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Exercise of the Week: Advanced Abdominal Brace

A long time favorite in my clinic, this "anti extension" exercise fits the bill for  aggressive abdominal co-contraction, lumbosacral stabilization, and whole body frontal plane stabilization.  It is also a "self limiting exercise", defined by Alwyn Cosgrove and Gray Cook as one that "requires engangement and mindfulness, and provides an automatic yet natural obstacle that prevents you from doing it wrong, or doing an excessive volume".  In this case, the "obstacle" is the neutral spine position itself- you can either sense and hold the correct position or not.  When you lose the position, it becomes very apparent, as it is easy to sense this quickly.  I refer to this feeling as "fatigue extension" and I have never had a patient or trainee not understand how this is sensed.  

Below, I outline two progressions, using an adjustable 45 degree back raise for both.  Equally as useful for the advanced progression is a GHR machine or Roman chair. 

 

PROGRESSION ONE

The first progression here is at 45 degrees.  This allows a shorter lever arm for the trunk musculature to deal with initially, as this exercise is harder than it looks. 

The key to set up is ensuring that appropriate neutral spine is achieved by guiding the trunk position at first using the arms. This is important at first, as a person with weaker abdominals may end up in too much of a lordosis to start.  Once you have the strength and motor control to understand the position, arm guidance isn't as imperative. 

Another important technique note includes appropriate neck positioning.  You can use the "neck pack" position, or just imagine a tennis ball sitting between your sternum and chin (the way I learned it ~20 or so years ago from Beverly Biondi).  This way, you also get great deep neck flexor activity, which in turn helps reflexively reinforce the abdominal activity (which is why you're here in the first place!). 

 

 

 You can also see that the lower quarter is pretty active as well.  This is important, as your shins, and or feet (as we will see below) are the anchor point for the whole technique, and vital if you want the pelvis to stabilize neutrally from "bottom up" (which, obviously, you do). 

When used in a strength and conditioning program, I start with 10 to 15 seconds per set, with 45 seconds to 1 minute of rest between sets.  5 to 10 sets per session are performed.  We progress up to 30 seconds per set before going "arms overhead", and then start back with decreased rep times (10-15 seconds) until 30 seconds can be maintained  for multiple sets.  Dumbells can be added after this, again decreasing time under tension at first, until good lumbopelvic control can be maintained and progressed. You can also choose to perform this activity between sets of your main strength exercises, as it shouldn't interfere with technical performance of your main lifts.

When we use this clinically for our lumbar spine patients, it is always later in their overall program, usually a minimum of 4-6 weeks after treatment has started.  Symptom control, hip and lower quarter mobility, and good understanding of basic abdominal bracing progressions are needed before moving to such an advanced activity.  Sets and reps can be progressed as outlined above.  The lumbar spine patient population is generally good with the first progression, and does not need to move on to the next progression unless their sport or activity level demands it.  

 

PROGRESSION TWO

Here, we are using a "parallel to the ground" position, increasing the lever arm that the abdominals have to deal with in resisting extension.

 

 

 

 Again, I utilize my arms to set up the "neutral spine" position, both entering and exiting the set.  This is even more important in the second progression, as the abdominals have to work ridiculously hard to maintain a neutral position due to the leverage demands.

Other things to consider with this progression:

1)  Set the glutes by squeezing your butt as well as isometrically externally rotating your hips.  Again, this provides a firmer pelvic foundation for the abdominals to work off of.

2)  Notice that my instep is the base of support for my feet vs. the shins.  This is a subtle way to increase the lever arm, making the exercise more challenging.

3)  Arms overhead should be used ONLY after a good, solid repetition can be held for 10-15 seconds over 5-10 sets.  This goes for dumbells in the hands as well.

4)  The set terminates when the lumbar spine falls into fatigue extension.  Trust me when I say this is easy to figure out when this occurs. 

5)  Remember to use your arms to "rescue" yourself from the, as "sitting up" is nasty for lumbar spine shear forces.