Abdominal Exercises not Involving LB (Full Version)

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Anonymous -> Abdominal Exercises not Involving LB (June 19, 2006 12:17:00 PM)

I'm having difficulty strengthening my abs without causing low back pain.

I've tried every ab exercise imaginable, and still have fairly severe pain in the low back.

Ab exercises that involve simultaneous contractions of the hamstrings+rectus abdominus seem to alleviate some of the LB pain, but I haven't yet found an exercise that gives my abs a good work out and doesn't stress the LB.

My PT gave me an exercise where I lied on a styrofoam roller on my back, lifted my pelvis into the air, put my hands behind my head to stabilize my neck while assuming a crunch-like position, and then I would roll the roller so that it touched my lower back, thus forcing my abs to work.

This seemed to cure most of the LB pain involved, yet it also tended to cramp my hamstrings. I'm guessing most the LB pain is stemming from my hip flexors, since the contraction of the hamstrings is suppose to help relax them.

Any ideas on exercises for the abs that will not contract the hip flexors. . .or is that even possible?

Thanks, and if more info is needed, just ask.



drbuddy -> Re: Abdominal Exercises not Involving LB (June 19, 2006 1:29:00 PM)

Have you tried side bridges, planks, or ab crunches? With the ab crunches, contract the abs even before you lift, hold, then curl up only until the scapula lifts off the floor.



Shill -> Re: Abdominal Exercises not Involving LB (June 20, 2006 7:52:00 AM)

nxixcxk,
In my opinion, Ab exercises are not often done as an immediate pain relieving mechanism, just as something that might lead to more "stability" and eventually less pain. Theres more to recovery from back pain than strong abs.

Buddy's advice on the planks or sidebridges is good, although I would have you hold off on ab crunches for now. I would have you learn to co-contract your erector spinae muscles prior to doing an ab crunch or any abdominal exercise with flexion of the spine. There is a lot of stuff out there about posteriorly tilting the pelvis for abdominal work, and NONE of it has any sort of basis in solid biomechanics of force dispersal away from the oft injured tissues. If you are currently getting PT, ask to go over your exercises with tweaks to make them non-painful, as you are not likely to get much from them in the long run if they currently reproduce and worsen your symptoms afterward.
A follow up question I would ask is what, during your average day, worsens your back pain?
Steve



drbuddy -> Re: Abdominal Exercises not Involving LB (June 20, 2006 8:50:00 AM)

Shill, what do you think of bridging for patients with LBP? The exercise where the patient is supine, knees bent, and raises pelvis off foor, and holds spine in the neutral position.



Anonymous -> Re: Abdominal Exercises not Involving LB (June 20, 2006 9:03:00 AM)

Thanks for the responses.

I have not tried side bridges before, so I'll try them. I have done planks, only I use one of those hand wheels.

Planks seem to work them well, so long as I am able to stabilize my back and prevent my pelvis from tilting anteriorly. . .otherwise it stresses my erectors too much. I also do a standing up variation of this, where I use a lat pull-down machine and pull the pulley bar down to my quads while making sure to stabilize my mid section. This gives me a good lat/ab work out.

Buddy, I'll try that modified crunch you suggested and see if it helps, but I doubt it will. Usually after 5-6 crunches I can start feeling low back pain.

It was also suggested to me that I contract my transverse abdominus (if that's the right word for the muscle), prior to doing flexion of the spine. I'm not sure what hte point of this was, but I do remember the contraction being very subtle.

Shill, how do I contract my erectors prior to doing a crunch? My guess would be that I tilt the pelvis anteriorly, but this seems like it would create more LB pain. (Generally, when I do any type of ab exercise, I try to flatten my LB against the ground via a posterior pelvic tilt)

As to your question, Shill, typically I don't have LB pain. I do have a "bubble-butt" or "ghetto-booty" and a noticeable anterior pelvic tilt, which, my PT once told me, contributes to my ability to jump high--but probably also contributes to my LB pain when I do ab work outs.

I definitely do not have weak erectors, b/c I do squats and weighted back extensions once a week. My abs, however, are weak in comparison with the rest of my body.

(PS. . .I'm not sure if this has any correlation, but when I was ~7years old, I was in a gymnastic class where the instructor made us do bridges and hold them for minutes at a time. I remember this caused severe LB pain. I also remember being able to do 80 situps in 1 minute at around that age, and only when I hit 80 or so did i begin to experience LB pain. As I've matured, that number has significantly decreased, not b/c I am not able to do that many, but simply b/c my LB pain kicks in at around 15-20 situps, thus preventing me from going futher.)



Sebastian Asselbergs -> Re: Abdominal Exercises not Involving LB (June 21, 2006 2:16:00 AM)

Dumb questions from me...Why do you do ab strengthening? What is your goal for your attempts? What is your purpose?



FLAOrthoPT -> Re: Abdominal Exercises not Involving LB (June 21, 2006 2:49:00 AM)

I'll be honest I agree with sebastian. How many non bed bound people under the age of 65 have functionally weak abs?? Now, the real question may be, how many people have poorly recruited and poor motor control of the functional unit of muscles that perform segmental stabilization. So that being the real question, it would be natural for me to answer that...BUT... will answer the original question. Lay on your back, put a blood pressure cuff under the space in the small of you back under your belly button. Bring your knees up with feet flat on bed/plynth/floor. Ijnflate the cuff until about 40 mmHg. Now Flatte your back and draw you belly button into the cuff until it gets to 60-70 mmHg. Ok, practice this a bit, because it is the important part for the rest. Ok..now that you can hold this and talk and breath hold it, conentrate on it, and slowly lower one leg down with knee straight until your heal is 1/4 inch above the table other knee still bent with foot on table. Keep the needle of the bp cuff between 60-70 the whole time do not let it drop. Try it 10 times or so and switch legs. When you get good at that, move on to doing the same with the bent le hoering above the table in the same position by about an inch. Repeat until you're good and switch legs....there is a whole long progression as you get good at this, adding in your arm with a swiss ball passing between arms and legs, etc..the trick is not to have an extended lumbar like they do in bridges nor a flexed like they do in crunches, but just bringing your back into a flexion direction yet staying closer to neutral. Your abs will surely feel it.....if this is not working..try this..:
Use a cable machine..get in the position facing the machine as if to do triceps...both arms straight and locked puch down on bar and flex at waist until you are bowing over keeping knees straight...slowly come back up and try to come into a bit of an arch with your pelvis coming a bit forward at the end, don't stop but try to reverse directions and go back down, repeat over and over.....there are 1000 more...the real point is why are you doing abs to begin with and what is causing your back pain because that will encourage and limit what you should be doing.

Dr. Benjamin Galin, PT, DPT, OCS



Shill -> Re: Abdominal Exercises not Involving LB (June 21, 2006 5:47:00 AM)

Buddy,
I think bridges are fine, seem to recruit erectors fine, and if one leg is lifted, this likely places some burden on multifidi, due to the need to not rotate.

nx,
Dont view your increased anterior tilt as a bad thing, and dont let anyone "correct it" unless it is actually causing a problem, which is awfully hard to prove.
To recruit the erectors during a crunch is tough, but not impossible. As you mentioned, try to anteriorly tilt first, but not to an extreme. This is best done while on a physioball, in a bridge position with your back on the ball, so that your spine can easily be palpated by you to assure you are maintaining both contractions. Purposely kicking in the erectors can inhibit the abs, and vice versa, and hence the difficulty. Again, it is trainable, just difficult.

As with Sebastian and Dr Galin, I think ab work can often be overdone. Nevertheless, this might allow you to do it without pain, so there you have it.



Anonymous -> Re: Abdominal Exercises not Involving LB (June 21, 2006 10:43:00 AM)

The purpose of my ab exercises are to strengthen my abs. It doesn't make sense to work every other muscle in my body save my abdominals. Naturally, the abs are working in a lot of the exercises I'm doing, but the work they perform is more of a secondary consequence. I want to be able to target them like I do the chest and back.

And I don't think my LBP is a result of overworking my abs. After 6-10 crunches, I start having LBP.

I'll try your suggestions Dr. Galin, I think I may already be doing the 2nd exercise you suggested. If we are talking about the same one with the cable machine, does the exercise also require you to work your lats?

The one I am talking about looks like this: http://www.e-weightloss-fitness.com/back_exercises/weightloss_diet_911.JPG

If she keeps her arms straight and brings them to her quads, she will have to use her abs to stabilize her torso if she is to prevent flexion of the spine.

I will also try subtly contracting my erectors before doing a crunch. Hopefully these exercises will help!



nari -> Re: Abdominal Exercises not Involving LB (June 21, 2006 11:15:00 AM)

I have the same question as Sebastian and Ben - why do abs???

If you get LBP after doing x crunches - why bother? Is it for general appearances?

Stabilisation would only help if you were very run down and weak, and that does not seem to be the case.

Nari



srcase -> Re: Abdominal Exercises not Involving LB (June 21, 2006 11:22:00 AM)

nx,
There is a reason why traditional ab strengthening exercises don't help people with back pain. Might I suggest checking out the book, Spinal Stabilization: The New Science of Back Pain, 2nd ed. by Rick Jemmett. It is written to be understandable to the layperson and professionals, and discusses the role of the transverse abdominis/multifidus muscles in stabilization of the spine.

These muscles become inhibited in people with back pain, thus any attempts at traditional strengthening only cause more problems because the motor control/timing issues create shearing forces in the spine rather than controlled motions. It's a great read and has many pictures with exercises starting from the most basic to the advanced. It is likely that your back pain will resolve after performing the first three exercises successfully.

The good news is you have stopped performing an exercise when it becomes painful, which is very smart. Just a guess, with your background in gymnastics and behavior of symptoms, you might have some sort of hypermobility problem, perhaps even spondylolisthesis (relatively common in gymnasts). Spinal stabilization is perfect for this type of problem. Good luck!
Sarah



tc -> Re: Abdominal Exercises not Involving LB (June 21, 2006 12:58:00 PM)

Have you tried any pilates classes?



rwillcott -> Re: Abdominal Exercises not Involving LB (June 21, 2006 3:11:00 PM)

I have to agree. Not all patients with LBP benefit from abdominal strengthening. There is a sub-group of patients that will benefit from abdominal strengthening.

Some PT's recommend McGill exercises (front plank, side bridging, front bridging) focusing on global muscles. Other PT's recommend more specific transversus abdominus and multifidus exercises (Richardson et al 1999).

If you meet some of the following prediction rules (Hicks et al 2005) I would focus on transversus abdominus and multifidus:

1. Abberant movements during forward bending (thigh climbing, catching pain, painful arc etc.)
2. Average passive SLR greater than 91 degrees
3. Hypermobility of lumbar spine ( assessed using PA mob)
4. Positive Prone Instability Test
5. Age less than 40
6. Fear Avoidance Beliefs Questionnaire (FABQ) Physical Activity score of greater than 9

If you meet some of these rules than there is a higher chance that you will benefit from specific stabilization exercises focusing on transversus abdominus and multifidus.

The description Dr. Galin gave using the pressure biofeedback unit is one of the more effective ways to train these muscles. Also, you would require a PT who is trained in the evaluation and teaching of these specific muscles since there are many ways to cheat when performing these exercises.

Hope this helps,

Rob

PS: There is a study by Koumantakis et al 2005 that compare general and specific spinal stability exercises. Be careful when reading this study since it it severely flawed. They excluded all patients that showed signs of spinal instability before beginning the study!



FLAOrthoPT -> Re: Abdominal Exercises not Involving LB (June 21, 2006 4:25:00 PM)

i am flattered by the Dr.Galin...I just finished my T-DPT, but I hate the way it sounds!!!!SO, from here on out..Ben works fine! I still think that any ab exercise should be incorporated into any functional strengthening and unless someone is purposely looking to create more defined abs (well first drop the body fat) then that is one thing, but i think we all agree the old precription of ab crunches for low back pain is not only disproved scientifically but can even cause injury or worsening of the underlying problem especiialy if there is hypermobility problems or recruitment issues. For example why do a pure bicep curl when you can do it standing with your back to a cable machine and recuit your abs while doing it, I think the whole mantra of functional training may be somewhat of a buzz word, but it is WAY underused and under adopted not only by PTs but in the hwole fitness world. Ok I am back to mind numbing tv, thanks for the ego boosts though everyone!
Doc Ben



nari -> Re: Abdominal Exercises not Involving LB (June 22, 2006 12:20:00 AM)

(Dr) Ben,

Congratulations and may all your clinical thoughts be great ones!

Nari ;)



Randy Dixon -> Re: Abdominal Exercises not Involving LB (June 22, 2006 2:27:00 AM)

NX,

I'd echo a lot of what has already been offered. There really is no need to specifically train the abs if you are training functionally. I take it you are doing Janda situps, contracting the hamstrings while crunching, the idea is that it will inhibit the hip flexors, but this has come into question. I think the issue you should be concerned about is not WHAT ab exercise you should do but WHY does ab exercises hurt. The most likely reason appears to be hypermobility, lack of stability. I think Sarah C.'s reference is good, here is an article to get you started:

http://www.performbetter.com/catalog/matriarch/OnePiecePage.asp_Q_PageID_E_79_A_PageName_E_ArticleBoyleAreYouDown



Sebastian Asselbergs -> Re: Abdominal Exercises not Involving LB (June 22, 2006 2:31:00 AM)

"The purpose of my ab exercises are to strengthen my abs. It doesn't make sense to work every other muscle in my body save my abdominals. Naturally, the abs are working in a lot of the exercises I'm doing, but the work they perform is more of a secondary consequence. I want to be able to target them like I do the chest and back."

This answer basically clarifies to me what you try to do in the gym. Not what your goals are. Strength? What kind? What for? A sport? Aesthetics? Why "target" muscles if not for aesthetics?
Have you been tested to show that you have weak abs? And how?



Anonymous -> Re: Abdominal Exercises not Involving LB (June 22, 2006 7:52:00 AM)

Thanks for the additional sources, I will check them out.

It's great hearing the wealth of information provided on this forum!

Planks hurt my LB just like crunches do, and it turns out that only after ~4 crunches does the LBP kick in.

Side bridges worked great, however!

Functionally, I do not think my abs are weak. In comparison with my other muscles, however, they must be weak since I can't remember the last time they were sore. (I'm sure a muscle can gain strenght w/o that sore feeling, but still!)

The additional strength added to my abs is partly for esthetics, and partly for increasing my vertical leap. Plus, I enjoy participating in exercises that require a lot of physical strength. I enjoy being able to do pull ups, handstand pushups, one-armed pushups and one-legged squats. Something about manipulating my body weight around like that brings me enjoyment, and I know that if my abs were stronger, these movments would become easier.

and tc, I have not tried any pilates classes. I remember doing a few yoga classes a while back, and some of those positions slaughtered my LB :( .

(PS, the LBP I experience isn't palpable, nor does it reappear when I strum my erectors like a guitar string. Because of this, and because contracting the hamstrings seem to alleviate some of the LBP while doing situps, I thought that the P was probably caused by the psoas msucle).



Anonymous -> Re: Abdominal Exercises not Involving LB (June 22, 2006 7:54:00 AM)

One more thing, "stomach vacuums"--where you suck in your stomach as much as you can and hold it, also causes the same LBP that crunches do



tc -> Re: Abdominal Exercises not Involving LB (June 22, 2006 9:55:00 AM)

the reason i mention pilates is that i found it is very different when used in rehab and quite effective. i had a lumbar strain than was extremely painful for walking, standing, sitting, etc. and i did very low level (to start) pilates exercises in PT and it did wonders. It is very gentle to your body while it strengthens it. I am not able to do yoga, either but could do the pilates. But I wouldn't recommend just a pilates class at your local gym, I'd go see a PT trained in it. Sometimes they offer classes at PT clinics in the evenings or you could go for individual therapy.
good luck



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