Let’s stop drawing in the abdominal wall during Pilates classes: Part II. Suggestions for the future
Introduction
In the first part of this article published in (June 2024 in The Pilates Journal), we provided a new perspective on whether the “abdominal drawing-in maneuver” (ADIM), also named “abdominal hollowing maneuver” (AHM), should be performed by Pilates practitioners or our clients. Below we summarize and recall our main conclusions here:
Concerning the use of the ADIM to perform a selective activation of the Transversus Abdominis (TrA) muscle, our opinion is that, although ADIM can increase TrA activation, Pilates exercises do not meet the requirements for isolated TrA-specific retraining. The application of ADIM during Pilates exercises, without quality control of the TrA activation, could impair spinal stabilization strategies. Enhanced activation of the TrA during ADIM increases the Inter Rectus Distance under diastasis rectus abdominis conditions and is discouraged in patients with hernia repair or severe uncorrected abdominal hernia. The continuous conscious activation of the core muscles can potentially jeopardize the structures of the spine. Neuroanatomy concepts contradict the use of a conscious muscle activation technique, such as ADIM, to enhance the postural tonic role of the TrA muscle.
With regard to the use of the ADIM to improve lumbo-pelvic stability, we conclude suggesting that excessive activation of TrA during an ADIM, an essential but ineffective local muscle for pelvic orientation control, may interfere with Rectus Abdominis muscle input for pelvic directional control during high-load Pilates exercises. In fact, ADIM was less effective at controlling pelvic rotation during two typical Pilates scenarios, an “active supine straight leg raises” (Lee, 2020) and a “front Plank” (Jung & Oh, 2022).
2. Systematic Review Study about the effectiveness of ADIM during High Load Tasks.
When you have been doing things one way for a long time, without even asking yourself anymore why you do them that way, it is very difficult to consider any changes. The objective of this second article is to make a clear proposal for change and suggest what to do from now on. But first, we would like to show the result of a recent publication that analyses the effectiveness of ADIM for core stability during High-Load Tasks that may add further foundation to what was said above.
In a recently published systematic review article it is shown how during high-load tasks (HLT) the conditions that used ADIM performed better only in 16. 66% of interventions, while other conditions, that did not use ADIM, performed better in 83. 33% of interventions (Figure I) (Aragon-Salamanca, 2024). In this review study is highlighted that ADIM performed worse on all of the HLT except one, the study by Fayh and colleagues (Fayh, 2018). But we think this study should not be taken in account because the intervention group that used ADIM received also some specific postural guidelines what could have affected the result. Postural guidelines that provides positional information and generates attention to a specific joint segment will affect the movement response during the execution of any task or exercise (Becker and Smith, 2015)(Sawai et al, 2022), due to what we could call an Internal Focus Effect (Aragon-Salamanca, 2024). Therefore, according to the result of this review, ADIM is less effective for Core Stability during HLT so we should not use ADIM during “stability and core strengthening” exercises.
Figure 1. During High-Load tasks ADIM performed better in only 16,66% of the studies, while other conditions that did not use ADIM (NO ADIM) perform better in the 83,33% of the studies (Original source Aragon Salamanca JC, 2024: under CC BY 4.0.).
The “stability and core strengthening” exercises, according to Mottram and Comerford, are described as high-load stability tasks, that are developed with high-load resistance or high speed, that promote co-activation of the local and global muscles and might generate muscle fatigue, with the dominance of High Threshold Recruitment (HTR) (Mottram and Comerford, 2008). A task with HTR domain is defined when the load of the exercise or task is such that it cannot be performed continuously for two minutes due to the onset of fatigue. If the exercise or task is performed at high speed, then it will be performed also with an HTR domain, even if the load is low. According to this description many of the core exercises used in the fitness, sport training and Pilates environment better match the concept of “stability and core strengthening” exercises, therefore, they are HLT. In figure 2 we show several examples of High-Load Pilates exercises.
Figure 2. Examples of High-Load Pilates exercises.
3. Personal Discussion
We are aware of the evidence suggesting that, in specific situations of low-back pain, in the rehab process, the TrA muscle may need an isolated retraining strategy; in these situations, a controlled and monitored ADIM could be used. Some subjects could benefit from the use of ADIM, when we assess that TrA has a low level of activation or as a strategy to develop awareness and control of the core muscles (McGill, 2013). However, we agree with the idea that, when we move, we do not think about contracting any muscle; we think about the movement itself or the intention and final goal of the movement, so our muscles become active in order to achieve these goals and automatically support the system (Cook, 2010). The Beevor Axiom says that “the brain knows nothing of individual muscle action but knows only of movement” (Voss et al, 1985). Although, in low-back pain scenarios it may be necessary to retrain the local TrA muscle in an isolated manner by drawing-in the abdominal wall, at some point, during the motor re-education program, we should stop using conscious muscle activation. “Individuals in an externally loaded state appear to select a natural muscular activation pattern appropriate to maintain spine stability sufficiently. Conscious adjustments in individual muscles around this natural level may actually decrease the stability margin of safety.” (Brown et al, 2006). Neuman points out that, although the local and the global muscles have been analyzed separately, they function together and, in healthy people, all muscles of the core contribute to the trunk static or dynamic stabilization (Neuman, 2010). Therefore, we agree with Lederman’s suggestion that says: “Patients who have been trained to use complex abdominal hollowing and bracing maneuvers should be discouraged from using them” (Lederman, 2010).
4. Our suggestion for the future
In accordance with the above, we think that we should stop using any conscious abdominal muscle activation during the core training but we believe that we must define different Order Parameters that should describe the optimum behavior of the system during each core stability training task.
a. Order Parameter #1: Lumbo-Pelvic Alignment.
We believe that we should continue to look at the position of the lumbo-pelvic region during Pilates exercises, because joint alignment will affect the optimal joint loading and optimal muscle activation (Sahrmann, 2011) (O’Sullivan and Beales, 2007). So, we suggest continuing to teach an optimal lumbo-pelvic alignment during the Pilates exercises through the development of a solid base of Segmental Body Awareness, especially of this body region (Figure 3).
Figure 3. Recognize and identify de Neutral Zone of the lumbo-pelvic in different positions.
b. Order Parameter #2: Lumbo-Pelvic Direction Control
Following the concept of Direction Control of Mottram and Comerford (Mottram and Comerford, 2008) we need to develop a strong Direction Control Awareness with the goal of developing specific direction avoidance patterns in the lumbo-pelvic region during the different core stability training tasks (Figure 4).
Figure 4. Differentiate the directions of movement of the pelvis in the sagittal plane to identify the direction of force to apply: At = Anterior Tilt, Pt = Posterior Tilt. Recognize the movement direction it should be avoided. Fa = Direction of the force that acts to destabilize the system. Fr = Direction of the force that resists Fr: direction of posterior tilting.
c. Order Parameter #3: Breathing pattern
We should also continue to be aware of the localization of the breathing movement because this will guide us about the right breathing pattern (Kapanji, 2017). Therefore, the 3-dimensional lower rib cage breathing pattern during the loaded-tasks should be encouraged during the Pilates exercises (Figure 5).
Figure 5: 3-Dimensional lower rib cage Breathing during Loaded-Positions.
d. Order Parameter #4: IAP control
And we may need to observe the effect of the Intra Abdominal Pressure (IAP) during the different Pilates exercises. An inappropriate control of the IAP increase, which will show an obvious departure or bulge of the abdomen from its basic state, means an incompetent abdominal muscle function during a loaded task (Cabañas and Chapinal, 2014). So, we suggest being aware of how the muscles of the core react to the different Pilates positions and exercises in relation to this IAP control. This should not be confused with continuing to “draw the abdominal wall in” to prevent the abdomen from coming out. We will need to teach clients how to identify the optimal amount of load that the system can handle. If a system cannot control the increase of IAP during the execution of certain exercise, it means that this exercise is not appropriate at that time and should be facilitated (Figure 6).
Figure 6: If the system is not able to control the increase of IAP caused by the execution of an exercise, showing an obvious bulging of the abdomen (photo 1), compared to the basal state (photo 2), it means that this exercise is not appropriate at that moment and should be modified or facilitated (photo 3 and 4).
Julio C. Aragón-Salamanca graduated in Physical Activity and Sport Sciences from the University of the Basque Country and holds a Master’s degree in Sport Injury Rehabilitation. A Certified Specialist in the Pilates Method, he has been the owner, technical director, and instructor at Pilates Studio el Patio, a Pilates and rehabilitation center in Madrid, Spain, since 2005.
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