Masterclass

Functional load abdominal

training: part 2
C. M. Norris

This article discusses current abdominal training by analysing the sit-up and leg-raise actions, and
body segment alignment is emphasized with reference to the lumbar spine. A new approach to
abdominal training based on the principles of spinal stabilization is proposed, consisting of three
overlapping stages. In stage one, the stabilizing function of the deep abdominal muscles is re-
educated, and several practical suggestions are made to assist this process. In stage two, static
stability is built emphasizing isometric control of the lumbar spine neutral position. In stage three,
apparatus is introduced for traditional exercises that are appropriate to functional training of the
trunk. * c 2001 Harcourt Publishers Ltd

Analysis of current abdominal ribs, causing the ribs to ¯are out and so
exercise technique increasing the infrasternal angle.
One of the problems poorly toned
To be able to develop more appropriate individuals face is `bow stringing' of the
exercises for the trunk it is essential to ®rstly abdominals, which is often seen at the initiation
understand what the traditional exercises for of the sit-up action. For rectus abdominis to pull
this region actually achieve. To this end the two ¯at, the deep abdominals (transversus
major categories of abdominal exercises, the abdominis and internal oblique) must be able to
`sit-up' and `leg-raise' will be brie¯y analysed pull on the rectus sheath to hold the abdominal
(Norris 1994). wall down. This movement demands a
coordinated action of both the super®cial and
deep abdominals, which is often lost. Where an
The sit-up imbalance exists with the deep abdominal
The sit-up is essentially an action where the muscles poorly recruited and the rectus
subject moves from a supine lying position to a abdominis lengthened, the abdominal wall will
long-sitting position by performing hip ¯exion be seen to dome and the pelvis to anteriorly tilt.
(trunk moving on a ®xed leg), usually with As a consequence the athlete may lift the trunk
trunk ¯exion. There are several modi®cations of with the lumbar spine extended or ¯at rather
this action, which will be dealt with below. than ¯exed.
In a classic sit-up, as soon as the head lifts, Fixation of the pelvis is provided by the hip
activity is seen in the rectus abdominis (Walters ¯exors, especially iliacus through its attachment
& Partridge 1957), and as a consequence the rib to the pelvic rim. The strong pull of hip ¯exors
Christopher Norris, cage is depressed anteriorly. The rectus is acting is partially counteracted by the pull of the
MSc MCSP here to stabilize the ribcage and hold it down lateral ®bres of external oblique and the infra-
Correspondence to: against the pull of the neck ¯exors attempting umbilical portion of the rectus abdominis
Christopher Norris, to lift the head. The initial period of trunk which tend to tilt the pelvic posteriorly. Action
1 Barkers Lane,
SALE, Cheshire, ¯exion emphasizes the supra-umbilical portion of the external oblique, if powerful enough, will
M33 6RP, UK. Tel.: of the rectus, the infra-umbilical portion and the compress the ribs and reduce the infrasternal
‡44 (0) 161 972 internal oblique contracting later in the angle once more (Kendall et al. 1993).
0512; E-mail:
cnorris500@AOL. movement (Kendall & McCreary 1993). As the In a poorly conditioned subject exercising at
COMs internal oblique contracts, it pulls on the lower speed, the initial movement in a sit-up may be a

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c 2001 Harcourt Publishers Ltd Physical Therapy In Sport (2001) 2, 149±156 149
doi : 10.1054/ptsp.2001.0033, available online at http://www.idealibrary.com on
Physical Therapy in Sport

momentary posterior tilting of the pelvis by sit-up is performed from the crook lying starting
action of the hip extensors. This will pre-stretch position, with the knees ¯exed to 908 and hips
the hip ¯exors, giving them a mechanical ¯exed to 458. The action is one of the trunk
advantage before hip ¯exion occurs (Ricci et al. ¯exion followed by, or performed with, hip
1981). ¯exion. The trunk curl is performed from the
same starting position, but no hip ¯exion occurs,
Effects of foot ®xation the lumbar spine remaining in contact with the
supporting surface. The bench-curl (`crunch'
If the sit-up action is attempted from the supine exercise) is performed from a starting position of
lying position without allowing trunk ¯exion, 908 hip ¯exion and 908 knee ¯exion, the shin
there is a tendency for the legs to lift up from being supported on a bench or chair. Bending
the supporting surface. This occurs because the the knees and hips to alter the starting position
legs constitute roughly one-third of the of the sit-up will affect both the passive and the
bodyweight and the trunk two-thirds.
active actions of the hip ¯exors, and the
As the abdominal muscles ¯ex the spine, the
biomechanics of the lumbar spine. In supine
centre of gravity of the upper body is moved
lying, the iliopsoas is on stretch, and aligned
caudally. Movement of the centre of gravity in
with the horizontal (Fig. 2). In this position,
this fashion reduces the lever arm of the trunk
vertebral compression is at its greatest as the
enabling the subject to sit up without the legs
muscle contracts, and trunk lifting is at a
lifting (Fig. 1).
mechanical disadvantage. The ratio of lifting to
compression is, therefore, approximately 1 : 10
(Watson 1983). As the knees are ¯exed, the
iliopsoas is pulled more vertically and so the
ratio of trunk lifting to vertebral compression
reduced to 2 : 5 in crook lying and 1 : 1 in bench
lying.

Fig. 1 Movement of the centre of gravity of the upper

body during a sit-up exercise.

In cases where the abdominal muscles are

weak and lengthened, maximum spinal ¯exion Pull of psoas
will not occur because the muscles are unable
to pull the lumbar spine into full inner range. In
Trunk
this case the lever arm of the trunk remains
lifting
long and the legs are seen to lift. The exact point 1:10 3.3:3.3
Vertical
at which this occurs in the movement will compression
depend on a subject's bodyweight and stature. 2:5
If the feet are ®xed, the hip ¯exors can now Fig. 2 Ratio of trunk lifting to vertebral compression
pull powerfully without causing the legs to lift. forces due to the pull of iliopsoas in a sit-up.
In addition, the act of foot ®xation itself may
facilitate the iliopsoas (Janda & Schmid 1980). With 458 hip ¯exion, tension development in
Foot ®xation requires the subject to pull against the iliopsoas has been shown to be 70±80% of
the ®xation point by active dorsi¯exion. This its maximum, while with the hips and knees
process stimulates the gait pattern at heel ¯exed to 908 this ®gure reduces to between 40%
contact increasing activity in the tibialis and 50% (Johnson & Reid 1991).
anterior, quadriceps and iliopsoas, a pattern However, passive tension developed by the
known as ¯exor synergy (Atkinson 1986). iliopsoas due to elastic recoil must also be
Modi®cations of the sit-up include the bent considered. If the hips are ¯exed, the iliopsoas
knee sit-up and the trunk curl. The bent knee will not be fully stretched, and will not be able to

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 Functional load abdominal training: part 2

passively limit the posterior tilt of the pelvis. Abdominal training based on
Instead, to ®x the pelvis and provide a stable spinal stabilization principles
base for the abdominals to pull on, the hip
¯exors will contract earlier in the sit-up action. Because one of the prime functions of the trunk
This contraction although occurring earlier, will is stability, the Functional Load Abdominal
be of reduced intensity (Walters & Partridge Training (FLAT) programme follows an exercise
1957) due to the length±tension relationship of progression based on spinal stabilization
the muscle. principles (Norris 1995). Initially the stabilizing
With the legs straight in the traditional sit-up function of the deep abdominal muscles is re-
position, the iliopsoas is stretched, and can educated. Once this has been achieved, the
passively limit posterior tilting of the pelvis. endurance of these muscles is built up and
However, in this stretched position, the static stability is enhanced. Only when these
iliopsoas is capable of exerting greater force two aims have been achieved are exercises used
during hip ¯exion. If the abdominal muscles are to enhance the performance of the trunk
too weak to maintain the position of the pelvis mobilisor muscles and complex multijoint
to tilt anteriorly, lengthening the abdominals, movements are begun. The ®rst action to be
and hyperextending the lumbar spine. This mastered in the back stability process is
type of action is, therefore, unsuitable for abdominal hollowing, a technique which has been
postural re-education if the aim is to shorten shown to be especially useful in the early stages
posturally lengthened abdominal muscles. of stability control (Richardson et al. 1992). This
movement emphasizes the internal oblique and
transversus abdominis muscle (Lacote et al.
1987) while reducing the dominance of the
Straight leg raising upper rectus (O'Sullivan et al. 1998). Muscle
The bilateral straight leg raise has been shown re-education of this type may be achieved in a
to create only slight activity in the upper rectus, number of starting positions, with four point
although the lower rectus contributes a greater kneeling and standing (wall support) being the
proportion of the total abdominal work than two most effective positions.
with the sit-up (Lipetz & Gutin 1970). The Stability muscles have been described as
rectus works isometrically to ®x the pelvis better suited to endurance ( postural holding)
against the strong pull of iliopsoas (Silvermetz and better recruited at low resistance levels
1990). The force of contraction of the iliopsoas is (Norris 1998). In the clinic, it is often found that
maximum when the lever arm of the leg is subjects begin with little control over the
greatest, near the horizontal, and reduces as the intensity of contraction which these muscles
leg is lifted towards the vertical. produce. Often, the contraction begins
In subjects with weaker abdominals, the minimally and then builds to high intensities
pelvis will tilt and the lumbar spine (60±70% maximum voluntary contraction
hyperextend. This forced hyperextension will [MVC]). This is acceptable during the early
dramatically increase stress on the facet joints in stages of learning as it enables the subject to
the lumbar spine. The movement is likely to be `feel the muscle working'. However, accurate
limited by impaction of the inferior articular control must be gained, and in all hollowing
processes on the laminae of the vertebrae exercises the subject should be instructed to
below, or in some cases by contact between the master changing the intensity of the muscle
spinous processes (Twomey & Taylor 1987). contraction. This is achieved by asking for a
Where this action occurs rapidly, damage may `maximal contraction' and then relaxing by half,
result to the facet joint structures. Once contact and half again. Once the minimal contraction is
has occurred between the facet and lamina, achieved, the intensity is then built up again in
further loading will cause axial rotation of the steps to reach the maximum. Only when
superior vertebrae (Yang & King 1984). The hollowing can be controlled with minimal
superior vertebra pivots, causing the inferior muscle intensity over a period of time (10
articular process to move backwards repetitions each of 30±40% MVC) can exercises
overstretching the joint capsule. be progressed. The position in which the

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Physical Therapy in Sport

Box 1 Neutral position of the lumbar spine ± a working de®nition

The neutral position of the lumbar spine is midway between end range ¯exion and end range
extension. In a neutral position the discs and facet joints are minimally loaded and the soft tissues
surrounding the lumbar spine reach a state of elastic equilibrium. In the normal (non-pathological)
subject, the neutral position will correspond to lumbar alignment in an optimal posture. In subjects
with a sub-optimal posture, pelvic tilt may be increased or reduced giving corresponding changes in
the depth of the lumbar lordosis. In either case, the neutral position remains mid-way between end
range ¯exion and end range extension. However, in such cases of postural malalignment, part of the
treatment aim must be to restore optimal posture by re-balancing the length of the surrounding soft
tissue elements. Neutral position may be found either passively (therapist moving the subject's
pelvis) or actively (subject moving his/her own pelvis through muscle action).

movements are performed is important. The To facilitate learning multisensory cueing

neutral position of the spine (Box 1) should be is used (Miller & Medeiros 1987) to increase
used whenever possible, and initially the the sensory input to the subject. Auditory cues
subject will need to be positioned correctly by can be provided by the therapist speaking to
the therapist. the subject and giving feedback about
As the transversus has horizontally aligned performance. Visual cues are given by
®bres, four point kneeling allows the abdominal encouraging the subject to look at the muscles
muscles to sag, giving stretch facilitation as they function, and by using a mirror placed
(Fig. 3). The subject is positioned with their on the ¯oor/couch below the abdomen.
lumbar spine in a neutral position, and the Kinaesthetic cueing is accomplished by
head looking at the ¯oor, between the hands encouraging the subject to `feel' the particular
rather than forwards. Head position should action, for example asking them to `feel the
re¯ect optimal alignment with the ear stomach being pulled in'.
horizontally aligned to the shoulder joint. The Tactile cues are provided by the therapist
hip should be directly above the knee, and the and/or belt touching the subject's abdomen.
shoulder directly above the wrist. The hands The abdominal region below the umbilicus is
and knees are shoulder width apart. palpated. The therapist places the heel of their
hand over the patient's anterior superior iliac
spine and points their ®ngers towards the
patient's pubic bone. The therapist's ®nger tips
will then fall over the retro-aponeurotic triangle
(Walters & Partridge 1957). The muscles are
sheet like and will ¯atten rather than bulge
when they contract. To facilitate the contraction
the therapist instructs the subject to `stop me
Fig. 3 Abdominal hollowing in four point kneeling. pushing in' as they palpate the abdominal wall.
A second method of facilitation is to instruct the
The subject focuses their attention on their subject to cough (visceral compression) and
umbilicus and is instructed to pull the hold the muscle contraction they feel beneath
umbilicus `in and up' while breathing normally. the therapists palpating ®ngers. This `cough
This action has been shown to dissociate and hold' procedure is also useful when used in
activity in the internal obliques and transversus conjunction with surface EMG. As the muscle
from that of rectus abdominis (Richardson et al. contraction shows on the EMG unit, the subject
1992). Dissociation itself makes the exercise is encouraged to maintain the contraction while
useful for re-educating the stabilizing function breathing normally, The contraction time is
of the abdominals where rectus abdominis has built up to a single 30 seconds hold or 10
become the dominant muscle of the abdominal repetitions of 10 seconds holding. The subject
group. should be encouraged to reduce the contraction

152 Physical Therapy in Sport (2001) 2, 149±156 *

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 Functional load abdominal training: part 2

intensity of the muscle to the minimum

required to maintain the hollow abdomen
position.
A webbing belt may be fastened around the
abdomen below the umbilicus, with the
muscles relaxed and sagging. The belt should
be tight enough to touch the skin but not so
tight as to pull the muscles in. The desired
action is to hollow the abdomen and pull the
muscles away from the belt, and then to relax
them completely to ®ll the belt again. Two
errors are common here: ®rstly, an inability to
draw the muscles away from the belt; secondly,
a contraction which is too strong and makes the
abdominal wall rigid, seen as an inability to
relax the muscles to ®ll the belt once more. With
full muscle control both actions should be
Fig. 4 Abdominal hollowing in wall support standing.
attainable. Once the contraction is achieved, the
holding time is built up to 10±30 seconds while
breathing normally. the action of `lifting the penis' is also useful
Visualization of correct exercise technique is imagery.
used following demonstration by the therapist. The abdominal hollowing action must be
Visualization or `mental practice' involves the differentiated from pelvic tilting, and care
subject relaxing, and `seeing' themselves should be taken to ensure that the subject does
performing the exercise in their imagination. not ¯atten their back against the wall indicating
Visualization of this type has been shown to posterior-pelvic tilting through the action of the
bene®t both motor skill acquisition (Fransler rectus abdominis. Once the abdominal
et al. 1985) and strength development hollowing action has been performed correctly
(Cornwall et al. 1991). to repetition, the subject should move forward
Some subjects ®nd four point kneeling from the wall and repeat the action without
dif®cult to control and tend to round their spine wall support. No spinal or pelvic movement
as they attempt abdominal hollowing. Where should occur.
this is the case, wall support standing is a more
appropriate starting position (Fig. 4). The
Building static stability
subject stands with their feet 6 inches from a
wall and their back ¯at onto the wall surface. A The crook lying position is used as the starting
neutral spinal position should be maintained. position for isolated limb movements to build
In an obese or poorly toned subject, the weight static stability. The neutral position of the
of the digestive organs will pull the abdominal lumbar spine is found and abdominal
wall out and down (visceral ptosis). Again a hollowing is performed to stabilize the spine.
belt is used and positioned below the umbilicus One leg is then slowly straightened keeping the
and the action is to contract the lateral heel resting on the ground to perform a heel
abdominals and to pull the abdominal wall `in slide action (Fig. 5). This movement is made
and up' trying to create a space between the easier if the heel is on a slippery surface (a cloth
abdomen and the belt. Since lateral abdominal if on a polished ¯oor or a piece of shiny paper if
action and pelvic ¯oor action are linked on a carpet). As the leg is straightened,
through motor programming as part of the abdominal hollowing must be continued and
intra-abdominal pressure mechanism, pelvic stability maintained. The moment the pelvis
¯oor contractions are also useful to aid learning anteriorly tilts and the lordosis increases, the
of abdominal hollowing. The instruction is to movement must stop and the leg be drawn back
pull the pelvic ¯oor in as though trying to `stop into ¯exion once more. The exercise is
yourself passing water' or `gripping'. In men progressed by using full limb weight, and

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c 2001 Harcourt Publishers Ltd Physical Therapy In Sport (2001) 2, 149±156 153
Physical Therapy in Sport

Box 2 Exercises to strengthen secondary stabilizing muscles

In each of the following exercise examples the movement is slow and controlled. At the mid-point of the action
the position is held and the weight slowly lowered back to its starting position. The emphasis is on both strength
and endurance. Perform each exercise for 8±12 repetitions taking a full 4±5 seconds to complete the full
movement. Medium (not heavy) poundages are used.
Hip Hinge
(Gluteals and erector spinae)
The subject stands with the knees slightly bent to relax the hamstrings and allow
free pelvic tilting. The action is to angle the trunk forward by moving the pelvis
on the ®xed hip, keeping the spine straight. The trunk moves to 458 and then
returns to the upright position.

Lateral pulldown
(lattisimus dorsi)
The subject sits beneath a high pulley machine and grasps a wide bar. The action
is to pull down until the bar rests either across the shoulders or at the top of
sternum.

Spinal extension
(erector spinae and gluteals)
The subject rests prone on an extension frame with the pelvis supported on the
low pad and the lower legs beneath ®xation rollers. The action is to straighten
the body by moving the trunk on the ®xed leg until the body is horizontal.

Horizontal side support

(quadratus lumborum)
The subject begins in side lying with the body resting on the underneath forearm.
The action is to lift the pelvis until the body forms a straight line from foot to
shoulder.

Seated rowing
(Shoulder retractors)
The subject sits in front of a low pulley machine with the knees slightly ¯exed to
allow a neutral spine position to be maintained. The action is to pull the machine
handle in towards the chest (lower sternum) while retracting and depressing the
scapulae.

performing leg lowering (Fig. 6). In supine lying, greater knee extension to allow the foot to touch
the hips are ¯exed to 908 and the knees are the ground further from the buttock, increasing
relaxed. The neutral position of the lumbar the limb leverage and, therefore, progressing
spine is found and abdominal hollowing the resistance. Eventually, single leg raises are
performed. The abdominal contraction is performed with the other leg still supported in
maintained as one hip is extended to allow the the crook lying position. The movement is
foot to contact the ground. Initially, the foot performed with alternating legs initially
rests on the ground near the buttock and allowing one leg to rest on the ground before
gradually the movement is performed with the other leg is lifted. As a progression on this

154 Physical Therapy in Sport (2001) 2, 149±156 *

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 Functional load abdominal training: part 2

Cornwall M W, Melinda P B, Barry S 1991 Effect of mental

practice on isometric muscular strength. Journal of
Orthopaedic and Sports Physical Therapy 13: 5
Fransler C L, Poff C L, Shepard K F 1985 Effects of mental
practice on balance in elderly women. Physical Therapy
65: 1332±1338
Janda V 1994 Muscles and motor control in cervicogenic
disorders. Assessment and management. In: Grant R
Fig. 5 Heel slide action. (ed) Physical therapy of the cervical and thoracic spine,
2nd edn. Churchill Livingstone, Edinburgh
Janda V, Schmid H J A 1980 Muscles as a pathogenic factor
in backpain. Proceedings of the International Federation
of Orthopaedic Manipulative Therapists. 4th conference.
New Zealand, pp 17±18
Johnson C, Reid J G 1991 Lumbar compressive and shear
forces during various trunk curl-up exercises. Clinical
Biomechanics 6: 97±104
Kendall F P, McCreary E K, Provance P G 1993 Muscles.
Testing and function, 4th edn. Williams and Wilkins,
Baltimore
Lacote M, Chevalier A M, Miranda A, Bleton J P, Stevenin P
Fig. 6 Leg lowering action. 1987 Clinical evaluation of muscle function. Churchill
Livingstone, Edinburgh
Lipetz S, Gutin B 1970 An electromyographic study of four
action, the limbs are again moved alternately abdominal exercises. Medicine and Science in Sports and
but the leg lifts after the other limb has moved Exercise, 2: 35±38. Lippincot, Philadelphia
McGill S M, Juker D, Kropf P 1996 Quantitative
from the ground. Finally, both legs may be
intramuscular myoelectric activity of quadratus
lifted and lowered together initially with lumborum during a wide variety of tasks. Clinical
minimal limb leverage and ®nally with Biomechanics 11: 170±172
increasing leverage. Some authors recommend Miller M I, Medeiros J M 1987 Recruitment of internal
the use of bilateral straight-leg raises as a ®nal oblique and transversus abdominis muscles during the
progression of this exercise, but the eccentric phase of the curl-up exercise. Physical Therapy
67: 1213±1217
compression and shear forces imposed by the
Norris C M 1994 Abdominal training. Dangers and exercise
psoas muscle upon the lumbar spine make this modi®cations. Physiotherapy in Sport 19 (5): 10±14
unsuitable for use in rehabilitation following Norris C M 1995 Spinal stabilization 5. An exercise
low-back pain. programme to enhance lumbar stabilization.
In the third stage of training, when muscle re- Physiotherapy 81 (3): 31±39. March
education and static stability have been Norris C M 1998 Sports Injuries. Diagnosis and
achieved, apparatus may be used. The aim is Management, 2nd edn. Butterworth Heinemann, Oxford
O'Sullivan P B, Twomey L, Allison G T 1998 Altered
now to use appropriate traditional exercises to abdominal muscle recruitment in patients with chronic
re-strengthen secondary stabilizing muscles and back pain following a speci®c exercise intervention.
to build relevant mobilisors. The muscles which Journal of Orthopaedic and Sports Physical Therapy
assist in stability, including the latissimus dorsi, 27 (2): 114±124
erector spinae (Vleeming et al. 1990) quadratus Ricci B, Marchetti M, Figura F 1981 Biomechanics of sit-up
lumborum (McGill et al. 1996) and the shoulder exercises. Medicine and Science in Sports and Exercise
13: 54±59
retractors (Janda 1994), are enhanced together
Richardson C, Jull G, Toppenburg R, Comerford M 1992
with the gluteals as they provide power during Techniques for active lumbar stabilization for spinal
lifting. Suitable exercises are shown in Box 2. protection: a pilot study. Australian Journal of
Physiotherapy 38 (2): 105±112
Silvermetz M A 1990 Pathokinesiology of supine double leg
lifts as an abdominal strengthener and suggested
alternative exercises. Athletic Training 25: 17±22
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c 2001 Harcourt Publishers Ltd