ABDOMINAL_TRAINING_2

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apparatus is introduced for traditional exercises that
trunk. *c 2001 Harcourt Publishers Ltd
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major categories of abdominal exercises, the
`sit-up' and `leg-raise' will be brie¯y analysed
(Norris 1994).
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this action, which will be dealt with below.
In a classic sit-up, as soon as the head lifts,
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abdominis and internal oblique) must be able to
pull on the rectus sheath to hold the abdominal
than ¯exed.
Fixation of the pelvis is provided by the hip
*c 2001 Harcourt Publishe
M
Christopher Norris,
MSc MCSP
Correspondence to:
Christopher Norris,
1 Barkers Lane,
SALE, Cheshire,
M33 6RP, UK. Tel.:
‡44 (0) 161 972
0512; E-mail:
cnorris500@AOL.
COMs
ivity is seen in the rectus abdominis (Walters
artridge 1957), and as a consequence the rib
e is depressed anteriorly. The rectus is acting
e to stabilize the ribcage and hold it down
inst the pull of the neck ¯exors attempting
lift the head. The initial period of trunk
ion emphasizes the supra-umbilical portion
¯exors, especially iliacus through its attachment
to the pelvic rim. The strong pull of hip ¯exors
is partially counteracted by the pull of the
lateral ®bres of external oblique and the infra-
umbilical portion of the rectus abdominis
which tend to tilt the pelvic posteriorly. Action
of the external oblique, if powerful enough, will
e sit-up
e sit-up is essentially an action where the
ject moves from a supine lying position to a
g-sitting position by performing hip ¯exion
nk moving on a ®xed leg), usually with
nk ¯exion. There are several modi®cations of
wall down. This movement demands a
coordinated action of both the super®cial and
deep abdominals, which is often lost. Where an
imbalance exists with the deep abdominal
muscles poorly recruited and the rectus
abdominis lengthened, the abdominal wall will
be seen to dome and the pelvis to anteriorly tilt.
As a consequence the athlete may lift the trunk
with the lumbar spine extended or ¯at rather
alysis of current abdominal
ercise technique
be able to develop more appropriate
rcises for the trunk it is essential to ®rstly
derstand what the traditional exercises for
s region actually achieve. To this end the two
ri
in
in
ab
o
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unctional load a
aining: part 2
M. Norris
s article discusses current abdominal training by
y segment alignment is emphasized with refere
ominal training based on the principles of spina
rlapping stages. In stage one, the stabilizing fun
cated, and several practical suggestions are mad
bility is built emphasizing isometric control of the
asterclass
he rectus, the infra-umbilical portion and the
ernal oblique contracting later in the
vement (Kendall & McCreary 1993). As the
ernal oblique contracts, it pulls on the lower
com
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doi :10.1054/ptsp.2001.0033,
dominal
nalysing the sit-up and leg-raise actions, and
ce to the lumbar spine. A new approach to
stabilization is proposed, consisting of three
tion of the deep abdominal muscles is re-
to assist this process. In stage two, static
lumbar spine neutral position. In stage three,
are appropriate to functional training of the
s, causing the ribs to ¯are out and so
reasing the infrasternal angle.
ne of the problems poorly toned
ividuals face is `bow stringing' of the
ominals, which is often seen at the initiation
he sit-up action. For rectus abdominis to pull
, the deep abdominals (transversus
press the ribs and reduce the infrasternal
le once more (Kendall et al. 1993).
n a poorly conditioned subject exercising at
ed, the initial movement in a sit-up may be a
Physical Therapy In Sport (2001) 2, 149±156 149
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this fashion reduces the lever arm of the trunk
enabling the subject to sit up without the legs
lifting (Fig. 1).
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In addition, the act of foot ®xation itself may
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same starting position, but no hip ¯exion occurs,
the lumbar spine remaining in contact with the
supporting surface. The bench-curl (`crunch'
exercise) is performed from a starting position of
908 hip ¯exion and 908 knee ¯exion, the shin
being supported on a bench or chair. Bending
the knees and hips to alter the starting position
of the sit-up will affect both the passive and the
active actions of the hip ¯exors, and the
biomechanics of the lumbar spine. In supine
lying, the iliopsoas is on stretch, and aligned
with the horizontal (Fig. 2). In this position,
vertebral compression is at its greatest as the
muscle contracts, and trunk lifting is at a
mechanical disadvantage. The ratio of lifting to
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150 Physical Ther
Physical Therapy
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cilitate the iliopsoas (Janda & Schmid 1980).
oot ®xation requires the subject to pull against
e ®xation point by active dorsi¯exion. This
rocess stimulates the gait pattern at heel
ontact increasing activity in the tibialis
In cases where the abdominal muscles are
eak and lengthened, maximum spinal ¯exion
ill not occur because the muscles are unable
pull the lumbar spine into full inner range. In
is case the lever arm of the trunk remains
ng and the legs are seen to lift. The exact point
t which this occurs in the movement will
epend on a subject's bodyweight and stature.
If the feet are ®xed, the hip ¯exors can now
ull powerfully without causing the legs to lift.
ig. 1 Movement of the centre of gravity of the upper
ody during a sit-up exercise.
omentary posterior tilting of the pelvis by
ction of the hip extensors. This will pre-stretch
e hip ¯exors, giving them a mechanical
dvantage before hip ¯exion occurs (Ricci et al.
981).
ffects of foot ®xation
the sit-up action is attempted from the supine
ing position without allowing trunk ¯exion,
ere is a tendency for the legs to lift up from
e supporting surface. This occurs because the
gs constitute roughly one-third of the
odyweight and the trunk two-thirds.
As the abdominal muscles ¯ex the spine, the
entre of gravity of the upper body is moved
audally. Movement of the centre of gravity in
in Sport
nterior, quadriceps and iliopsoas, a pattern
nown as ¯exor synergy (Atkinson 1986).
Modi®cations of the sit-up include the bent
nee sit-up and the trunk curl. The bent knee
il
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apy in Sport (2001) 2, 149±156
ompression is, therefore, approximately 1 : 10
atson 1983). As the knees are ¯exed, the
iopsoas is pulled more vertically and so the
tio of trunk lifting to vertebral compression
duced to 2 : 5 in crook lying and 1 : 1 in bench
ing.
With 458 hip ¯exion, tension development in
e iliopsoas has been shown to be 70±80% of
s maximum, while with the hips and knees
exed to 908 this ®gure reduces to between 40%
nd 50% (Johnson & Reid 1991).
Pull of psoas
1:10 Vertical
compression
2:5
Trunk
lifting
3.3:3.3
ig. 2 Ratio of trunk lifting to vertebral compression
rces due to the pull of iliopsoas in a sit-up.
it-up is performed from the crook lying starting
osition, with the knees ¯exed to 908 and hips
exed to 458. The action is one of the trunk
exion followed by, or performed with, hip
exion. The trunk curl is performed from the
However, passive tension developed by the
iopsoas due to elastic recoil must also be
onsidered. If the hips are ¯exed, the iliopsoas
ill not be fully stretched, and will not be able to
*c 2001 Harcourt Publishers Ltd
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to create only slight activity in the upper rectus,
althoughthe lower rectus contributes a greater
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portion of the total abdominal work than
h the sit-up (Lipetz & Gutin 1970). The
tus works isometrically to ®x the pelvis
inst the strong pull of iliopsoas (Silvermetz
0). The force of contraction of the iliopsoas is
ximum when the lever arm of the leg is
atest, near the horizontal, and reduces as the
is lifted towards the vertical.
n subjects with weaker abdominals, the
vis will tilt and the lumbar spine
erextend. This forced hyperextension will
matically increase stress on the facet joints in
lumbar spine. The movement is likely to be
ited by impaction of the inferior articular
cesses on the laminae of the vertebrae
ow, or in some cases by contact between the
nous processes (Twomey & Taylor 1987).
ere this action occurs rapidly, damage may
ult to the facet joint structures. Once contact
occurred between the facet and lamina,
ther loading will cause axial rotation of the
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sively limit the posterior tilt of the pelvis.
tead, to ®x the pelvis and provide a stable
e for the abdominals to pull on, the hip
ors will contract earlier in the sit-up action.
is contraction although occurring earlier, will
of reduced intensity (Walters & Partridge
7) due to the length±tension relationship of
muscle.
ith the legs straight in the traditional sit-up
ition, the iliopsoas is stretched, and can
sively limit posterior tilting of the pelvis.
wever, in this stretched position, the
psoas is capable of exerting greater force
ring hip ¯exion. If the abdominal muscles are
weak to maintain the position of the pelvis
tilt anteriorly, lengthening the abdominals,
hyperextending the lumbar spine. This
e of action is, therefore, unsuitable for
tural re-education if the aim is to shorten
turally lengthened abdominal muscles.
aight leg raising
e bilateral straight leg raise has been shown
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erior vertebrae (Yang & King 1984). The
erior vertebra pivots, causing the inferior
icular process to move backwards
rstretching the joint capsule.
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dominal training based on
inal stabilization principles
ause one of the prime functions of the trunk
tability, the Functional Load Abdominal
ining (FLAT) programme follows an exercise
gression based on spinal stabilization
nciples (Norris 1995). Initially the stabilizing
ction of the deep abdominal muscles is re-
cated. Once this has been achieved, the
urance of these muscles is built up and
tic stability is enhanced. Only when these
o aims have been achieved are exercises used
enhance the performance of the trunk
bilisor muscles and complex multijoint
vements are begun. The ®rst action to be
stered in the back stability process is
ominal hollowing, a technique which has been
wn to be especially useful in the early stages
stability control (Richardson et al. 1992). This
vement emphasizes the internal oblique and
nsversus abdominis muscle (Lacote et al.
7) while reducing the dominance of the
per rectus (O'Sullivan et al. 1998). Muscle
education of this type may be achieved in a
mber of starting positions, with four point
eling and standing (wall support) being the
o most effective positions.
tability muscles have been described as
ter suited to endurance (postural holding)
better recruited at low resistance levels
orris 1998). In the clinic, it is often found that
jects begin with little control over the
ensity of contraction which these muscles
duce. Often, the contraction begins
nimally and then builds to high intensities
±70% maximum voluntary contraction
VC]). This is acceptable during the early
ges of learning as it enables the subject to
l the muscle working'. However, accurate
trol must be gained, and in all hollowing
rcises the subject should be instructed to
ster changing the intensity of the muscle
traction. This is achieved by asking for a
aximal contraction' and then relaxing by half,
half again. Once the minimal contraction is
ieved, the intensity is then built up again in
ps to reach the maximum. Only when
unctional load abdominal training: part 2
lowing can be controlled with minimal
scle intensity over a period of time (10
etitions each of 30±40% MVC) can exercises
progressed. The position in which the
Physical Therapy In Sport (2001) 2, 149±156 151
movements are performed is important. The
neutral position of the spine (Box 1) should be
used whenever possible, and initially the
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152 Physical Ther
Physical Therapy
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range ¯exion and end range extension. However, in s
treatment aim must be to restore optimal posture by
tissue elements. Neutral position may be found ei
pelvis) or actively (subject moving his/her own pelvis
F
ubject will need to be positioned correctly by
e therapist.
As the transversus has horizontally aligned
bres, four point kneeling allows the abdominal
uscles to sag, giving stretch facilitation
ig. 3). The subject is positioned with their
mbar spine in a neutral position, and the
ead looking at the ¯oor, between the hands
ther than forwards. Head position should
¯ect optimal alignment with the ear
orizontally aligned to the shoulder joint. The
ip should be directly above the knee, and the
houlder directly above the wrist. The hands
nd knees are shoulder width apart.
in Sport
Box 1 Neutral position of the lumbar spine ± a w
The neutral position of the lumbar spine is midw
extension. In a neutral position the discs and facet
surrounding the lumbar spine reach a state of elas
subject, the neutral position will correspond to lum
with a sub-optimal posture, pelvic tilt may be increa
the depth of the lumbar lordosis. In either case, the
The subject focuses their attention on their
mbilicus and is instructed to pull the
mbilicus `in and up' while breathing normally.
his action has been shown to dissociate
ctivity in the internal obliques and transversus
om that of rectus abdominis (Richardson et al.
992). Dissociation itself makes the exercise
seful for re-educating the stabilizing function
f the abdominals where rectus abdominis has
ecome the dominant muscle of the abdominal
roup.
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apy in Sport (2001) 2, 149±156
ig. 3 Abdominal hollowing in four point kneeling.
To facilitate learning multisensory cueing
used (Miller & Medeiros 1987) to increase
e sensory input to the subject. Auditory cues
an be provided by the therapist speaking to
e subject and giving feedback about
erformance. Visual cues are given by
ncouraging the subject to look at the muscles
s they function, and by using a mirror placed
n the ¯oor/couch below the abdomen.
inaesthetic cueing is accomplished by
ncouraging the subject to `feel' the particular
ction, for example asking them to `feel the
tomach being pulled in'.
Tactile cues are provided by the therapist
nd/or belt touching the subject's abdomen.
he abdominal region below the umbilicus is
alpated. The therapist places the heel of their
and over the patient's anterior superior iliac
pine and points their ®ngers towards the
atient's pubic bone. The therapist's ®nger tips
ill then fall over the retro-aponeurotic triangle
king de®nition
y between end range ¯exion and end range
oints are minimally loaded and the soft tissues
c equilibrium.In the normal (non-pathological)
ar alignment in an optimal posture. In subjects
ed or reduced giving corresponding changes in
neutral position remains mid-way between end
uch cases of postural malalignment, part of the
re-balancing the length of the surrounding soft
ther passively (therapist moving the subject's
through muscle action).
alters & Partridge 1957). The muscles are
heet like and will ¯atten rather than bulge
hen they contract. To facilitate the contraction
e therapist instructs the subject to `stop me
ushing in' as they palpate the abdominal wall.
second method of facilitation is to instruct the
ubject to cough (visceral compression) and
old the muscle contraction they feel beneath
e therapists palpating ®ngers. This `cough
nd hold' procedure is also useful when used in
onjunction with surface EMG. As the muscle
ontraction shows on the EMG unit, the subject
encouraged to maintain the contraction while
reathing normally, The contraction time is
uilt up to a single 30 seconds hold or 10
petitions of 10 seconds holding. The subject
hould be encouraged to reduce the contraction
*c 2001 Harcourt Publishers Ltd
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om the wall and repeat the action without
all support. No spinal or pelvic movement
ould occur.
uilding static stability
he crook lying position is used as the starting
osition for isolated limb movements to build
atic stability. The neutral position of the
mbar spine is found and abdominal
ollowing is performed to stabilize the spine.
ne leg is then slowly straightened keeping the
eel resting on the ground to perform a heel
ide action (Fig. 5). This movement is made
sier if the heel is on a slippery surface (a cloth
on a polished ¯oor or a piece of shiny paper if
n a carpet). As the leg is straightened,
dominal hollowing must be continued and
ability maintained. The moment the pelvis
*c 2001 Harcourt Publishe
F
g.
ensity of the muscle to the minimum
uired to maintain the hollow abdomen
ition.
webbing belt may be fastened around the
omen below the umbilicus, with the
scles relaxed and sagging. The belt should
tight enough to touch the skin but not so
ht as to pull the muscles in. The desired
ion is to hollow the abdomen and pull the
scles away from the belt, and then to relax
m completely to ®ll the belt again. Two
ors are common here: ®rstly, an inability to
w the muscles away from the belt; secondly,
ontraction which is too strong and makes the
ominal wall rigid, seen as an inability to
x the muscles to ®ll the belt once more. With
l muscle control both actions should be
inable. Once the contraction is achieved, the
ding time is built up to 10±30 seconds while
athing normally.
isualization of correct exercise technique is
d following demonstration by the therapist.
ualization or `mental practice' involves the
ject relaxing, and `seeing' themselves
forming the exercise in their imagination.
ualization of this type has been shown to
e®t both motor skill acquisition (Fransler
l. 1985) and strength development
rnwall et al. 1991).
ome subjects ®nd four point kneeling
®cult to control and tend to round their spine
they attempt abdominal hollowing. Where
s is the case, wall support standing is a more
ropriate starting position (Fig. 4). The
ject stands with their feet 6 inches from a
ll and their back ¯at onto the wall surface. A
tral spinal position should be maintained.
an obese or poorly toned subject, the weight
the digestive organs will pull the abdominal
ll out and down (visceral ptosis). Again a
t is used and positioned below the umbilicus
the action is to contract the lateral
ominals and to pull the abdominal wall `in
up' trying to create a space between the
omen and the belt. Since lateral abdominal
ion and pelvic ¯oor action are linked
ough motor programming as part of the
ra-abdominal pressure mechanism, pelvic
th
im
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if
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ab
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Fi
r contractions are also useful to aid learning
abdominal hollowing. The instruction is to
ll the pelvic ¯oor in as though trying to `stop
rself passing water' or `gripping'. In men
ant
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action of `lifting the penis' is also useful
agery.
he abdominal hollowing action must be
ferentiated from pelvic tilting, and care
uld be taken to ensure that the subject does
¯atten their back against the wall indicating
sterior-pelvic tilting through the action of the
tus abdominis. Once the abdominal
lowing action has been performed correctly
repetition, the subject should move forward
4 Abdominal hollowing in wall support standing.
unctional load abdominal training: part 2
eriorly tilts and the lordosis increases, the
vement must stop and the leg be drawn back
o ¯exion once more. The exercise is
gressed by using full limb weight, and
Physical Therapy In Sport (2001) 2, 149±156 153
p
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154 Physical Ther
Physical Therapy
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in Sport
Box 2 Exercises to strengthen secondary stabilizin
In each of the following exercise examples the movement
the position is held and the weight slowly lowered back to
and endurance. Perform each exercise for 8±12 repetit
movement. Medium (not heavy) poundages are used.
erforming leg lowering (Fig. 6). In supine lying,
e hips are ¯exed to 908 and the knees are
laxed. The neutral position of the lumbar
pine is found and abdominal hollowing
erformed. The abdominal contraction is
aintained as one hip is extended to allow the
ot to contact the ground. Initially, the foot
sts on the ground near the buttock and
radually the movement is performed with
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apy in Sport (2001) 2, 149±156
Hip Hinge
(Gluteals and erector spinae)
The subject stands with the knees slightly bent to relax the
free pelvic tilting. The action is to angle the trunk forward
on the ®xed hip, keeping the spine straight. The trunk m
returns to the upright position.
Lateral pulldown
(lattisimus dorsi)
The subject sits beneath a high pulley machine and grasps a
is to pull down until the bar rests either across the shoul
sternum.
Spinal extension
(erector spinae and gluteals)
The subject rests prone on an extension frame with the pe
low pad and the lower legs beneath ®xation rollers. The a
the body by moving the trunk on the ®xed leg until the b
Horizontal side support
(quadratus lumborum)
The subject begins in side lying with the body resting on the
The action is to lift the pelvis until the body forms a strai
shoulder.
Seated rowing
(Shoulder retractors)
The subject sits in front of a low pulley machine with the k
allow a neutral spine position to be maintained. The action
handle in towards the chest (lower sternum) while retractin
scapulae.
muscles
s slow and controlled. At the mid-point of the action
its starting position. The emphasis is on both strength
ns taking a full 4±5 seconds to complete the full
reater knee extension to allow the foot to touch
e ground further from the buttock, increasing
e limb leverage and, therefore, progressing
e resistance. Eventually, single leg raises are
erformed with the other leg still supported in
e crook lying position. The movement is
erformed with alternating legs initially
llowing one leg to rest on the ground before
e other leg is lifted. As a progression on this
*c 2001 Harcourt Publishers Ltd
hamstrings and allow
by moving the pelvis
oves to 458 and then
wide bar. The action
ders or at the top of
lvis supported on the
ction is to straighten
ody is horizontal.
underneath forearm.
ghtline from foot to
nees slightly ¯exed to
is to pull the machine
g and depressing the
act
but
fro
lift
mi
inc
the
pro
com
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un
low
I
edu
ach
now
re-
to b
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ere
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ret
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lift
Re
Atk
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*c 2001 Harcourt Publishe
F
Fig.
Fig.
ion, the limbs are again moved alternately
the leg lifts after the other limb has moved
m the ground. Finally, both legs may be
ed and lowered together initially with
nimal limb leverage and ®nally with
reasing leverage. Some authors recommend
Fr
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5 Heel slide action.
6 Leg lowering action.
use of bilateral straight-leg raises as a ®nal
gression of this exercise, but the
pression and shear forces imposed by the
as muscle upon the lumbar spine make this
suitable for use in rehabilitation following
-back pain.
n the third stage of training, when muscle re-
cation and static stability have been
ieved, apparatus may be used. The aim is
to use appropriate traditional exercises to
strengthen secondary stabilizing muscles and
uild relevant mobilisors. The muscles which
ist in stability, including the latissimus dorsi,
ctor spinae (Vleeming et al. 1990) quadratus
borum (McGill et al. 1996) and the shoulder
ractors (Janda 1994), are enhanced together
h the gluteals as they provide power during
ing. Suitable exercises are shown in Box 2.
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inson H W 1986 Principles of treatment. In: Downie P A
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	Functional load abdominal training: part 2
	Analysis of current abdominal exercise technique
	The sit-up
	Effects of foot fixation
	Straight leg raising
	Abdominal training based on spinal stabilization principles
	Building static stability
	References
	Figures
	Figure1
	Figure2
	Figure3
	Figure4
	Figure5
	Figure6
	Boxes
	Box1
	Box2