The Basics of Lumbar Stabilization, Part I

I've beem somewhat reluctant to blog about the specifics of my physical therapy because I've been questioning the ethics about detailing my own therapy regimen.  I wouldn't want anyone injuring themseles in any way trying to do what I'm doing.  Then one of the assistants at my practice mentioned that she recommends to patients that they keep a journal about their therapy to chart their progress.  When I told her about this blog, she thought it sounded great.  So this is what I decided: I can only talk about my own journey and what that entails.  As with any new exercise you want to try, please discuss it with your doctor before starting on your own. While the purpose of these exercises is to stabilize the spine through core strengthening, doing them, or for that matter any exercise incorrectly could in fact be damaging.

The basis of all spine stabilization exercises is the transverus abdominus contraction, or TrA.  If you don't have this manuever down, the exercises will not be effective.  I found the following on the internet which I thought could explain the basics of it better than I can:

Transversus abdominis (TrA) contraction

- It is essential that this is mastered before progressing any further

- For all core stability exercises a TrA contraction should be maintained

- Lie on back with knees bent to about 90º and pelvis in neutral

- Rest your left hand on your stomach at the level of the bottom of the rib cage

- Place your right hand just inside the pelvis – on the soft tissue immediately inwards  from the bone.

- As you contract your TrA, you should feel a slight tightening under your right hand, but no change under your left hand. Think about tightening your pelvic floor muscles and the abdominal muscles below your navel. You should feel the part of your abdomen below your navel sinking down towardsthe floor – ‘abdominal hollowing’

- Make sure you keep breathing normally whilst you hold the contraction

- Practise this until you can easily

My doctor also told me to put my hands on either side of my stomach (kind of like when you put your hands on your hips) and press my fingertips in, and that a proper TrA contraction should push back against your fingers that are pressing inwards.  So it's sort of like you're holding the front of your stomach in while pushing the sides out.  It's a little tricky to learn but once you know it, it becomes second nature.  They have also mentioned to me at various times thoughout the last couple of months that without overdoing it, I should try to maintain The TrA contraction as much as possible throughout my waking day - even when I'm not exercising.  This again reminded me of ballet class when I was a child, and the teachers who taught me that if I always held my stomach in, the muscles would learn to stay that way.  I kind of wish I had stayed with that, but then it's never too late to start again.

Moving on, I'm going to share a few of the beginner exercises for lumbar stabilization.  Just make sure you have the TrA down before you start these.  That's not something you want to rush through learning. 

1. Basic TrA Activation - Quadruped

-Support yourself on your hands and
  knees with your back flat
-Eyes looking down
-Draw in yor lower abdomen while gently breathing
 Eg. "Pull your belly button into your spine"

       "Hollow out your stomach"

2. Basic TrA Activation - Supine

-Contract pelvic floor
-Draw in lower abdomen while gently breathing
-Use your fingertips to monitor muscle contraction, just inside the front corners of your     pelvis (what I was talking about earlier)
-You should feel a small to moderate amount of tension develop under your fingertips as you contract the pelvic floor and TrA (and more to that end)

3. TrA with Arms Reaching Overhead

-Manitain TrA contraction while letting arms move overhead.

-Only move arms as far as you are able while keeping TrA contracted

4. TrA with Bent Knee Fall Out

-Maintain TrA contraction while letting knee move slowly outwards  towards the floor
-Once to the right, then once to the left = one rep

I started all my exercises with one 10 rep set.  I'm onto intermediate exercises and I still do one 10 rep set of each, every other day.  When we first started they wanted me to do more than that and it ended up hurting me so we dropped back, and this is what works for me - for now.  This is not "go for the burn" exercise.  This is getting your body strong in a smart way that will help your body protect itself against pain and further injury in the future.  This is not exercise for weight loss, although now that I'm building some muscle tone I have dropped a few pounds.  So if you're looking for some crazy lose five pounds a week kind of fad thing, that's not what I'm about.  I'm okay with slow, smart progress.  You want to know why?  Because I have been feeling better, and for now that's worth more than fitting into my skinny jeans.  I'll worry about that stuff later.

I probably won't blog again tomorrow, but I am going to try to get a post up about once a week,  Hope everyone has been well.  See you again soon!