The transversus abdominus muscle (TA) plays a very important role in pelvic floor (PF) rehabilitation and function, yet most explanations for controlling continence don’t mention any exercises other than Kegels. Why is this? Have our media outlets failed us by over-simplifying the method of PF strengthening, leaving those who are following their direction destined for failure? I believe so. Today let’s take a closer look at this postural muscle and the role it plays in core stability and pelvic floor strength.

First let’s get a good visual of our anatomy (you can find a good visual here: http://www.easyvigour.net.nz/fitness/hpilatesintro1_2.htm ). The muscle fibers of the TA, or lower abdominals, encircle our abdomen and pelvic area, reaching around to the thoracolumbar fascia of our lower back. This area that our TA muscle encircles narrows from our waistline down within our pelvic inlet (the area bordered in the back by our sacrum and on the sides by our two pelvic bones.) The transverse fibers of our lower abdominals run around our waist and within our pelvic inlet like a corset or brace that we can cinch up by drawing our belly button in. This corset of transversus muscle fibers narrows like a cone, ending at the level of our pubic bone. As our TA contracts, this cone squeezes like a shrink wrap, displacing air and pressure upwards and providing more stability to the individual segments of our lower spine. I also like to describe this TA squeeze as a vacuum, helping to pull our PF up and our lower abdominals in tight, only to displace the pressure upwards to our expanding lower rib cage and chest. It is easy to recognize someone standing or sitting with the TA muscle engaged because their chest will be lifted making them stand and sit taller.

Now let’s focus on the role the TA plays in PF strength. It has been shown that the lower fibers of our TA muscle that lie within our pelvic inlet work closely with our PF muscles, which span the base of our pelvis. Some preliminary studies have even shown that there may be a direct connection of some of the fibers of the PF and TA. Whether or not this is proven to be true – one thing we do know is that these two muscles work together as the deepest contraction, the first stabilizers, as the root of our core. (You can also include our multifidi muscles in this deep contraction but we will talk about those segmental stabilizers on another day).

You can feel this intimate connection between your pelvic floor and your TA as you perform pelvic floor elevations. When doing the two-step Kegel that I teach on the Hab-It: Pelvic Floor DVD, you will begin to feel how your TA is activated every time you work to draw your pelvic floor up into your pelvic outlet. Conversely, you can also feel your PF contract every time you work to draw your TA in while holding neutral posture. Studies have shown an increase in contractile force of our TA and PF muscles when activated together vs. contracting individually. This paints a clear picture that we need a strong TA firing along with our PF muscles to achieve optimal strength gains and efficient firing of our pelvic floor. Complete resolution of incontinence or better control of our prolapse symptoms can not be expected if we don’t have both these muscles firing together.

Now that we know the importance of our transversus abdominus muscle, how do we strengthen it? The easiest way to identify and begin TA strengthening is in a 4-point kneeling position (i.e., knee and then place your hands on the floor, right underneath your shoulders). Initially as you start, I recommend you be in front of a mirror, positioned so that you have a side view of your belly. To begin, in the 4 point kneeling position, drop your back down to a “flat back position” and relax your belly, allowing it to hang down with the pull of gravity. From this position, draw your belly up to a tighter position without rounding or lifting your back. The side view you have in the mirror will be great visual feedback; you should see your belly draw up as if you are cinching up your midsection, being careful to maintain your flat back position throughout. Lifting your belly and holding for a 5 count, 3 times each day is a great start to finding and “waking up” your TA.

Once you become aware of your TA you can begin to activate and draw this muscle in tight when you sit down at your computer, when you stand in the grocery line, as you drive your car, etc. I recommend you use a mirror to view the cinching up of your midsection in sitting and standing positions as well to ensure that you are working the right muscles.

Some other helpful tips:
• You should be able to continue with a regular breathing pattern while holding your belly in this drawn in position.
• You should see no movement of your back when you activate your TA. If your buns tuck under then you know you have activated your rectus abdominus instead of your TA. Remember, your belly should draw in with no movement of your low back.
• You may feel a tightness in your low back as you contract and hold your TA in. This is because of the attachment of the TA to the fascia of your low back and the co-contraction of the multifidi muscles of your lower back that also work to hold neutral spine.

To close this blog, I want to stress the complex rehabilitation of the pelvic floor. “Do your Kegels” should no longer be the very simply message going out to those suffering from incontinence or prolapse symptoms. The truth of the matter is that strengthening our pelvic floor and changing our symptoms requires knowledge of finding and holding your neutral spine in sitting and standing, strengthening of your TA and other coordinating muscles of our abdomen and pelvis, as well as a thorough, two-part, Kegel contraction. Continence will come with consistency!

Published by Tasha

5 Comments

  1. I hope it is ok to add in a question here on the timescale of prolapse recovery?
    I have been doing kegels for 6 mths now and feeling discouraged that my prolapse (cystocele/rectocele) are still the same degree (or slightly worse) despite pelvic tone being better. I have recently started doing some pilates exercises to exercise the other muscles in the pelvic basket (looking forward to the Hab-it DVD arriving in the post soon!)Does it surprise you that I have found the prolapses to stay the same/slightly worsen during this time or is this somewhat to be expected?
    Also, while my prolapse is no doubt related to 2 difficult births it only became apparent 2 years postpartum – does that make recovery more challenging because the natural postpartum window of healing is over?
    Many thanks for your thoughts

    Reply
  2. P.S. I have since read your blogs on quantity of daily kegels. I have been doing 30 “endurance” kegels of 8 seconds a day and 60 quick flick kegels for the last 6 mths. Could this explain the increase in symptoms? Is the downside to doing too many kegels a short-term one or does it cause longterm increase in prolapse?

    Reply
  3. MS, there are no long term effects from over-doing your kegels, but you more than likely were fatiguing those muscles with your daily routine, which will not improve your prolapse symptoms. With your pelvic floor fatigued, you begin to recruit the wrong muscles and fire them in the incorrect pattern, just trying to hold on and support your pelvic organs.

    With prolapse symptoms, it is very important that you become aware of your neutral spine posture and learn how to “turn on” your transversus abdominus and your multifidi muscles to begin to tighten up your pelvic basket. Your pelvic floor will not give the support it needs to your pelvic organs unless you keep your tail bone lifted and master the transversus abdominus contraction drawing your belly up and in. The simple mistake of recruiting your rectus abdominus instead of your transversus abdominus will cause pressure to be pushed down on your pelvic floor instead of lifting it.

    Quite often in pilates, the intensity of the exercises can jump beyond what the transversus abdominus can handle and we immediately recruit our rectus abdominus, which will increase the pressure down on our pelvic floor. I will caution you on any double leg lift or lowering routine as this is too much for transversus abdominus to hold.

    Tune in to my next blog, which should be uploaded by 6/22 that will again focus on the transversus abdominus. I will be giving some good examples of plank exercises, which are a nice way to advance your transversus abdominus strength with your body in an extended position.

    Tasha

    Reply
  4. And on the 2 years removed from childbirth question – not a problem. We may have to work a little harder to “wake up” the muscles we are trying to recruit, but once you do the rehabilitation potential is the same.

    Reply
  5. Thankyou so much! I look forward to seeing the next TA blog

    Reply

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