Hello friends! Did you know your body has its own natural back brace? You have a muscle called the transverse abdominis. In the pelvic health world, we love this muscle because it works with the pelvic floor! However, when this muscle is weak or not engaging at the right times, we can have problems.
The transverse abdominis is a large muscle that runs from your back to the front of the abdomen. It works with the other muscles of the core (the diaphragm, pelvic floor, and back muscles) to create stability in the spine and pelvis (Ehsani, 2020).
One of the great things about the transverse abdominis is how closely it works with the pelvic floor muscles. Many times when individuals have pelvic floor dysfunction, the transverse abdominis is not working at its best either. Using the transverse abdominis helps to engage the pelvic floor muscles and vice versa (Ehsani, 2020; Sapsford, 2011). This means that we can use the transverse abdominis to help train the pelvic floor muscles.
So what happens when the transverse abdominis isn’t working the way it was designed to?
The transverse abdominis is important in helping to avoid diastasis recti (DRA), especially postpartum. If you do develop DRA, learning to contract your transverse abdominis muscle in isolation and with functional activities is key for treatment (Keeler, 2012). A pelvic floor physical therapist can be a great resource to teach you how to do this properly.
Low back pain can be a result from a poorly functioning transverse abdominis. (Did you know that individuals who have urinary incontinence are twice as likely to have low back pain?) Since it helps to stabilize the spine, a weak or uncoordinated muscle can lead to low back and pelvic girdle pain. Training the transverse abdominis to engage at the right times and strengthening it can help to improve low back pain (Ehsani, 2020).
In the postpartum period, engaging the transverse abdominis can help you recover. Learn to engage the transverse abdominis with activities like rolling to get out of bed or standing from a chair. If you are having a hard time (or having symptoms of pelvic floor dysfunction) a physical therapist can help!
How to engage the transverse abdmoninis
Think of the transverse abdominis as a muscle that gives a big hug around your abdomen. Start by lying on your back to learn to engage the transverse abdominis, but it’s important to progress to engaging it in different positions and with functional activities (like lifting a basket of laundry from the floor). Inhale and then as you exhale, gently draw your belly button in towards your spine. Note: you should not be sucking in your stomach. Watch your chest as you draw the stomach in, if your chest rises or moves away from your body, you aren’t engaging the muscle properly.
There are many other techniques to activate and engage the transverse abdominis and it often takes practice. You may need some help from a trained professional (like a physical therapist). If you need help finding someone, check out our free resources to help find someone near you at www.myPFM.com. We have links to 4 free searchable databases under Find a PT.
Here are some great resources to help you:
A Problem-Solving Approach to Diastasis Rectus Abdominis with Grainne Donnelly BSC Hons, MCSP, HCPC
How to Start and Acute Care OB PT Program Q&A with Dr. Ann Croghan, PT, DPT, and Dr. Hannah Poe, PT, DPT
Differential Diagnosis for Sciatic Pain Part 1 with Michelle Nesin, PT, FAAOMPT, OCS, FCFMT
Differential Diagnosis for Sciatic Pain Part 2 with Michelle Nesin, PT, FAAOMPT, OCS, FCFMT
Written by Emily Reul, PT, DPT
1. Sapsford RR, Hodges PW, Richardson CA. Co-activation of the abdominal and pelvic floor muscles during voluntary exercises. Neurourol Urodyn. 2001;20:31-42.
2. Keeler J, Albrecht M, Eberhardt L, Horn L, Donnelly C, Lowe D. Diastasis recti abdominis: a survey of women’s health specialists for current physical therapy clinical practice for postpartum women. J Womens Health Phys Therap. 2012;36(3):131-142.
3. Ehsani F, Sahebi N, Shanbehzadeh S, Arab AM, ShahAli S. Stabilization exercise affects function of transverse abdominis and pelvic floor muscles in women with postpartum lumbo-pelvic pain: a double-blinded randomized clinical trial study. Int Urogynecol J. 2020;31(1):197-204.