Fascial ‘Core’ Stability (Hollow or Brace?)
Even today, core stability is a heated topic in the movement therapy world. There are many different schools of thought, some based on evidence and some based on tradition. Unfortunately it can be difficult to know what is a charismatic opinion and what is an evidence based view. It’s important to be informed by research as this has an influence on our movement/therapy practice either in the studio, gym or clinic. It’s a professional duty (and ethic) as health practitioners to be evidence based with our approach to an individual’s movement and health… why? - Because it’s their health!
Back pain is a multifactorial world wide issue. Although there have been studies (1-4) showing a correlation between lower back pain and ‘weak’, ‘delayed’ or asymmetrical ‘core’ musculature (typically transverse abdominis and multifidus being studied the most), there are MANY other reasons for an individual experiencing lower back pain that go beyond the study of the trunk musculature. However, if we’re going to talk about ‘core’ stability (as exercising the trunk can be beneficial for some back pain individuals), then we should address how the geometry of the lower back fascia helps optimise the contractile forces of the deep abdominal soft tissue. Are we working with this mechanism or against it?
Lumbar ‘stabilisation’ is achieved through the successful communication of three sub-systems, active (muscle), passive (ligaments), neural (afferent/efferent nerve signals). The transverse abdominis is thought to be one of the primary ‘stabilisers’ of the spine (although it has other functions too). The transverse abdominis is a ‘membrane tightener’ (a term borrowed from Dr. Robert Schelip) as it ‘pulls’ on a distinct fascial structure - Lumbar Interfascial Triangle (LIFT). The LIFT can be located along the lateral border of a fascial membrane that envelopes the erector spinae musculature - the paraspinal reticular sheath (PRS). The LIFT can be viewed as an intersection between the posterior ‘layer’ and middle ‘layer’ of the thoracolumbar fascia (5).
The theory is for the transverse abdominis to transfer forces efficiently to the spine (transverse processes), the LIFT has to be in the ideal geographical location. This requires the activation of the lumbar erectors to ‘push’ out into their surrounding collagenous tissue (PRS) when increased force is placed on the spine, moving the LIFT slightly forward and in-between the transverse abdominis and transverse processes of the lumbar spine. This is known as hydraulic amplification. The supposive advantage of this mechanism is that it allows the spine to tolerate more load (becoming stronger), reducing the risk of injury. This isn’t to imply that if this fascial mechanism isn’t ‘perfect’ this will increase the risk of injury as the spine can adapt (Wolff’s Law 1892).
Typically the ‘hollowing’ strategy for ‘core’ engagement down regulates the erector spinae (6). Although there may be specific clinical scenarios for using the ‘hollowing’ technique (post an abdominal surgical intervention for example), it’s not necessarily a ‘functional’ long term solution as we don’t naturally ‘hollow’ the abdomen to perform sagittal lifts (lifting objects off the floor, squats/deadlifts).
It’s important to consider the myofascial arrangement of the lower back as this can inform what approach we decide to take when training an individual’s abdomen (do we hollow, brace or neither?). This ability (or lack there of) for the fascial tissue to move for optimal force transfer may align with the research correlating lack of lumbar spine mobility and back pain (7).
As always the appropriate intervention depends on the individual. Despite this, anatomy is informed by function. Understanding human anatomy gives us deeper insight into human function and performance - surely this is what we’re aiming to improve in exercise and rehabilitation in the first place? As it is theorised that the deep fascial system of the spine significantly aids in the ability to exert more force when lifting, hollowing isn’t the best strategy as it down regulates some of the primary muscles for lifting (the erector spinae), decreasing the overall power and ‘stability’ of the spine (8).
Do you want to become a better movement practitioner and deepen your knowledge about the fascia of the lower back to help your clients move with more freedom and less discomfort?
Become a Franklin Method Lower Back Fascia Trainer, 9-11th October!
To book click on the link below:
Lower Back Fascia Trainer Online Certifcation
Movement is medicine.
Tom
References
1.The relationship of transverse abdominis and lumbar multifidus clinical muscle tests in patients with chronic lower back pain. Julie Hides, Warren Stanton, M Dilani Mendis, Margot Sexton. 2011
2. Multifidus muscle recovery is not automatic after resolution of acute, first episode of low back pain. J A Hides, C A Richardson, G A Jull. 1996
3. Evidence of lumbar multifidus muscle wasting ipsilateral to symptoms in patients with acute/subacute low back pain. J A Hides, M J Stokes, M Saide, G A Jull, D H Cooper. 1994
4. Inefficient muscular stabilisation of the lumbar spine associated with low back pain. A motor control evaluation of transversus abdominis. P W Hodges, C A Richardson. 1996
5. A description of the lumbar interfacial triangle and it’s relation with the lateral raphe: anatomical constituents of load transfer through the lateral margin of the thoracolumbar fascia. M D Schuenke, A Vleeming, T Van Hoof, F H Willard. 2012
6. Comparing lumbo-pelvic kinematics in people with and without back pain: a systematic review and meta analysis. BMC musculoskeletal disorders. Laird, R. A. Gilbert, J. Kent, P. Keating, J L. 2014
7. Effects of performing an abdominal drawing-in manoeuvre during prone hip extension exercises on hip and back extensor muscle activity and amount of anterior pelvic tilt. Jae-Seop Oh, Heon-Seock Cynn, Jong-Hyuk Won, Oh-Yun Kwon, Chung-Hwi Yi. 2007
8. Is the lumbodorsal fascia necessary? Serge Gracovetsky. 2008