Matt Kurz PT, DPT
Prevent and Alleviate Low Back Pain with This Exercise Progression
Targeting the forgotten core muscle: the Transverse Abdominis
You probably remember some variation of a physical during elementary school, during which you may have run, performed sit ups, push-ups, or other tests. During the sit up test, you would have likely been told to “crunch” your midsection up towards your knees. This test, while assessing one muscle in our core, is not effective in assessing or targeting the most important muscle in the abdominal complex: the Transverse Abdominis (TA).
Our core has 4 primary muscles, the rectus abdominis, external oblique, internal oblique, and beneath it all, the TA. Unlike the other muscles of the core, the TA does not create visible movement in the trunk, but instead is responsible for bracing the midsection, stabilizing the spine, and limiting excessive forces on our skeletal and ligamentous systems.
A weak TA may cause instability around the spine, thus placing excessive loads on the skeletal and ligamentous structures that make up our low back, or lumbar spine. While our skeletal system and spinal ligaments are incredibly durable and can tolerate a great deal of force, every day movements with poor mechanics and/or TA weakness can cause our back to “give out" or gradually breakdown. This creates and perpetuates that low back pain cycle so many of us are familiar with.
Learning how to properly engage and strengthen the TA can help you avoid pain and build a stable lumbar spine. The first step to strengthening the core is learning how to properly activate the TA. Below is a progression of TA activation and stabilization exercises that you can begin to introduce into your routine. This would be a good warm up before your typical exercise or done simply on its own as an effective core building routine.
Progression #1: TA activation
Start by laying on your back with your hips and knees bent so that your feet are firmly planted on the floor or mat. Then contract your abdominal muscles by flattening your stomach, pulling your navel (belly button) towards your spine (like trying to fit into a tight pair of pants), and slightly flattening the arch in your low back. This is bringing your pelvis to a neutral position. Hold this position for 5-10 seconds, then relax. You can incorporate the breath into this exercise by exhaling as you tighten the core. Keep the core tight as you inhale and return to a normal breathing pattern. You can also practice this exercise in different positions for an additional challenge (lying, sitting, standing).
When to progress:
Once you can hold your core tight for a full minute without fatigue, you may progress to #2.
Active the TA as described above in exercise #1, as you slowly raise one knee in towards your chest, pause, then slowly lower. Alternate legs. If you feel yourself losing your core activation, pause the exercise and reset.
When to progress:
Once you can perform 10 consecutive repetitions on each side without disengaging the core or losing the neutral spinal position, you may progress to #3.
Engage the TA as described above in exercise #1, then bring one knee in toward your chest and hold your thigh with your hands. While keeping the TA engaged, slowly lift the opposite leg to about 45 degrees and hold for 3 seconds. Slowly lower and repeat.
When to progress: If you can repeat this for 2 sets of 6 repetitions on each side without disengaging the core or losing the neutral spinal position, then you are ready to progress to #4.
Engage the TA as shown in exercise #1 as you bring one hip to 90 degrees, then the other. Maintain the TA contraction as you slowly alternate lowering the legs to tap your foot to the floor or mat. Alternate sides.
When to progress:
If you can repeat this exercise for 2 sets of 10 repetitions without disengaging the core or losing the neutral spinal position then progress to #5.
Engage the TA as shown in exercise #1 as you slowly bring one hip to 90 degrees, then the other. Maintain the TA contraction as you slowly extend the one hip/knee until your leg is resting in an extended position on the floor. Slowly bend the hip and knee back to the starting position and repeat with the other side. It is important to check in and reset TA contraction between repetitions.
When to progress:
If you are able to perform 2 sets of 10 repetitions on each side without disengaging the core or losing the neutral spinal position, then progress to #6.
Start by lying on your back with your hips flexed and your knees bent to 90 degrees. Contract your TA as you slowly extend and lower your legs until straight and resting on the table. Keeping the TA contracted, slowly pick up both legs as you bend your knees and hips and return back to the starting position. Aim to complete 2 sets of 10 repetitions.
Remember, muscles take time to progress! Make sure you are comfortable completing each progression before moving onto the next. If you would like videos of these exercises, check us out on instagram at @wmphysicaltherapy. We encourage you to get in touch with us for a fully customized plan to get you on track for a healthy low back!
*Disclaimer: This is general information. No guarantees of results are made without the supervision and direction of a physical therapist. We encourage you to get in touch with us for a specific home program tailored to your individual needs.