Why squeezing the stomach can make lower back pain worse

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This is part of a forthcoming post regarding my October 17th visit to the North American Spine Society’s (NASS) annual conference. I attended the one day course for “State-of-the-Art in Motor Control and Low Back Pain.” This post is in regards to Andry Vleeming’s presentation. 

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I really enjoyed this talk. I wasn’t familiar with Vleeming’s name. For those who also aren’t, but perhaps know Tom Myers and Anatomy Trains, this talk was Tom esque in that it was very fascia oriented.

Andry discussed the following study:

• A description of the lumbar interfascial triangle and its relation with the lateral raphe: anatomical constituents of load transfer through the lateral margin of the thoracolumbar fascia

The transverse abdominus, which is always a popular muscle when discussing lower back pain, was hit on. Andry wanted to get the importance of this following picture across:

The idea here is to show how muscles from the front of the torso connect into fascia, which connects into other muscles. The little triangle called LIFT.

This triangle runs from the ilium (top of the hip) to the 12th rib. It’s long/ tall. It’s a fatty tissue, and the authors call it things like the “lumbar interfascial triangle.” The fact it’s tall has them call it the LIFT. And the general area they call the “lateral raphe.”

This triangular area has the transverse abdominus connect into it, and then a continuous layer of fascia continues to and around the paraspinal muscles. It bifurcates, going anteriorly and posteriorly, forming what the group calls a “canister.”

Due to the connection of these areas, fascially, we know the muscles are related. Meaning if you do something like focus on the transverse abdominus, you are going to have an affect on the paraspinal muscles at the same time.

If the transverse abdominus tensions, it’s going to exert a force on the paraspinals. It’s like we have our own weight-belt already:

Think of it like the paraspinals are being choked:

We end up compressing the spine not in an up and down fashion, but in a side to side fashion.

Because the paraspinals end up being closer to the spine, their lever arm is decreased, so it’s easier for them to generate the work they might need to do. This can potentially fit well with some of the research out there showing differences in transverse abdominus activity correlating to lower back pain. Faulty activity can = faulty ability to control the spine.

Another area this is important is for those who get caught up in the “pull your stomach in” cue. Or those who squeeze their stomach to prevent any spinal motion. Some do this to such a degree it ticks their back off. I’ve seen people do an exercise where their form is great, yet they still have back pain while doing the exercise. This can even be during something low intensity, like a leg raise on your stomach.

Sometimes I find this person is squeezing their stomach so hard, trying to prevent any spinal motion, that it’s actually hurting their back.

One explanation for this is they are not only squeezing their stomach, but they are also squeezing their already sensitive back at the same time!

This is one reason it’s typically best to start with movement cues, not muscle cues. “Don’t let your back move” vs “Squeeze your stomach.” First, the latter cue is a hope cue. You’re hoping squeezing the stomach means not moving the back, when you could just tell someone to not move their back. (“Hope is not a strategy.”) Second, when you tell someone to squeeze a musculature, it’s common to squeeze as hard as possible, which can cause its own problems.