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 rehabilitation.

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 rotators.

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, diaphragm).

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 knee.
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.

Pelvic Tilt

This exercise increases lower abdominal muscle control, including the transverse abdominis. These are important muscles to integrate to eliminate pooch belly.

Position: Lie on your back on an exercise matt or comfortable surface with your feet about 6-8 inches away from your gluteus maximus (buttocks).


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.

Heel Slides

NOTE: This exercise requires a blood pressure cuff.

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 diaphragmatic breath.


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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