Strengthen This Core Muscle to Help Your Back Pain

The transverse abdominus isn’t a sexy six-pack muscle, but this integral part of your core can help stabilize your spine and reduce or avoid back pain. Here are four ways to strengthen it.

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In a lot of ways, your core protects your spine just like your spine protects your spinal cord (we know, bear with us). Your spinal cord is part of your central nervous system, your body’s command center. It’s incredibly important, but it’s also vulnerable and needs protection. That’s why it’s encased in a column of bone: your spine.

Similarly, although your spine isn’t exactly delicate, you don’t want it damaged. Plus, it’s super flexible. It needs protection and stability, and that’s where your core comes in.

Back pain transverse abdominusStrengthen your transverse abdominus core muscle to help stabilize your spine and prevent back pain.

What Is the Transverse Abdominus?

You’ve heard the term “core” spoken by everyone from media personalities to medical professionals to fitness gurus to your health-minded friends and family, but what are they all talking about? Simply, it’s a group of muscles that wraps around your torso—not just the front, but the back and sides as well.

Though it’s often overlooked, the transverse abdominis muscle (TVA) is vital to a healthy core—especially if you have back pain. Often referred to as the "seatbelt muscle,” it’s nestled deep in your abdomen and wraps around your waist. It has nothing to do with six-pack abs and everything to do with long-term core strength and function.

Which is why, although the moves that develop your TVA aren’t “sexy,” says Sonja Stilp, MD, it’s vital that you do them regularly, particularly if you have frequent or chronic back pain. Dr. Stilp is the founder of RISE, a Boulder, Colo. medical practice offering premier innovative, personalized health care, with a focus on women's orthobiologics.

She calls a well-developed TVA “a functional corset,” that protects your spine. According to Dr. Stilp, a strong TVA muscle contracts to give your spine the right amount of support and stability every time you move. Data suggests that people without low back pain tend to engage their TVA 30 milliseconds before a shoulder movement, whereas subjects with low back pain had comparatively delayed contraction of their TVA muscles. And a study published in the journal Spine found that people who regularly engaged in TVA-strengthening exercises were less likely to experience a recurrence of low back pain.

Core Anatomy Basics 

The first step to strengthening your TVA begins in your head, not on your yoga mat. To understand the rationale behind the moves and how to do them correctly, you first need some basic anatomy knowledge. Dr. Stilp says it’s helpful to think of the core as a “muscular box,” in which the front is the abdominals, the back is comprised of the spinal stabilizing muscles, the base is your pelvic floor, the top is your diaphragm, and the sides are your hip muscles. 

Now, says Dr. Stilp, imagine that box moves like a Rubik’s cube. All activities of daily living (ADL’s), from carrying a laundry basket to playing basketball, require you to move your core in different planes of motion—just like the different ways you can twist and turn a Rubik’s cube.

Like the four-sided puzzle, your core moves in three basic ways: you flex and extend whenever you bend forward and stand back up, you perform a lateral side bend when you bend your trunk to one side, and you rotate your trunk anytime you twist your torso.

According to Dr. Stilp, a well-functioning core is strong and stable on all six sides and when moving in all directions.

Two Common Causes of Transverse Abdominus Weakness

The transverse abdominus often suffers from neglect, which means a greater chance of you suffering from back pain. Here are two of the most common reasons the TVA isn’t as strong as it could be.

Focusing on the “Six-Pack” Muscles

Your core is made up of a variety of muscles that can be divided into two categories: local and global. The local muscles (such as the TVA and multifidi) are smaller and act as stabilizers. The global muscles (including the rectus abdominis and the external obliques) are larger and more superficial (close to your body’s surface). According to Dr. Stilp, we often focus too much on strengthening the global muscles—at the expense of the local muscles.

She compares your core to a house, explaining that the local muscles act as the foundation. Without a solid foundation, even a house made of the strongest, most durable materials will be shaky and weak. When your small, stabilizer muscles cannot support the large, dramatic movements of your global muscles (think swinging a golf club or performing bicycle crunches), you’ll inevitably run into problems—potentially including low back pain.

“A lot of us don’t train our local system,” says Dr. Stilp, adding, “If your local stabilizing muscles fail, the whole system fails.” And although the exercises targeting the stabilizers are “small and boring,” they’re tremendously important.        

Exercising in Only One Plane of Movement

Another issue that can contribute to back pain is that we don’t necessarily train the core muscles in all planes of motion, says Dr. Stilp. For example, even if you’re addressing the TVA by performing pelvic tilts, you’re still only moving in one plane as you tilt your hips forward and back (flexion and extension). According to Dr. Stilp, to translate to functional strength, your core routine needs to include movements that incorporate side bending and twisting as well.

How to Strengthen Your Transverse Abdominus

So how do you strengthen your TVA? Dr. Stilp recommends the following progression.

1| Pigeon Pose

Remember the box analogy? According to Dr. Stilp, many of us, especially those of us who sit at a computer all day, are excessively tight along the sides of the box—our hips. She suggests first increasing your hip mobility before attempting core strengthening. Why? If your hip muscle fibers are shortened, that can adversely affect hip joint function and efficiency during functional core movement, and interfere with your progress. Dr. Stilp recommends Pigeon Pose as a hip opener. Here’s how to do it:

  • Get on all fours, with your knees and palms on the ground.
  • While sliding your left leg back so your hip is extended, externally rotate your right hip (i.e. turn your leg out from your hip). Aim to position your right shin perpendicular to your body. (You’ll still get a good stretch even if you can’t get all the way there.)
  • Extend your trunk so you’re upright, lifting your chest, arching your bac and directing your gaze toward the ceiling, while resting your fingertips on the floor a few inches forward of your hips.
  • Hold the pose for 30 seconds and then switch sides.

This stretch targets the hip flexor muscles in the extended leg and the rotator and outer hip muscles in the flexed leg.

Back pain transverse abdominus pigeon posePigeon pose is good prep for core strengthening.

2| Slow Down and Engage Your TVA During ADL’s

If you think you don’t have time for core strength exercises, this part of the progression exercise is perfect for you. According to Dr. Stilp, you can train your TVA muscles to activate more quickly and effectively throughout the day by simply slowing down and moving more intentionally.

She suggests first placing your hands around your waist, “where a corset would be,” and then engaging your core so that you can feel your muscles contracting, in order to get a feel for the movement. Once you’re comfortable with it, remember to engage your abdominal muscles in this way just before and while you reach, twist, or lift household items.

3. Pelvic Tilt
This move does require you to get on the floor for a few minutes. It’s not dramatic but it’s vital for building the smaller foundational muscles that support a strong, healthy core. Here’s how to do it:

  • Lie on your back with your knees bent and your feet on the floor.
  • While engaging your TVA, gently tilt your pelvis upward toward your head.
  • Return your pelvis to a neutral position.
  • Repeat.

Start with 3 sets of 10-12 repetitions. When this no longer feels challenging, or you can complete all three sets without increasing your back pain, advance to more challenging exercises such as dead bug, bird dog, a plank, or plank variation.

4. Standing Exercises

To translate the core strength you’ve developed into functional strength and pain-free movement, once you’ve mastered the exercises above, Dr. Stilp recommends progressing to standing exercises that require rotation. One example of this type of movement is a standing lunge with rotation. Here’s how to do it:

  • Assume a lunge stance; your front leg should be flexed to 90 degrees at the hip, knee, and ankle. Your rear leg should be extended at the hip with your knee touching or almost touching the floor.
  • Twist from your waist. When you feel comfortable doing this movement you can hold a weight such as a dumbbell, a medicine ball, or a gallon jug of water in both hands, gradually increasing the weight as you get stronger.

Wherever you are in the process of strengthening your core, consistency is key. In other words, it’s much better to commit to a short workout every day than to do one monster workout once or twice a week. According to Dr. Stilp, ten minutes a day is enough to build strength, improve function, and decrease back pain. 

Updated on: 01/04/21
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Building Core Strength to Reduce Back Pain
Sonja Stilp, MD
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