Distinguen Abdominal Riostras de un Agujero еn еl Estómago

Distinguish Abdominal Bracing From Abdominal Hollowing

Maintaining a mild contraction of the abdominal wall can also help ensure sufficient spine stability. This maneuver is called abdominal hollowing in many back care circles, but we prefer to avoid that terminology, as it suggests to most people either pulling in or puffing out the abdominal wall. When the contraction is performed correctly, no geometric change at all occurs in the abdominal wall. In other words, rather than "hollowing or drawing in" the abdominal wall, the patient simply activates the muscles to make them stiff. «`c call this contraction "abdominal bracing," or "stiffening," whereas when we speak of abdominal hollowing, we are referring to the pulling in of the abdominal wall, discussed in more detail next.

Figure 10.5 Allowing the patient to feel spine (a) flexion and (b) extension helps them to eliminate these from the squating motion. Others "get it" by (c) adopting the shortstop "ready position" and then (d) standing up.

Figure 10.6 fa, b) The wall roll begins with the patient in the "plank" with both elbows planted on the wall. Focus is on spine and hip motion, generally adjusting the spine and hip posture to shift the pelvis toward the wall in order to find the "sweet spot" in spine position with minimal pain. (c) The abdominal muscles are braced and the rib cage is "locked" on the pelvis. The patient pivots on the balls of the feet, pulling one elbow off the wall. No spine motion is permitted. These corrections are repeated until the patient can control their spine and eliminate pain.

Some confusion exists in the interpretation of the literature regarding the issue of abdominal hollowing and abdominal bracing. Richardson's group observed that the hollowing (see figure 10.7a) of the abdominal wall recruits the transverse abdominis. On the other hand, an isometric abdominal brace (sec figure 10.76) coactivates the transverse abdominis with the external and internal obliques to ensure stability in virtually all modes of possible instability (hiker et al., 1998). Note that in bracing, the wall is neither hollowed in nor pushed out. Bracing also stabilizes the spine in bending and twisting challenges, whereas hollowing does not. In this way, abdominal bracing is superior to abdominal hollowing in ensuring stability. With this background, Richardson and colleagues (1999) suggested that the recruitment of transverse abdominis is impaired following injury. This idea remains controversial as some others have either not been able to replicate these results in people with back pain on both sides of the torso, or have found opposite results. Nonetheless, the group developed a therapy program designed to reeducate the motor system to activate transverse abdominis

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