Abdominal Bracing

Lumbar stability is a critical goal when treating low back pain.  And if
our objective is to stabilize the spine during real life activities it is
paramount that we train this stability within our rehabilitation
programs.
If we want to get this right the first thing we need to train is the ability
to properly activate the lumbar stabilizers.  An awareness of how to
generate and control this stabilizing contraction is the foundation of
stability training.  It is the thread that holds each successive stage of
the rehab progression together.

But this first critical step is often neglected. When this happens care
suffers and the rehab plan stands on shaky ground. This is a major
problem.

We don’t want this to happen.  So lets let’s take a look at how tackle
this first critical step.

Creating the Foundation with

Abdominal Bracing
Stability is a joint’s capacity to maintain proper alignment under load
and/or during movement.  It is a joint’s ability to resist internal and
external forces.  For the lumbar spine this is related to how effectively
the abdominal muscles are able to create and maintain an isometric
contraction.  It is this isometric contraction that creates resistance to
movement.

So the first thing we need to teach our patients is how to properly

activate and and maintain a proper abdominal contraction.
The most effective way to do this is to simply teach them how to
perform an isometric contraction of the abdominal muscles.  McGill
refers to this as an abdominal brace (1). This brace will co-activate the
transverse abdominis with the internal and external obliques to
increase stiffness and stability throughout the lumbar spine (2).

The Importance of Respiration

But remember, it’s not just about being able to contract the abdominal
muscles.  You also need to be able to maintain the contraction during
activities.

Later stages of the rehab plan will focus on holding the abdominal
brace with more complex and functional movements (i.e., progressing
from isolation to integration). The goal in this initial stage is to teach
control of the abdominal brace in conjunction with respiration.

You see, it’s common for back pain patients to be unable to hold an
abdominal brace while breathing. The contraction is often lost as they
inhale.  This is a problem. Abdominal control needs to be independent
of respiration.  Otherwise the spine will become unstable and more
susceptible to injury with every breath.

So as the patient gets the feel for how to active the abdominal
muscles, they also need to work on maintaining the contraction as
they breathe.

Here’s how to perform the basic abdominal brace:

 Begin on your back in a relaxed neutral spine position

 Gently contract your abdominal muscles. It is often helpful to
imagine you are about to be hit in the stomach and you need to
tense your abdominal muscles for protection
  Now try to hold the abdominal contraction as you breathe in and
out
 Note: It can be helpful in the initial stages to lightly squeeze or
press into your abdominal muscles with your hands to feel the
muscle contraction. The contraction / stiffness of the abdominal
muscles should remain steady with each breath
 Repeat this process for a few minutes several times per day

 Think Ahead to the Next Rehab Phase

Learning the abdominal brace is usually easiest in a supine position.
But that does not mean it needs to be done exclusively from a supine
position.  Subsequent exercises will be done in seated, quadruped,
and standing postures.

So think ahead to these next phases. By incorporating these postures

into the initial abdominal bracing sequence will make the transition to
these subsequent exercises smoother.