important role in supporting the spine, and that strengthening this region is valuable in all prevention and treatment programs for lower back pain. 

The paraspinal muscles, particularly multifidus, co-contract with transversus to maintain a “neutral” lumbar spine. This refers to the low back, or lumbar segment of the spine as neither extended nor flexed, with the pelvis flat and not tilted. Learning to control this “neutral” position is the focus of most care stability exercises. Research shows that poor multifidus activity is found in back pain patients. Walters suggests that we should be striving for a comprehensive program of exercises that effectively strengthens all the muscles and movements of the spine. Lower back pain has a variety of causes, and while focusing on a neutral spine is important in the early stages of rehabilitation, global musculature and functional movements must be incorporated for optimal function.

Back movement and function:

Any back movement is a combination of the basic flexion, extension and rotation. The key muscles involved in the performance of each of these movements are:

Flexion: rectus abdominis, internal and external obliques and hip flexors

Extension: erector spinae, quadrats lumborum, gluteus maximus and hamstrings

Rotation: rectus abdominis, obliques and erector spinae

The most effective lower back pain programs involve all the muscles, how they move and function and in which positions these movements occur. This comprehensive approach also takes into consideration that back injury and lower back pain can be caused by various factors, including poor posture, lifting strain, poor stability, muscle strength imbalances, small repetitive stresses and poor flexibility. The more comprehensive and varied the lower back pain program, the more likely all these factors will be accounted for.

Clinical Relevance:

Any rehabilitative training needs to be specific to the individual patient and progressed according to the diagnosed contributing factors. A progressive program may start with specific activiation and co-contraction training of transversus and multifidus, but should progress to exercises such as planks, bridging, trunk twists, back extension and superman type exercises to recruit more global musculature. More advanced exercises could include the wood chop, deadlifts, and squats. It is important to incorporate two pull movements for every push movement. Functional training exercises with equipment such as the multi-directional cables, TrX, and kettle bells challenge the body in ways that conventional lifting cannot. The key point of the latter exercises is that most of these require the body to move or stabilize in a rotational direction thus simulating everyday life tasks. The final point is that rehabilitative and training exercise programs need to be regular to generate the stress to create an adaptive process.

At Corona Station Physical Therapy, our team of experienced physiotherpists believe in a comprehensive rehabilitation approach to treating low back pain as well as working to prevent recurrence. For further information please contact us by phone or email and ask to speak to one of our physiotherapists.

References:

Haladay, D., Miller, S., Challis, J. & Denegar, C. (2013). Quality of Systematic Reviews on Specific Spinal Satbilization Exercise for Chronic Low Back Pain. JOSPT, 43(4).

Walters, P. (2000). Back to Basics. Health and Fitness Journal, 4(4).