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:
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.
Joe D.
December 11, 2015
Thanks as usual very interesting…
reddyb
December 13, 2015
Thanks Joe. Hope you’re doing well.
cindy
December 12, 2015
HI Brian,
great article and explains why when my bulging lumbar disc is acting up anything involving tightening my core causes exacerbation of that pain (ab work, lifting heavy objects etc). I am most at peace when things make sense, especially things concerning my body, and this article helped put things into perspective for me. Now instead of “working through” that discomfort , I can rest until my disc is quiet again. Thanks for your thoughtful posts!
reddyb
December 13, 2015
Thanks Cindy! That’s great to hear this resonated with you. It’s true particularly with lower backs, that when they’re sensitive, often the thing you want to do is get a person to relax -often psychologically and their back musculature- rather than work the general core area. This is why it’s so common to lay on the floor with the legs up, when someone’s back is “thrown out.”
Tangent: That doesn’t mean when someone hurts their back, or has a flare up, they should do nothing. You often want to move as much as you can without exacerbating things. For instance, someone’s back flares up: squeezing the abdominals -tensing- may not feel great, despite a person having heard they need to strengthen their core. However, going for a long walk -often relaxing- may help loosen things up to where the person feels better afterwards.
Derek
January 12, 2016
Interesting. I remember you teaching to squeeze the stomach in to prevent pain. It did end up causing me more pain. I suppose we all learn new things though.
reddyb
January 12, 2016
Hey Derek,
What are you referencing when you say me teaching squeezing the stomach to prevent pain?
Bobby
January 21, 2016
This is brilliant. Just had a “clicked” moment regarding a don’t allow this to happen cue versus a squeeze this and hope one.
reddyb
January 22, 2016
That’s great. Glad it was helpful!
Lewie
September 24, 2016
Great article Brian!
Like Bobby below, I had an “ahhh haaa!” moment regarding the movement cues. Multiple therapists and PTs have told me to squeeze my core as tight as I can to protect it during lifts and some general activities. I’ve followed that advice my whole life thinking I was protecting my spine but really I was pissing it off with excessive pressure to my already stressed muscles.
Keep up the good work.
Cheers.
reddyb
September 25, 2016
Thanks Lewie. Glad you got something out of it.