You were listening to the nasm CPT podcast with Rick Richie the official podcast of the National Academy of sports medicine. Welcome to the nasm CPT podcast. My name is Rick Ritchie. And today we're going to have a debate the debate is on whether there is a controversy here between drawing in the navel to stabilize the spine or abdominal hollowing versus to brace this. Heh.embracing so abdominal hollowing or drawing in the navel sucking in the belly button towards the spine and that's where the transverse abdominis is primarily is which wraps around the entire abdominal region when you contract that it sucks the belly button in towards the spine abdominal bracing on the other hand is almost like I don't know you're gonna get punched in the abdomen and you tighten your core really tight in order to make your abs tight so which Is a value in order to stabilize the spine and the debate is really coming because there are people that have a tendency and these are Professionals in the field that do this as well. They have a tendency to pick one and then they downplay the validity and the value of the other even though they both have plenty of research behind them so show value it's just why are they valuable? And what did they do? And is there a potential where one would work and Lieu of another or work better than another so we're going to look at the evidence today. This is going to be a research heavy day. And I don't actually I've got all the research here and I've got it written out but I write out their name, so I can't pronounce a lot of these peoples names and there's a lot of atolls in here. So what I'm going to do is I'm just going to say research shows and that's going to that's going to help to cover my base for the Purposes of this podcast and then we'll be able to provide some maybe some written content. So you can look at some of the research itself. If you wanted to look it up and find out where it comes from but let's talk about research surrounding abdominal hollowing and abdominal bracing we're provide a better understanding of the literature and the research and the evidence that is out there. Now one thing very important to note a research study doesn't prove anything research studies. Don't prove anything. Search studies show a correlation between variables and it is important to use all of the research that's out there. So this is things like systematic reviews. These are meta-analysis. This is taking all or many of the research that is out there on a particular topic put it together in a large study to find out what content is there and see if it creates a better whole picture understanding of what certain things do. So with that being said, Ed there is a lot of research on each one of these topics. So what I want to do is discuss it and get into the idea of where these things started and really a part of it started with Berg Mark who in 1989 identified the lumbo-pelvic hip complex and divided it into two systems like a local system where those are the intrinsic stabilizers of the spine and a global system which are the Larger movement muscles of the spine that also crossed the lumbo-pelvic hip complex and these muscles influence everything that we do because the lph see the lumbo-pelvic hip complex. The core is the center of the body. So anytime we push with the arm then it has to Anchor itself onto our axial skeleton with muscles and the axial skeleton has to stay strong in order for us to push pull rotate and stabilize things when we are grasping. So same thing goes with our legs. So the core is very important and exercise and we're going to look at let's let's talk about abdominal hollowing first. All right. So let's just have the conversation of domino hollowing is drawing in the navel towards your spine and there's a landmark study that created this this real big buzz around the transverse abdominis and its importance in training. So a very long time you started getting people across the boards and Fitness and in Pilates and modalities that were really important and helping with spinal stabilization queuing over and over again draw the navel in belly button in belly button towards the spine. So whatever their their language was in order to use it people are trying to get people to suck their belly buttons and towards their spine activating their transverse abdominus and creating this intra-abdominal pressure through the drawing in maneuver. Well, that's a good it was good because there's a there's content to support that we're going to talk about it. But let's talk about where it got its start and Richards Richardson and Hodges had a landmark study back in the day and I don't actually have to study written down in my notes right now, but it is a landmark study and it showed that there was a delayed and transverse abdominis activation for people that experienced chronic low back pain. People with chronic low back pain when they would have them do a movement muscles would activate and then it would be a delayed activation of the transverse abdominus and this was a very important thing to notice and so they started pushing this concept and and the industry started picking up on the concept that spinal stabilization and lower back pain was linked with the transverse abdominis. Now, we don't know if there's a chicken or an egg situation though. That is the lower back pain in existence because there was a delayed reaction in the transverse abdominus or is there a delay in the transverse abdominis because their back hurts we don't know but I think one of the concepts here is that people would start creating this Pre activation of the transverse abdominus to support the spine. So they would say drawing your navel and that would then create this spinal support before people would start to do movement and exercises. But a study in 2009 came out and said that these patterns are exhibited in multiple different muscle types. Not just the transverse abdominus so that might happen with the internal obliques. I might happen with rectus abdominus or the ql that these delayed activation patterns are not solely seen in the transverse abdominis, which people are low back pain and they're not solely seen in people with low back pain that there is always some type of delay. Way in something when people are doing exercises when it comes to muscle recruitment Activation. So we're we're almost at a stalemate right now these Concepts because yes as a transverse abdominis important to spinal stabilization, I believe so lower back pain. Yes, we believe so but what is the literature than continue to say about the drawing in maneuver? And then we spent a little bit more time talking about abdominal bracing. So the stabilization of the spine is incredibly important. Yeah, I don't think you're going to find any therapist or researcher that's going to argue that point that it's not it definitely is and we're going to we're going to go through some of the literature talking about a gentleman named Stu. McGill Stuart McGill. It's kind of like the father of spinal exercises and spinal research when it comes to exercise but Stu McGill downplays the value of drawing in the belly button or abdominal hollowing Slowly so just solely abdominal hollowing. So let's talk about some of the research that's out there. Let's talk about Stu McGill stance. Let's talk about abdominal bracing and evidence does show that the Deep abdominal muscles are going to be more activated with abdominal hollowing than surface muscles that actually are activated more when you do abdominal bracing and abdominal hollowing has showed to increase local spinal stabilizers strength. Been shown to say that we're going to minimize the facility facilitation of the global muscles during activity when you're drawing in so the other muscles don't have to support in it stabilization as much when the drawing in maneuver takes place abdominal Halloween was found Superior to abdominal bracing for increasing lumbo-pelvic hip stability and legs stiff and stiffness and hopping task. So single-leg Dynamic activity. Well again, that's one study. But this was the outcome that was seen and though it does seem that maintaining a neutral spine and Costo diaphragmatic breathing that is chest and belly breathing is important for the optimization of abdominal hollowing when it comes to stabilization of the spine. So that means when you go into like an anterior pelvic tilt and do abdominal bracing or posterior pelvic tilt then it doesn't stabilize the spine as much as when you 10 more of a neutral spine position also when it comes to breathing doing just belly breathing or just chest breathing is not as advantageous when it comes to stabilizing the spine as it is if you use both you breathe as a unit not just pick your chest or pick your belly in order to breathe from which I believe is probably a better outcome when it comes to breathing anyway using the entire abdominal a thorax region to support breathing. Then then we find research that supports that doing that while abdominal Halloween helps to support the spine. Okay. There's also some very interesting information about breathing when it comes to stabilization of this by and and there was a study done and McGill was part of this study that talked about expiration and the full expiration if you just breathe everything out shows It's significant increase in external obliques internal obliques transverse abdominis activation when compared to both abdominal hollowing and abdominal bracing. So I like adding this into it because we're looking at now using our breathing to help create support for the spine while doing exercise and what might that look like. So again, this is this is the research we're not looking at any practical applications right now. We're just finding research that I see. supporting the validity of doing the drawing in maneuver abdominal hauling As a thank you for listening to the nasm CPT podcast. I've got a special offer for you 20% off of any nasm order. You can use that 20% to get certified as a personal trainer through a CPT program the standard for the fitness industry or expand your career with one of our specializations, including our latest One nasm Nutrition certification, which gives you the skills to be a certified nutrition coach get 20 percent off your order by calling 804 6-0 6-2 7-6 or visiting nasm or org and using the code podcast 20 that's 804 6-0 6-2 7-6 and the discount code is podcast 20 start changing even more lives today. But the debate is not over because they're researchers that note that abdominal bracing is a more effective technique to activate the Deep core musculature. And I think that's interesting because usually when you get people who are advocating for one or the other then you'll have the abdominal hollowing crew that says it's better for the smaller muscles around your spine and the bracing is better because I can be better for certain. Things because the global muscles are starting to work and to help stabilize the spine, but I don't think that that is completely and always the case. So we want to be conscious of what the information says and then how we start to apply it. So we've got here a vertical jump Landing tests and they had abdominal bracing and says that it shown to enhance pelvic stability increase sensory motor. And positioning of the lower extremity and helps with reducing biomechanical factors associated with ACL and a jury while protecting the lumbar spine. That sounds valuable. Let's look at and you know check mark for abdominal bracing. We've got multiple data out there that questions the efficacy of treating lower back pain solely by using abdominal hollowing. So for those that say somebody's got lower back pain just do abdominal hollowing and that can help. Mitigate the effects of lower back pain and that's not necessarily true either research out there supports it. But if you're looking at it said you're all you're doing is abdominal hollowing then you might not be doing enough. So let's continue down this this this line of questioning here. Let's go back to McGill. Now who's arguably one of the generations top researchers on exercise and it's fun and admittedly he is not a fan of abdominal Halloween because he argues that the transverse abdominus should activate when you do abdominal bracing and he's a big proponent of abdominal bracing in order to stabilize the spine, but why I only draw in when when you can support the spine from multiple different ways that create intra-abdominal pressure and have the transverse abdominis be a supporting role in that as well. As matter of fact, he he said in his textbook. Let's see his textbook which I purchased recently. I'm a big fan of it's called Low back disorders evidence-based prevention and Rehabilitation. It's in its Third Edition, which is the one I have and I like this and in there he talks about The transverse abdominis and says that they yes, you need to have the transverse abdominus be a part of this and it's a vital importance for the transverse abdominis to participate in stabilization of the spine, but he just doesn't believe that abdominal hollowing is the best way to do that. He believes abdominal bracing and engaging the transverse abdominis is highly indicated for that and I'm I like that I like the idea of saying Let's do bracing and he's not saying do abdominal hollowing as a matter of fact, he says that the isometric activity should take place that when you do your abdominal bracing you're not drawing in and your abdomens not protruding at all. As a matter of fact, there is no change in the size of the and the abdominal muscles. You're just creating stiffness. And his ultimate goal when it comes to protecting the spine is creating stiffness around the spine. Well, I agree. I think this is really wonderful information. So so far. I've agreed and pointed out literature and empirical evidence that shows abdominal hollowing helps to increase stability at the spine and helps with low back pain. I've also found research and pointed out that doing abdominal. Living solely solely for mitigation of low back pain is not ideal and that abdominal bracing can be more effective in certain circumstances than Hollins. What do we do? What do we do? We got evidence support support both but here's the thing and application. What should we employ? I think early on in stages of training. You got to you got to Q abdominal hauling and it's probably it's a good starting point when it comes to trying to get somebody neuromuscular lie to understand what's going on and how to create this transverse abdominis drawing in maneuver. So practicing drawing in is valuable and practicing abdominal bracing is valuable because once you go into abdominal bracing it, you're going to get more out of your stabilization. Let's say you're doing a standing single arm chest press and you're not bracing your abdomen. You're just drawing in. Well, you're missing out on some of the stiffness that you're all of your muscles can help to create stabilization through your LP HC. So adding stabilization in adding in the drawing in maneuver or the abdominal hollowing to support your spine is vitally important to know how to do both of them. But what I don't want to do is downplay the importance of increasing neural facilitation towards a particular muscle that may not be doing its job and we know that the transverse abdominus and internal obliques are very closely. And it's almost impossible to to separate those two muscles when it comes to spinal stabilization. So when you draw in the navel, then you are also getting a very strong activation of your internal obliques that is going to work concurrently with each other through the thoracolumbar fascia or aponeurosis to stabilize the spine and the SI joint, which we also have support from drawing a maneuver and bracing to support The SI joint so doing these particular exercises drawing in an abdominal bracing are both valuable. Don't pick one at the loss of the other. I think you should practice both same way that you would say. All right. Well, I'm going to work. I don't know where let's say calves right but you don't want to work your posterior tibialis. Well, that's that's going to be difficult because they're all plantar flexors. So posterior tibialis is going to be an important component. That's going to help support plantar flexion, but might there be a time where through trying to get the best out of learning how to control the foot that we preferentially activate the posterior tibialis in order to create more support at the foot and ankle and that the answer is going to be guests. Of course, we can put our foot into plantar flexion and then we can create inversion and do plantar flexed inversion exercises in order to to strengthen the posterior tibialis and that can then help to support my foot and ankle complex as I go through ambulation and movement. While going through plantar flexion and eat the same thing or similar thing would happen at the core. I can work everything together. But sometimes you need to pick out some muscles and whether that's the transverse abdominis or where it was the primary focus on the lumbar multi fat, I or whatever it doesn't matter. Sometimes you have to focus on pieces and not the whole So incorporating abdominal hollowing into your training drawing in the belly button to help support the spine those local muscles vitally important. They should be practiced doing abdominal bracing to support the spine, especially as you start to do heavier lifting. You can't just draw in and do a heavy lift. It is a natural component where you start to lift heavier you start to increase the bracing and the intra-abdominal pressure. So And say if you're going to start out with somebody and we're going to pick a pattern to follow maybe start out with some abdominal bracing. Sorry abdominal Halloween getting people to practice sucking in the belly button and support the smaller muscles of the spine and then start including bracing into it where you're creating transverse abdominis activation and co-contraction of a lot of muscles. So we're talking about the internal obliques and external obliques. And if you look at the pattern of those things when you brace and draw in you the Internal and external obliques create a crisscross pattern thing about a crisscross pattern like if you're walking through Construction in New York City and you see scaffolding up you walk through all of that scaffolding has X shaped metal creating a crisscross in there and that that egg shape that crisscross pattern creates stability and we want that stability. Fortunately. We have internal and external obliques on both of the sides the flanks of our body that creates spinal stabilization because they run, Obliquely, they have support and sagittal plane transverse plane and then they're on the side of our body. So also in the frontal plane. Why why just pick drawing in when I know that we can do other things that support our spine? We are also looking at rectus abdominus can be a component that helps to support our our spine the way that our thorax and our pelvis stabilize but it is that drawing in maneuver that does work all of those smaller muscles in the lumbar spine. Let's get both of them practiced in our systems and as we start to get heavier and heavier. With the weight we start adding in more and more bracing because we already know that the drawing in maneuver is there to support the smaller stabilizers in our spine. All right. I hope this helped and basically what I said is both abdominal hollowing and abdominal bracing work and do them both. Why is there a debate because you may do one and not the other and you made downplay the value of the one that you're not doing don't do that. This is an integrated training model when you find information that works and is of value. You just start integrating it into your system find the truth and as much truth as you can fit into your workouts and how you work with coach and train clients and athletes. Let's do it all. All right. Thank you so much for listening. This is the nasm CPT podcast, which report
 Abdominal hollowing (or the draw-in maneuver) and abdominal bracing are both incorporated by therapists, trainers, and other exercise specialists to benefit persons with lumbar instability (Vaičienė, Berškienė, Slapsinskaite, Mauricienė, & Razon, 2018). There is a tendency for professionals to pick one of these interventions while downplaying the validity and value of the other. Integrated training is based on the implementing all evidence that works during the appropriate time with an understanding of how we can optimize outcomes for our clients. We will review the research surrounding abdominal hollowing and abdominal bracing to provide a better understanding of the evidence of their practical applications. Evidence shows that deep abdominal muscles are more activated with abdominal hollowing and surface muscles more activated with abdominal bracing (Vaičienė, Berškienė, Slapsinskaite, Mauricienė, & Razon, 2018). Hollowing has shown to increase local spinal stabilizers (Lee et al., 2013; Suehiro et al., 2014; Kim & Oh, 2015; Lee et al., 2016) and LPHC stability while minimizing the facilitation of global muscle activity during exercise (Suehiro et al., 2014; Kahlaee, Ghamkhar, & Arab, 2017). Abdominal hollowing was found superior to abdominal bracing for increasing LPHC stability and leg stiffness in hopping tasks (Dupeyron, Hertzog, Micallef, & Perrey, 2013). Though it does seem that maintaining a neutral spine (Reeve & Dilley, 2009) and costodiaphragmatic (chest / belly) breathing is important to the optimization of muscle activation while performing abdominal hollowing (Ha, Kwon, Kim, & Choung, 2014). Multiple data questions the efficacy of treating LBP solely using abdominal hollowing (Unsgaard-Tondel et al., 2012; Vasseljen et al., 2012; Wong et al., 2013). McGill, arguably one of this generation’s top researchers on exercise and the spine, is not a fan of abdominal hollowing, and argues that the transverse abdominus should activate when abdominal bracing is done appropriately without the need to draw-in the navel (2016). He provides evidence that core stiffness is of far more value when it comes to protecting the back (Lee & McGill, 2015). Evidence supporting both abdominal bracing and abdominal hollowing work to increase LPHC stabilization. We are not left with a debate on efficacy of these two techniques, but application. Which application should we employee and when? Get 20% off your order now by calling 800-460-6276 or visiting NASM.org, and using the code Podcast 20. 