4-Point Transversus Abdominis Vacuum
This exercise is great for isolating the transverse
abdominis, for correcting "pooch belly," and
reconnecting with the nervous system. It is particularly
valuable for pre-surgery preparation and post-surgery
In surgical procedures such as caesarean
section and hernia, the muscles, nerves, and tissues are
cut, causing a loss of neurological impulse (your brain
tries to call your muscles to wake them up, but the
muscles don't answer!). Lack of neural drive to the core
muscles is one reason for the belly hanging out. Certain
exercises can help reconnect the nervous and muscular
systems so your "pooch belly" gets the message from the
brain loud and clear and pulls those muscles in.
NOTE: Using a dowel rod can help you
keep good neutral exercise posture and provide
biofeedback (as the rod touches different parts of your
body, it makes you aware of your body position). If you
use the dowel technique, place the rod along your spine,
making sure the back of your head, upper back, and
tailbone are in contact with the rod.
Position: Get down on all fours as
though you were going to crawl. Place your hands
directly underneath your shoulders and your knees
directly underneath your hips.
o Inhale and allow the transverse
abdominis to hang out towards the floor.
o Exhale, drawing the belly button in toward the spine.
o Avoid any spinal movement during this exercise such as
contracting the glutes, hamstrings, or external
Horse Stance Vertical
The first exercise in the Horse Stance
series is the Horse Stance Vertical, which integrates
the stabilizer muscles of your spinal column with the
other muscles of the inner unit. It targets the inner
unit (multifidus, pelvic floor, transverse abdominis,
Position: Get down on all fours with
your hands directly underneath your shoulders and your
elbows slightly bent.Your knees should be directly
underneath your hips at a 90-degree angle.
o Raise your left hand and right knee
approximately one centimeter off the ground (that's
about the thickness of the sheet of paper-look closely
at the center photograph and you will see the hand
slightly off the matt. The right knee is also raised
slightly off the matt, although it cannot be seen in the
photograph). Hold this position for 10 seconds.
o Repeat with the right hand and left
o Alternate back and forth until you have done the
exercise for a total of 2 minutes. To help you with
proper exercise duration, use a kitchen timer.
o Do not let your hamstrings flex the lower leg toward
the ceiling. Ensure that your pelvis does not shift into
the hip that is in contact with the ground.
This exercise increases lower abdominal
muscle control, including the transverse abdominis.
These are important muscles to integrate to eliminate
Position: Lie on your back on an
exercise matt or comfortable surface with your feet
about 6-8 inches away from your gluteus maximus
o Contract the lower abdominals and
gently press your lower back toward the floor.
o Release the contraction.
o Repeat for the prescribed number of reps.
Avoid contracting your rectus abdominis
(your six-pack muscles) while doing this integration
exercise. This exercise can be very difficult at the
beginning, so have patience.
Optional: If you have one, you can also
use a blood pressure cuff for good biofeedback. Place
the cuff beneath your back directly under your belly
button and pump the cuff to 40 mm Hg. Take a deep
diaphragmatic breath and, slowly exhaling, draw your
belly button in toward your spine. Contract your lower
abdominals so the blood pressure cuff reads 70 mm Hg. If
you do not have access to a blood pressure cuff, just
fold a towel until it is the thickness of your hand and
place it under your lower back. When your skin comes in
contact with the towel, it will send a signal to the
brain about how hard you are pushing down.
Rememberů Avoid all rectus abdominis
involvement in this exercise.
NOTE: This exercise requires a blood
Heel slides are a great integration
exercise for the inner unit, lower abdominals, and lower
extremities (your outer unit).
Position: Lie supine (back down, face
up) on the floor with your shoes off. Bend your hips and
knees, placing your heels about 8 inches from the
buttocks. Keep your spine in a neutral position. Place a
blood pressure cuff under your lumbar spine. Pump the
blood pressure cuff up to 40 mm Hg and take a deep
o Slowly exhale and draw your belly
button in toward your spine.
o Exhale and then slowly slide the left leg out, away
from the starting position. There should be very little
movement of the blood pressure cuff needle. If the
pressure on the cuff begins to increase or decrease by
more than 5 mm Hg, stop the movement and slide your leg
back to the beginning position. Make a note of the
distance. The distance is now your ending point.
The goal is to extend your leg further
out without the blood pressure cuff changing its
reading. The further you can extend your leg, the better
the integration of your inner unit and outer unit.
o Repeat for the opposite leg.
o Repeat for the prescribed number of reps.
Try to achieve 10 reps at a slow pace
for each leg. Do not rush this exercise!
Do this exercise daily until you can alternate sliding
each leg in and out, keeping the blood pressure cuff at
40 mm Hg.
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