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Journal of Bodywork and Movement Therapies (2008) 12, 31–36
Journal of
Bodywork and
Movement Therapies
www.intl.elsevierhealth.com/journals/jbmt
L.A. Sports and Spine, 10474 Santa Monica Blvd., #202, Los Angeles, CA 90025, USA
Table 1 Exercise profiles (Axler and McGill, 1987; Table 2 Stability training variables (modified
McGill, 1995, 1998; McGill et al., 1996). from Liebenson, 2007).
Safe exercises Unsafe exercises Intensity: submaximal, less than 50% of single
repetition maximum (1RM)
Quad single leg Sit-ups bent knee: Sets and repetitions: start with 1 set of
raise: 2000–2300 N 3350 N approximately 6 reps
Opposite arm/leg Sit-ups straight J Progress to 1 set of 15 reps
raise: E3000 N knee: 3500 N Further progress following the
Side bridge on Curl up on ball: reverse pyramid approach of adding
knees: o2000 N 4000 N a 2nd set of 12 reps then a 3rd set of
Side bridge on Prone superman: 8 reps
ankles: 2600 N 4300 N
Curl-up: 2000 N Hold times: emphasize endurance by holding for
one to two breaths (6–10 s)
Form: movements should be performed slowly
with appropriate form for motor control training
the subacute low back pain patient. Other factors and injury prevention
that should be considered include maintaining the Frequency: daily or twice a day to improve
‘‘neutral lordosis’’ posture, the abdominal brace, motor control
Duration: up to 3 months required to reeducate
and cardio-respiratory fitness or coordination of
movement patterns in a chronic patient
breathing with abdominal activity (Cholewicki and
McGill, 1996; Cholewicki et al., 2005; Gardner-
Morse and Stokes, 1998; Granata and Marras, 2000;
McGill et al., 1995). Incoordination in elite weight
lifters whereby they fail to control lumbar lordosis Other than the cat–camel which is used during a
has been shown to precipitate spinal injury warm-up all the other exercises are used to
(Cholewicki and McGill, 1996). Involuntary abdom- improve motor patterning and endurance. During
inal and back muscle co-contraction is an important these exercises a few fundamental principles
back stabilizing function (Cholewicki et al., 2005; should be observed. The spine should always be
Gardner-Morse and Stokes, 1998; Granata and neutral (e.g. slight lordosis). Normal respiration
Marras, 2000). Such co-contraction involves all should be maintained (avoid holding the breath or
the muscles encircling the lumbar spine in parti- always timing exertion with exhalation). The
cular the oblique abdominals (Grenier and McGill, abdominal brace should be maintained to keep
SELF-MANAGEMENT: CLINICIAN SECTION
2007). Active co-contraction or abdominal bracing the spine reasonably stiff. And, the thoraco-lumbar
has been shown to stabilize the spine during junction should be held in a neutral position—avoid
specific voluntary tasks (e.g. leg raising) (Liebenson hyperextension or kyphosis—by moving the anterior
et al., 2007). Fatigue during weight lifting has been ribs inferiorly.
shown to disturb the coordination between breath-
ing and abdominal muscle contraction, thus com-
promising low back stability (McGill et al., 1995).
Warm-up
individual functional capacity. However, a seden- The ultimate goal of care is to restore optimal
tary person, weekend warrior or elite athlete may function to enhance participation without limita-
all have equally large gaps. It is just that the tions in ADLs. The specific goal is to identify
athlete’s are skewed towards the higher perfor- a successful self-management routine, which
mance end of the spectrum (see Figure 5). allows for resumption of social activities with
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ARTICLE IN PRESS
A modern approach to abdominal training 35