Deydre Teyhen is the queen physical therapist in the States leading research on activation of the core using ultrasound imaging. I would guess that if you looked into what she has published, you’d find the answer. In acute low back pain, after manipulation, there is better recruitment, so the patient is able to perform a stabilization exercise more effectively. I do not recall the exact way the patient is told to perform the activity.

In the physical therapy world, for patients with low back pain, using the treatment based classification system, the individuals with hypermobility with lumbar segmental testing, aberrant movement, active straight leg raise greater than 91 degrees, under the age of 40. Hicks, Fritz, Delitto and McGill only described the stabilization exercises for the tranversus abdominus as “bracing.”

If someone has chronic low back pain, recent research (and forgive me for not remember who published it) is suggesting a lack of body awareness in the trunk region. The lack of awareness, I believe determined by lack of 2-point discrimination, actually leads to the person not being able to even perform stabilization exercises – no matter how you want to do them – bracing or hollowed.

I guess, the short response… I have no idea which is the best way. Research isn’t always completely specific in the details of the methods of performance of the activity.

I cue bracing using McGill’s “fight me” cue as I “rake” the clients’ core. I show them how to do it themselves by placing thumbs on the rib cage, fingers down and spread out so that pinkies and 3rd fingers are touching obliques and other fingers are hitting some combination of TVA and rectus abdominus. Then I cue them to basically push their fingers into their core and then resist all fingers with their core muscles. I find most people are surprised that this is activating the core, but almost all of them also comment on how much more stable it feels.

http://www.clinicalrehabspecialists.com/phpBB/viewtopic.php?f=2&t=36

I have found that the cue to “hollow” usually causes folks to posteriorly tilt and flatten their lumbar spines, which according to work by Sapsford and Hodges significantly reduces Core activity. Neutral pelvis elicits the greatest Core effort from each of the 4 inner unit components (Diaphragm, Transversus Abdominis, Pelvic Floor, and Multifidus).

Instead, I have found that cueing dynamic pelvic floor contraction to elicit deep Core function brings a better response. This is not a Kegel, which is an isolated isometric of the muscle group, this is a powerful contraction of one of the Core elements (“up and in”-works on dudes too). One study by Sapsford indicated that the Pelvic Floor actually turns on before all of the abdominals. Linking the pelvic floor to diaphragm action (following the rest-work cycle of the Core components established by inhale and exhale movement of the diagphragm) is powerful, particularly if performed in neutral pelvis.

Kind regards-Julie

a) Drawing in “feels” like a vulnerable position to be in. I would never walk a heavy squat out with my abdominals drawn’ in, as this does not feel safe (and there is even a slight flexion moment placed on the spine during the drawn in, as people posteriorly tilt with that position).

b) Like McGill states, core function is bigger than just one muscle (the TVA). The TVA needs to fire just prior to movement, to provide stability (just like all the inner unit muscles – diaphgram, multifidi, pelvic floor, tva – and if you read Kolar, in the ISS system, the deep neck flexors). So, drawing in is training the TVA to be a concentric muscle – but it doesn’t not serve a concentric action, so are we really getting what we hope to get from this sort of training?

c) The biggest issue with the drawing in, is people tend to not breath properly when they suck in their tummy. Breathing, and proper diaphragm acitivty, is essential to probiving stability to the spine (as well as allowing the T-spine to move properly, and the shoulder and upper extremity to function optimally). By drawing in, you lose that ability to push the diaphgram down and “belley breath”.

I teach breathing first, then bracing, and then “breathe with the brace” to integrate the two.

Patrick

On a performance front, I’ll simply say that hollowing never made much sense to me, since you have to consciously think about doing it, and in real life and sport, the blink of an eye can often be a moment too late, so relying on hollowing wouldn’t seem prudent. That said, my inner Frank Zane will occasionally cause me to practice a few brief sets of vacuums from various positions (supine, quadruped, and standing. I’ll exhale, draw in my navel, and then breath naturally for as long as I can hold it (although this tends to be a bit shallower than usual to prevent losing the draw-in). I can’t say that this contributes much, if anything, but I figure it can’t hurt, and it doesn’t take much time.

In any event, I will no stop my rambling and allow the more educated folks with clinical experience to have the microphone back. But thanks for allowing me to add my thoughts.

I kind of like it…but more so for the athletic population.

However, in a clinical situation…this can be VERY difficult. So can many of the above methods.

Is one strategy superior to the other in a clinical situation vs an athletic conditioning environment?