Spine stabilization exercise strategies are under debate in the physical therapy field. Some researchers suggest a local approach in which you isolate a single muscular effort. Other researchers suggest a global approach in which you contract many muscles at the same time. We find that patients that learn to isolate a single muscular effort are better prepared to then contract many muscles at the same time. Therefore, we provide a comprehensive approach by teaching both local control and global control. The best core exercise for local control is the abdominal draw-in maneuver.
Best Core Exercise
The abdominal draw-in maneuver (ADIM) targets the transversus abdominis muscle which is one of the muscles that make up the cylinder of core muscles. This is often a starting point for retraining the deep muscles that support the spine. The hooklying position (on your back, knees bent with feet flat) is often the starting position. It can also be performed in prone (lying on your belly), quadruped (hands and knees), sitting, standing, and can be combined with other functional movements. Please see the video demonstration below.
The Action of the Abdominal Draw-in Exercise
Patients locate their belly button. We describe the area below the belly button as their lower abdomen. We instruct patients to draw the lower abdomen down without moving the hips or spine. We also instruct patients to breath normally; you should not have to hold your breath. We tell them that we are training a muscle deep inside their belly that supports their spine. Patients are taught that if they feel that they are pushing their bellies out, they are training a different muscle. Patients are also taught that if they feel that they are hollowing out their entire abdomen up to the rib cage, they are are training a different muscle. We also cue the patient to simultaneously engage the pelvic floor muscles.
The physical therapist assesses for the quality of the contraction, the use of the proper muscle, the symmetry, proper breathing and length of hold. Contractions can be held for 5 seconds, and then we can progress the patient to 10 seconds, 15 seconds, etc.
Once the patient can activate the muscle, we layer other movements over this basic starting point. For example, the patient sits on a physioball or lays on his or her back while maintaining the abdominal draw-in maneuver. We can further progress patients by performing specific controlled arm and leg movements.