I have noticed that some clients have particular difficulty activating their abdominal muscles. Some of these clients have given birth via caesarean section (in some cases, many years ago), and I wonder if nerve damage makes it harder for them to connect with these muscles.
I have tried many different techniques, including talking about and demonstrating extensively the look and feel of true core activation, always incorporating use of the pelvic floor. They do get some sense of the work, but it is definitely much harder for them.
When it comes to activating the “core,” there are many factors that contribute to as well as inhibit it from happening. The inner unit is composed of the TVA, internal oblique, thoracolumbar fascia, deep erector spinae, multifidus and pelvic floor muscles. There are many reasons why this unit might not function properly, and they are a somatic (muscle) to somatic and visceral (organ) to somatic reflex inhibitory patterns. As you have experienced with clients, surgery has a large impact on this activation as well.
There are many ways to determine if someone’s inner unit is working properly. One is assessment of the TVA using the TVA strength and coordination tests, a prone TVA test with a BP cuff, the forward flexion activation test and observing in supine and standing position if a client can breathe with proper dynamics. (Proper breathing is essential for proper TVA activation. Just having an inverted breathing pattern alone can create faltered inner unit dynamics. For more on this, click on "related articles" at right and read "Breathing for Optimal Health" by JP Sears and "The Core" by Matthew James Wallden).
After assessing your clients, from there you can decipher whether or not they have proper inner unit function. From there, you can use various supine exercises such as 4 Point TVA and lower abdominal #1-#4 with BP cuff. Basic breathing education drills and proper inner unit activation during all exercise routines is essential.
I am going to briefly explain how inhibitory reflex, postural dysfunctions, proper nutrition and surgery can and will inhibit inner unit functions. The “core” should prevent compression, shearing and torsion of the lumbar spine, working in conjunction with hydraulic ampliphier mechanism, intra-abdominal pressure and thoracolumbar fascia gain.
Inhibitory Reflex Patterns
This is something that most osteopaths, Chinese medical doctors and neuromuscular therapists focus on when working with clients. To keep it simple, the site of pain or dysfunction is usually the byproduct of something bigger. For example, when a muscle’s length tension is altered, you will have what is called reciprocal inhibition. If the psoas becomes shortened (according to Vladimir Janda, the psoas is the beginning place of most dysfunctions elsewhere in the body), the muscle that does the opposite action on the opposite side of the body will become inhibited. This would be the gluteus maximus because it produces hip extension, whereas the psoas produces hip flexion. This correlates to the inner unit because of its close relationship with the pelvis. When one has an anterior rotated pelvis/lower cross syndrome (short psoas, rectus femoris, erector spinae and long glutes and abdominal muscles - not to be confused with a Sway Back, which is something totally different), the synergy of the inner unit will become dysfunction secondarily to the TVA and internal obliques becoming elongated (this has to do with their O and I on the pelvis, etc). This is just one simple example, and there are many more. This explains a somatic to somatic inhibitory reflex pattern.
The other type of reflex pattern I mentioned above is a visceral to somatic reflex. In my clinical opinion, this is why most of America has altered posture and inhibitory/dysfunction within their inner and outer units within the body. The first example would be related to nutrition. Most of America eats the standard American C.R.A.P. (Caffeine, Refined/Processed foods, Alcohol or Aspartame and Pasteurized Milk). Not to get into this too deep or go off onto a tangent, but all of these foods will cause inflammation in the GI system. Once there is inflammation, there will be inhibition.
According to Hilton’s Law (a nerve trunk that supplies a joint also supplies the muscles of the joint and skin over the insertions of such muscles) and Arndt’s Law (weak stimuli excite physiological activity, moderately strong ones favor it and strong ones retard it and very strong ones arrest it), this can be understood. If one has inflammation or dysfunction in any organ, the skin over that specific area, the muscles that cross over that specific organ and nerve trunks that supply the muscle as well as the inflamed organ will become inhibited.
A simple example of this is stomach, small intestine or large intestine inflammation. These physiological excited organs will create heat and inflammation in the solar plexus region. This will inhibit any muscle crossing over this region (TVA, internal oblique and pelvic floor). This will create inhibition of these muscles of the inner unit, thereby elongating them. This will in turn create dysfunction of the inner unit and the other muscles of the inner unit, and the muscles of the outer unit will compensate for this dysfunction. This will lead to other dysfunctions such as visceroptosis, frequent urination or incontinence, low back pain, disc problems, SIJ problems and on and on.
You will see this in most women who have had a C-section. When cutting through all of the abdominal muscles to get to the baby, this disrupts and stops the neurological feedback loop of the inner unit to the brain and from the brain to the inner unit. Typically, the women is stitched up and bed ridden for a short period of time but never educated prior to as well as after pregnancy on the proper rehabilitation and movement dynamics as well as possible dysfunctions secondary to the C-section.
Stitching back up the abdominal wall will not do the trick. You will have large scar tissue build up, no neurological loop from the brain to the inner unit and back. Also, the female is at high risk from developing low back problems. As I have said, the inner unit prevents compression, shearing and torsion of the lumbar spine. So without it, this type of client is destined for low back pain. There are many things that can be done though to facilitate the healing process:
- Educate your client on how to massage the scar daily with certain essential oils such as Rose Hip Oil. Some women do not feel comfortable doing this, so this is where you might have to step in and have this as part of your treatment plan. The scar tissue is going to be the major roadblock in the healing process. Eliminating it will make or break the facilitation of the inner unit.
- Regular neuromuscular therapy on the abdominal muscles and scar will help re-create the neurological feedback loop. Purchase any book by Leon Chaitow, and you can learn a lot of information on releasing adhesion, scar tissue, etc with your clients.
- Eliminating all C.R.A.P foods will reduce inflammation and facilitate healing.
- Educate your client on proper breathing techniques, which will help facilitate inner unit activation.
- Your exercise selection, sequence and the variables (rest, intensity, sets, reps and tempo) are very important and will make or break compliance and progress. You want to focus on Compound Movements or what I call Primal Movement Patterns (push, pull, squat, bend, twist and lunge) within her physiological load and skill levels. Focus on setting the variables initially for all exercises so the type 1/slow twitch postural muscles are being activated. Slow twitch muscles require about 60 seconds of rest and respond to time under tension (slow tempos such as 202, 212, 303, etc.). As well, you want to incorporate exercises and stretches that are going to realign the body in order to eliminate reciprocal inhibition. The other TVA exercises I mentioned in the beginning are a must in the program. You can also find more core exercises in the PTN Exercise Library.