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. 2013 Nov 19;7:1189–1199. doi: 10.2147/PPA.S50436
Week Core stabilization exercise
Isolated transversus abdominis and lumbar multifidus training
1 Train transversus abdominis muscle activation in a prone lying position without spinal and pelvic movements for 10 seconds with ten repetitions. Keep respiration normal. You gently draw in the lower anterior abdominal wall below the navel level (abdominal drawing-in maneuver) with supplemented contraction of pelvic floor muscles, control your breathing normally, and have no movement of the spine and pelvis while lying prone on a couch with a small pillow placed beneath your ankles.
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Train lumbar multifidus muscle activation in an upright sitting position. You raise the contralateral arm while performing the abdominal drawing-in maneuver in a sitting position on a chair.
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Integrated transversus abdominis and lumbar multifidus training light activities
2 Perform cocontraction of transversus abdominis and lumbar multifidus muscles while sitting on a chair. You use the index and middle fingers to palpate contraction of transversus abdominis muscle and the opposite two fingers to palpate contraction of lumbar multifidus muscle. This exercise progresses from 10- to 60-second holds of cocontraction for ten repetitions.
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Train cocontraction of these muscles with trunk forward and backward while sitting on a chair and keeping your lumbar spine and pelvis in a neutral position. The second exercise this week required 10-second holds with ten repetitions.
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3 Perform cocontraction of the two muscles in a crooked lying position with both hips at 45 degrees and both knees at 90 degrees. Then you abduct one leg to 45 degrees of hip abduction and hold it for 10 seconds.
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Train cocontraction of these muscles in a crooked lying position with both hips at 45 degrees and both knees at 90 degrees. Then you slide a single leg down until the knee is straight, maintain it for 10-second holds and then slide it back up to the starting position.
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4 Perform cocontraction of the two muscles while sitting on a balance board. You perform cocontraction of the muscles with trunk forward, backward, and sideways while sitting on a balance board and keeping your lumbar spine and pelvis in a neutral position. You perform each pose for 10-second holds with ten repetitions.
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Integrated transversus abdominis and lumbar multifidus training heavier activities
5 Perform cocontraction of the two muscles while raising the buttocks off a couch from a crooked lying position until your shoulders, hips, and knees are straight. You sustain this pose for 10 seconds and then lower the buttocks back down to the couch with ten repetitions.
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Train muscle cocontraction while raising the buttocks off a couch from a crooked lying position with one leg crossed over the supporting leg. You raise the buttocks off the couch until the shoulders, hips, and knees are straight. You sustain this pose for 10 seconds and then lower the buttocks back down to the couch with ten repetitions.
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6 Perform cocontraction of the two muscles while raising a single leg from a four-point kneeling position and keeping your back in a neutral position. You sustain this pose for 10 seconds and then return the leg to the starting position with ten repetitions.
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Train muscle cocontraction while raising an arm and alternate leg from a four-point kneeling position and keeping your back in a neutral position. You sustain this pose for 10 seconds and then return to the starting position with ten repetitions.
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7 Perform cocontraction of the two muscles in a standing position while a mini ball is behind your upper back and against the wall. You flex the hip and knee of one leg to 90 degrees. Sustain this pose for 10 seconds and then return to the starting position with ten repetitions.
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Train the muscle cocontraction in a standing position with ankle movement. Perform ankle movement in the forward-backward direction while keeping your lumbar spine in a neutral position. Sustain this pose for 10 seconds and then return to the starting position with ten repetitions.
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Integrated transversus abdominis and lumbar multifidus training in pain aggravating activities
8–10 Perform muscle cocontraction while walking at normal, faster and fastest speed for 5 minutes at weeks 8, 9, and 10 respectively. In addition, choose two aggravating activities or tasks that you anticipate would cause pain or instability and perform muscle cocontraction while doing these activities or tasks without having pain. Each aggravating activity or task is performed for 2.5 minutes.
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