However, in an ideal scenario, we don’t necessarily want our patients to be limited to an increased pressure system for support in movement. We tell them to breathe, but do we really fully realize what is happening here?Ī breath holding strategy is one (very effective, if not terribly functional) way to increase intra-abdominal pressure. We are probably all too familiar with the Valsalva maneuver as a movement strategy-we show people how to do a movement, or ask them to activate a muscle and then realize that their facial color is slowly darkening into red or purple as they hold their breath. When we teach a bracing strategy, we are essentially teaching our patients to increase their intra-abdominal pressure-which does provide spine support but at what cost? In fact, while a bracing strategy can provide some short term symptom relief, it may set patients up for non ideal movement strategies that can have consequences down the line. One of the key things to understanding this concept is that in an ideal scenario, IAP control should not be dependent on a bracing strategy for movement. This is one of my favorite resources for understanding the concept of this canister and intra-abdominal pressure in general. The more current concept of intra-abdominal pressure essentially says that when all the muscles making up the “core canister” (diaphragm, pelvic floor, abdominals, multifidus, obliques, etc.) are contracting together and in a balanced way, that generates a pressure within the abdominal cavity, and the pressure provides support to the spine. We now know this isn’t accurate, and it is actually detrimental to teach people to (not) move this way. “Old” spine stability teaching was that our spinal support comes directly from the action of muscles that connect to the spine and the way we increase stability is by tightening or bracing the muscles to prevent the spine from moving. However, to put it simply, intra-abdominal pressure is a key component of our dynamic stability system. Now, do realize, this is a fairly complicated concept and can and has been the subject of entire book chapters, articles, blog posts, and CE courses (I teach half and full day CE courses on this topic), so a fully comprehensive explanation is not likely in a simple blog post. So this blog post is based on our current understanding of the topic at hand and I reserve the right to retract it if the evidence changes in 5 years! Today I wanted to have a little chat with you folks about intra-abdominal pressure (IAP)-what is it, how can we use it to maximize our patients’ benefit from therapy, and is there such a thing as too much? Now I do also want to throw out there that the research on this topic is not 100% clear, and as with anything else in the study of human beings and movement, it may be subject to change as new information comes out/studies are done. I’m sorry, I got that song stuck in your head, didn’t I? I just couldn’t help myself,
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