Abdominal bracing exercises

In this article, we will cover an understanding of abdominal strengthen exercises to help rehabilitate injuries that can reach from toe to neck. If you are reading this article there is a good chance that you either have chronic low back, hip, knee, and shoulder pain and you have tried many exercises and techniques to help alleviate this problem, or, you are a person who is athletic or has a physically demanding job and you are trying to accelerate the healing of a more acute type injury.

Most of you are probably looking right now for something you can do on your own and that is how you wound up here.

Before we get into the main subject of this article, abdominal bracing exercises, let’s first go over some explanatory notes.

At Caring Medical we specialize in repairing and rebuilding damaged connective tissue. Our medical staff does this through regenerative medicine injection techniques. In support of these treatments, we also offer pre and post-treatment instruction for muscle activation, chiropractic adjustments, and evaluation and recommendation for core and body symmetry. Simply, this is a comprehensive program to help someone get out of pain and stay that way. Let’s start with probably what you came here for. An exercise demonstration and discussion of this exercise’s benefit.

Caring Medical Abdominal Bracing Exercises

Below is a video of Brian Hutcheson DC and our patient Morgan. Here Dr. Hutcheson will be demonstrating a proper technique in performing abdominal bracing exercises. Below the video are explanatory notes.

We perform abdominal bracing exercises for our patients to help them with problems related to poor core strength. There are patients who are in obvious jeopardy for problems and weakness in their core strength. These are people who sit all day at computers, slouch and lead sedentary lifestyles.

But what about the patient with a more athletic physique?

People who are athletic or have physically demanding lines of work clearly do not lead sedentary lifestyles, how do they get a weakened core? Many of these athletic or good physique people do not know. They assumed that because they have a visual appearance of a strong, muscular stomach that their core was strong. Even though these people are more attuned to the workings of their muscles, many are very surprised to discover that their abdominal muscles are not working properly.

Abdominal bracing exercises for deep abdominal stabilizers

This exercise helps strengthen the deep abdominal stabilizers that are so important for spinal health, posture, and post-injury rehabilitation.

The person in this video is Morgan. She is a patient of ours.

Exercise explanation and demonstration at (0:42)

Activating this exercise

The patient is laying on her back.
I’m going to place my hand under her low back and as the hand goes under the low back, I am asking Morgan to pull down on her abdomen and put pressure on my hand essentially eliminating the gap between her low back and the table.
As she is pulling down her abdomen, I remind her that we need to engage the rib cage, so we have the rib cage pulling down. When teaching this exercise the goal is to have the patient “crush,” or “smash down my hand, so the patient knows that they are performing this exercise correctly.
- What we don’t want to do is to engage the upper back, we do not want to get that area involved, and we don’t want to engage the lower leg. We want to focus on the area between the lower rib cage down the sacroiliac joint.

Looking for weak areas in the core.

As we initially begin to teach the patient this exercise routine, I look for those areas that need to be worked on. The weak spots. We may find one spot where the muscles are not firing as much and we will help her activate and engage that area.
The patient here has been working on this exercise the last few weeks and she is now performing this exercise in a manner perfect for her.
We will ask the patient to alternate with this exercise.
- Pull or hold abdomen and rib cage down for 5 seconds.
- Build this pull-down up to 15 – 20 seconds in order to be able to tolerate different daily life positions so daily living does not weaken the core

Flaring the ribs

At 2:15 of the video:

Morgan squeezes down on her abdominal area to flatten her back against the table. Eliminating the space between her back and the table and eliminating “rib flare.”
The main goal here is to bring the rib cage down because people have a habit of flaring their ribs during this exercise.
In the flared position the exercise is not being performed correctly because in the flared rib position the rib cage’s balance with the pelvis is disrupted and separated. The strengthening of the core is lost and can be a reason this exercise will not help people with back pain when not performed correctly.

Postural restoration

Our techniques, analysis, and therapies have many similarities to a postural restoration specialist. We are focused on the integrity of the entire human body, frame, and tower. On occasion, restoring posture may be uncomplicated – only requiring a few tips and an adjustment or two. However, often, there are multiple things that must be addressed and rehabilitated before postural and body integrity can be obtained.

An example is: A patient may require regrooving of a healthy abdominal breathing pattern where the diaphragm descends smoothly and equally, filling the lower abdomen, sides, and back with air – almost as a balloon fills each direction equally with air. This helps to eliminate torsions and weaknesses that are created from faulty breathing mechanics.

Other times patients may require ADL (Activities of Daily Living) modifications including instruction on how to change and alter sitting positions and/or sleeping positions.

What is the connection between the rib cage and pelvis?

In the video demonstration above a key point is repeated. “Don’t separate the rib cage from the pelvis.” Why? Because the rib cage and the pelvis are the boundaries that we work with to provide the core strength that you are looking for. If you flare the ribs, as demonstrated above, you are separating the pelvic area and the rib cage area by ignoring a boundary or place to anchor the exercise. The rib cage and the pelvis share many soft tissue connections. Mainly the tendons of the common abdominal muscles. But the core is also supported by a vast network of ligaments.

Often, the rib cage is externally rotated and elevated, which disconnects the rib cage from the pelvis, resulting in faulty posture, poor stability, weakness, pain, and dysfunction.

Treating the more difficult cases

Sometimes the deep muscles of the core have to be retrained. This includes the:

Multifidus muscle stabilizes the lumbar spine and works together with the outer core side muscles the transversus abdominis. Together with the connect the core and lumbar spine to the pelvic floor muscles.
Rotatores. These small muscles play a more oversized role in postural control.
Intertransversalis muscles attach at the transverse processes of the spine and provide stability during extension, flexion, and rotation of the vertebral column.
Interspinalis which are important spine stabilizer muscles.

When these exercises may not help you

For some, core exercise, yoga, physical therapy can make the problem worse. This is explained in our article: Why physical therapy and yoga did not help your low back pain. Portions of that article are summarized here:

When a new patient comes to our center with back pain, hip pain, weakness in their core, and, a history of physical therapy and other strengthening and stretching programs, they are often confused by the lack of results, we often hear:

“I have been getting physical therapy and chiropractic treatments over the last few years. Sometimes it helps, sometimes it does not help. I am doing yoga now too. It is basically the only exercise I can do. I am not sure how much it is helping but I know it is not helping enough to be able to help me avoid surgery.”

The goal of any treatment is to strengthen the core and spine.

When a patient is diagnosed with degenerative disc disease or chronic injury-causing core and lumbar and hip pain and weakness, the initial treatment response is to strengthen the spine or the “core,” muscles with physical therapy and/or relieve spasms with yoga to alleviate the pain. What physical therapy and yoga may not achieve is getting the vertebrae back into their natural positions to remove pressure on the spinal nerves. The missing treatment is the restoration of the normal lumbar spinal curvature.

Addressing spinal, pelvic, and hip ligament weakness.

The primary role of the core muscle systems in the lumbar spine and pelvis is to provide segmental control and dynamic stability to the spinal column. It cannot be done without strong ligaments.
The lumbar region is well endowed with the core muscles, which play a role in the stability of the spine. These muscles—the abdominal muscles, the psoas major, and the erector spinae—are all actively involved in maintaining the functional stability of the lumbar spine in both upright and sitting postures. Their muscle action is especially crucial during the very high loading that the lumbar spine typically undergoes. Without these muscle forces, such large loads would cause disruptions in the lumbar vertebral column and likely result in spinal instability and severe pain.

What are we seeing in this image?

The tensor fascia lata muscle, a stabilizing muscle often referred to as “core” muscle since they attach to the axial skeleton and pelvis, which are considered the foundation of the human body. When sacroiliac ligaments are weak or damaged, the pelvis becomes unstable and the needed resistance to strengthen the tensor fascia lata muscle is not there.

What are we seeing in this image?

The vast array of ligaments that supply the core with is “behind the scenes,” support. It is the ligament network of the lumbar region and the pelvic and hip region that, with the muscles of the core, hold everything together.

Treating ligaments with Prolotherapy

Prolotherapy is an injection technique that stimulates the repair of unstable, torn or damaged ligaments. When the cervical, thoracic, or lumbar spinal ligaments are unstable, they allow for excessive movement of the vertebrae, which can stress tendons, atrophy muscles, pinch on nerves, and cause other symptoms associated with core instability.

We utilize Prolotherapy and sometimes Platelet Rich Plasma injections to strengthen and repair these ligaments.

In our clinical and research observations, we have documented that Prolotherapy can offer answers for sufferers of core instability, as it treats the problem at its source. Prolotherapy to the various structures of the pelvic, hip, and lumbar spine eliminates the instability and the sympathetic symptoms

In some non-responsive patients, postural restoration can be achieved with a multi-discipline approach.

Curve correction therapy

In this illustration, we demonstrate that top to bottom, from cervical neck pain to foot pain, joint instability impacts walking and gait. This includes hip pain, pelvic malalignment, and adult spinal deformities including increased lordosis. Increased lordosis in the unnatural curvature of the spine caused by spinal instability and spinal ligament laxity and weakness.

Through a combination of curve correction therapy and specific adjustments with instrument techniques – curve correction is where we use weights to create curves and reset proprioceptive fibers. Performing the curve correction and confirming with x-ray (DMX) that the appropriate changes have been made is one of the things that separates us from a postural restoration specialist.

Performing these manipulations we are often able to create great/significant change in a very short period of time, where it would initially be very challenging to activate the correct muscles to create the pull necessary to reform/change the position of the bones.

Summary and contact us. Can we help you?

We hope you found this article informative and it helped answer many of the questions you may have surrounding core exercises. If you have questions for our staff please send us an email.