Abdominal Muscles: Difference between revisions

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== Introduction  ==
== Introduction  ==
The abdomen describes a portion of the trunk connecting the thorax and pelvis. An abdominal wall formed of skin, fascia, and muscle encases the abdominal cavity and viscera. In contrast to the thorax and pelvis, the abdomen has little skeletal support, comprising of only the vertebral column and lower ribs posteriorly. The abdominal wall connects to the skeletal framework at the thoracic cage superiorly and pelvic bones inferiorly. This relative bony deficiency allows flexibility of the trunk as well as distensibility to accommodate dynamic changes in the volume of abdominal contents<ref>Flynn W, Vickerton P. [https://www.ncbi.nlm.nih.gov/books/NBK551649/ Anatomy, Abdomen and Pelvis, Abdominal Wall.] Available:https://www.ncbi.nlm.nih.gov/books/NBK551649/ (accessed 11.2.2022)</ref>.
[[File:Muscles of the abdominal wall - Kenhub.png|alt=Overview of the muscles of the abdominal wall (anterior view)|right|frameless|600x600px|Overview of the muscles of the abdominal wall (anterior view)]]
The abdominal [[Muscle|muscles]] are the muscles forming the abdominal walls, the abdomen being the portion of the trunk connecting the [[Thoracic Anatomy|thorax]] and [[pelvis]]. An abdominal wall is formed of [[skin]], [[fascia]], and muscle and encases the abdominal cavity and viscera<ref name=":0">Flynn W, Vickerton P. [https://www.ncbi.nlm.nih.gov/books/NBK551649/ Anatomy, Abdomen and Pelvis, Abdominal Wall.] Available:https://www.ncbi.nlm.nih.gov/books/NBK551649/ (accessed 11.2.2022)</ref>.  


== Structure and Function ==
The abdominal muscles support the trunk, allow movement, hold organs in place, and are distensible (being able accommodate dynamic changes in the volume of abdominal contents)<ref name=":0" />.
The abdominal muscles may be divided broadly into anterolateral and posterior components.


# Anterolateral muscles include five paired muscles: the external oblique, internal oblique, transversus abdominis, rectus abdominis, and pyramidalis.
The deep abdominal muscles, together with the intrinsic [[Back Muscles|back muscles]], make up the [[Core Muscles|core muscles]] and help keep the body stable and balanced, and protects the spine.
# Posterior muscles include psoas major and quadratus lumborum bilaterally.  


The abdominal muscles contribute to movements of the trunk, including flexion, extension, lateral flexion, and rotation.  
Causes of abdominal muscle strains include overstretching, overuse or a violent, poorly performed movement of the trunk, improper technique while playing sports that require running, turning, and jumping, lifting heavy objects, laughing, coughing, or sneezing<ref name=":2">Better health [https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/abdominal-muscles Abdominal muscles] Available: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/abdominal-muscles<nowiki/>(accessed 12.2.2022)</ref>.


'''The posterior abdominal wall''' consists of [[Lumbar Anatomy|lumbar vertebrae]], [[Pelvic Floor Anatomy|pelvic girdle]], muscles, and associated fascia ([[Quadratus Lumborum|quadratus lumborum]], [[iliacus]], [[Psoas Major|psoas major]] and [[Psoas Minor|minor]]).
Image: Overview of the muscles of the abdominal wall (anterior view)<ref >Overview of the muscles of the abdominal wall (anterior view) image - © Kenhub https://www.kenhub.com/en/library/anatomy/anterior-abdominal-wall</ref>


Acting together forming a firm wall that supports the [[Muscle|muscles]] of the spine and helps to maintain an erect posture, Support internal visceral organs where there is no bone, protect the abdominal viscera from injury and help to keep them in their anatomical position. In addition, the contraction of these muscles helps in forceful expiration and to increases the intra-abdominal pressure such as in sneezing, coughing, micturating, defecating, lifting, and childbirth.<ref name="Grays">Drake RL, Vogyl AW, Mitchell AW. Gray's anatomy for students. 3rd edition. Philadelphia: Churchill Livingstion Elsevier; 2015. 282p.</ref>Have a role in preventing hyperextension.
== Anatomy ==
[[File:Cross section abdominal muscles.png|thumb|Cross section abdominal muscles]]
When people think of abdominal muscles it is these four main muscles


== Anterolateral Abdominal Wall ==
#[[Transversus Abdominis|Transversus abdominis]] – the deepest muscle layer. Its main roles are to stabilise the trunk and maintain internal abdominal pressure
The anterolateral abdominal wall is formed by skin, fascia, muscles, and peritoneum<ref>Flament JB. [https://link.springer.com/article/10.1007%2Fs00104-006-1184-5 Functional anatomy of the abdominal wall.] Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen. 2006 May;77(5):401-7.</ref>.  
#[[Rectus Abdominis|Rectus abdominis]] – slung between the [[ribs]] and the [[pubis]] at the front of the [[pelvis]]. When contracting, this muscle has the characteristic bumps or bulges that are commonly called ‘the six pack’. The main function of the rectus abdominis is to move the body between the ribcage and the pelvis
#[[External Abdominal Oblique|External oblique muscles]] – these are on each side of the rectus abdominis. The external oblique muscles allow the trunk to twist, but to the opposite side of whichever external oblique is contracting. eg the right external oblique contracts to turn the body to the left
#[[Internal Abdominal Oblique|Internal oblique muscles]] – these flank the rectus abdominis and are located just inside the hipbones. They operate in the opposite way to the external oblique muscles. eg twisting the trunk to the left requires the left side internal oblique and the right side external oblique to contract together.


'''Anterolateral Abdominal Wall Muscles''': consists of two vertical muscles located on the midline and bisected by [[Linea Alba|linea alba]]; [[Rectus Abdominis|Rectus abdominis]] and pyramidalis and three flat muscles on the anterolateral side arranged from superficial to deep; [[External Abdominal Oblique|external abdominal oblique]], i[[Internal Abdominal Oblique|nternal abdominal oblique]], [[Transversus Abdominis|transversus abdominis]].
== Structure and Function ==
 
[[File:Trunk muscles.jpeg|right|frameless|423x423px]]
# [[External Abdominal Oblique|External obliques]] muscle, the most superficial anterolateral abdominal muscle its fibers run inferomedially, unilateral action results in ipsilateral side flexion and contralateral rotation of the trunk bilateral action to flex the vertebral column by drawing the pubis towards the [[Ribs|xiphoid proces]]<nowiki/>s<ref name="Action">Drake RL, Vogyl AW, Mitchell AW. Gray's anatomy for students. 3rd edition. Philadelphia: Churchill Livingstion Elsevier; 2015. 286p</ref>.
The abdominal muscles are more extensive than those listed above, and are be divided broadly into: Anterolateral; and Posterior walls.
# [[Internal Abdominal Oblique|Internal obliques]] directed superiomedially perpendicular to the external obliques it acts unilaterally for ipsilateral trunk rotation and side flexion and bilaterally to compress the abdominal viscera, pushing them up into the diaphragm, resulting in a forced expiration.
'''Anterolateral Abdominal Wall Muscles''': consists of  
# [[Transversus Abdominis|Transversus abdominis]] is the deepest of the abdominal muscles, it is an important core muscle and its primary function is to stabilise the [[Lumbar Anatomy|lumbar]] spine and [[pelvis]] before movement of the lower and /or upper limbs occur<ref name="Lee">Lee D. The Pelvic Girdle. 2nd Ed. Edinburgh: Churchill Livingstone, 1999.</ref>.
# [[Rectus Abdominis|Rectus abdominis]] is a long strap muscle that extends the entire length of the anterior abdominal wall lies close to the midline, it is an important postural and core muscle. With a fixed pelvis, contraction results in flexion of the lumbar spine. When the ribcage is fixed contraction results in a posterior pelvic tilt. It also plays an important role in forced expiration and in increasing intra-abdominal pressure.<ref name="Action" />
# Pyramidalis with rectus abdominis it forms the anterior abdominal wall when they contract bilateral tense the linea alba.
 
'''Rectus Sheet'''[[File:Rectus abdominis sheath.jpeg|right|frameless]]
The three anterolateral flat muscles (obliques and transversus abdominis) form an [[aponeurosis]] on both sides that is a broad flat tendon called [[Rectus Sheath|rectus sheath]], enclose the rectus abdominis, and consists of two layers anterior and posterior layer.
 
Anterior layer consisting of the aponeurosis of the external obliques and half of internal obliques, the posterior layer formed by the behalf of internal obliques and transversus abdominis. join in midline forming linea alba (in which the abdominal muscles insert) extend from xyphoid process of sternum to symphysis pubis.<br>At a point midway between the umbilicus and symphysis pubis the posterior wall of the rectus sheet disappears and all aponeurosis sheet presented anterior forming anterior wall.
 
=== Peritoneum ===
[[File:General Distribution of the Peritoneum.jpg|thumb|289x289px|Fig1. visceral and parietal peritoneum]]
It is a membrane that linin the abdominal cavity, covers all abdominal viscera support the viscera with abdominal muscle and provide, and divided into two layers visceral and parietal Fig1.<br>
 
{| class="FCK__ShowTableBorders" width="40%" cellspacing="1" cellpadding="1" border="0" align="centre"
{{#ev:youtube|mxOajxO8mX0|}} <ref>Anatomy Zone. Muscles of the Anterior Abdominal Wall-3D Anatomy Tutorial. Available from: http://www.youtube.com/watch?v=mvOajxO8mXO [last accessed 11/07/15]</ref>
|}
 
== Posterior Abdominal Wall ==
The posterior abdominal wall consists of lumbar vertebrae, pelvic girdle, muscles, and associated fascia.


* 2 vertical muscles located on the midline (bisected by [[Linea Alba|linea alba]]): Rectus abdominis; and [[Pyramidalis Muscle|pyramidalis]]
* 3 flat muscles on the anterolateral side arranged from superficial to deep; external abdominal oblique, internal abdominal oblique, transversus abdominis.<ref>Flament JB. [https://link.springer.com/article/10.1007%2Fs00104-006-1184-5 Functional anatomy of the abdominal wall.] Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen. 2006 May;77(5):401-7.</ref>
[[File:Muscles of the Abdomen Posterior.png|thumb|305x305px|Muscles of the Abdomen Posterior]]
'''Posterior Wall Muscles'''
'''Posterior Wall Muscles'''
#[[Quadratus Lumborum|Quadratus]]: One of the functions of QL is lateral flexion and extension of the vertebral column and during the inhalation assist with the diaphragm and fixes the 12th rib.
#[[Psoas Major|Psoas major]]
#[[Psoas Minor|Psoas minor]],
#[[Iliacus]],
#[[Muscles of Respiration|Diaphragm]], the posterior aspect of the diaphragm.
== Muscle Actions ==
All the abdominal muscles have different muscle fibers orientation and act in all three planes during movements and are linked together by having a common site of connection or by fascia.


# [[Quadratus Lumborum|Quadratus]], quadrate shape on the lateral side of the posterior abdominal wall. originate from the ilium directed superior medially to insert into transverse process of L1-L4 and lower border of 12th rib. One of the functions of QL is lateral flexion and extension of the vertebral column and during the inhalation assist with the diaphragm and fixes the 12th rib.
Actions associated with abdominal muscle control can be complex. A single muscle does not usually work in isolation but in harmony with others. Physical activity involves a nearly infinite number of variations all regulated by the brain. eg The abdominal muscles work together to control the movement of the spine, pelvis, and  
# [[Psoas Major|Psoas major]], located lateral to the lumbar vertebrae, originate from the transverse process of T12-L5 directed inferolateral and insert into the lesser trochanter. It flexes the thigh at the hip.
[[File:Abdominal curl-CDC strength training for older adults.gif|thumb|[[Curl-ups|Abdominal curl]]]]rib cage during [[gait]]. Counter-rotation occurs between the upper and lower parts, and the arm and leg are moving in opposite direction to each other. During normal
# [[Psoas Minor|Psoas minor]], doesn't present in all populations and originates from Tthe 12-L1 transverse process and inserts into pubic pectineal line.
gait, there is a time when:
# [[Iliacus]], originates from the iliac fossa, and with psoas major they form iliopsoas muscle that is the main flexor of the hip.
# [[Muscles of Respiration|Diaphragm]], the posterior aspect of the diaphragm.
 
'''Posterior Wall Fascia'''
 
* It is presented between the muscles and peritoneum and is a continuous sheet with transversals fascia, it is named according to the area it covers<ref>Posterior abdominal wall<nowiki/>https://teachmeanatomy.info/abdomen/muscles/posterior-wall/</ref>. It attaches to the lumbar vertebrae medially and [[Thoracolumbar Fascia|thoracolumbar fascia]] laterally and continuous inferiorly with iliac fascia covers the psoas major muscle (psoas fascia).
* [[Thoracolumbar Fascia|Thoracolumbar fascia]], consists of three layers anterior, middle, and posterior, between which the muscles enclose, quadratus lumborum between anterior and middle, deep back muscles between the middle and posterior layers.
 
{{#ev:youtube|ovQYBAiv8cI|}}<ref>Anatomy Zone. Muscles of the Posterior Abdominal Wall - 3D Anatomy Tutorial. Available from: http://www.youtube.com/watch?v=ovQYBAiv8cI[last accessed 17/5/2020]</ref>
 
== Muscle Actions Explained ==
[[File:Cross section of abdominal and lumbar muscle B9781416067269000055 f005-004-9781416067269.jpg|thumb|236x236px|cross-section abdominal muscles]]
From all we mentioned before we can see that all abdominal muscles have different muscle fibers orientation and act in all three planes during movements. are linked together even by having a common site of connection or by lying fascia. When contracting one muscle other muscles will contract. For example when you aim to contract TrA at the beginning of contraction you will involve it then if you will continue or contract stronger IO will be involved then EO if you will keep going the rectus abdominis will be involved in the function.
 
Our body is designed to move, they work together to control the movement of the spine, pelvis, and rib cage, during [[gait]] there is relatively a counter-rotation between the upper and lower part and the arm and leg are moving in opposite direction to each other.
 
During normal gait, there is a time when rectus abdominis and external obliques at one side act eccentrically to decelerate the anterior pelvis tilting created by the extension of the hip of that side and RA and external obliques of the other side work eccentrically to control thoracic extension and rotation created by the extension of the shoulder.


"To describe the function of abdominal muscle it can be easily demonstrated from the supine position and flex the spine as this movement is controlled by the brain but this isn't how they actually work" stated Dr, Gray a physical therapist<ref>ACE, [https://www.acefitness.org/education-and-resources/professional/prosource/april-2016/5865/functional-anatomy-series-the-abdominals/ Functional anatomy of abdominal muscles]</ref>. During mid-range of spine flexion, RA and external obliques shorten and the transversus abdominis lengthen and work together and internal obliques generate maximum of its force<ref>clinical gait, [https://clinicalgate.com/anatomy-and-mechanics-of-the-abdominal-muscles/#bib14 anatomy, and biomechanics of abdominal wall muscle].</ref>.
* Rectus abdominis and external obliques at one side act eccentrically to decelerate the anterior pelvis tilting created by the extension of the hip of that side
* The RA and external obliques of the other side work eccentrically to control thoracic extension and rotation created by the extension of the shoulder.
Virtually all actions involve the abdominal muscles to some degree, from biking, running and walking, to swimming, swinging a golf club and playing chess. Even when the body is at rest, the abdominals (in concert with other core muscles) help keep it stable and balanced.


During the exercise program, we need to involve muscles in functional exercise for better outcome<ref>McGill S. Core training: [https://journals.lww.com/nsca-scj/Fulltext/2010/06000/Core_Training__Evidence_Translating_to_Better.4.aspx Evidence translating to better performance and injury prevention.] Strength & Conditioning Journal. 2010 Jun 1;32(3):33-46.</ref>.
This an animated video is titled How Abdominal Muscles Work{{#ev:youtube|4MeLHSjESlU|}}<ref>tendosport. How Abdominal Muscles Work. Available from: http://www.youtube.com/watch?v=4MeLHSjESlU[last accessed 20/5/2020]</ref>
[[File:Muscles involved in forceful breathing in and out.jpeg|thumb|Forceful breathing. Muscles: red contracting, blue relaxing.|alt=|209x209px]]The abdominals don’t bulk up to the degree of other muscles because they are relatively thin structures. Those with so-called "six-pack abs" look that way to a large degree because of low belly fat, showing muscle detail very well. But reducing this fat won’t happen by performing sit-ups. Burning off body fat is best accomplished by improving the metabolism, where diet plays a dominant role.<ref>MAF [https://philmaffetone.com/abdominal-muscles/ The Abdominals] Available:https://philmaffetone.com/abdominal-muscles/ (accessed 12.2.2022)</ref><ref>McGill S. Core training: [https://journals.lww.com/nsca-scj/Fulltext/2010/06000/Core_Training__Evidence_Translating_to_Better.4.aspx Evidence translating to better performance and injury prevention.] Strength & Conditioning Journal. 2010 Jun 1;32(3):33-46.</ref>


{{#ev:youtube|4MeLHSjESlU|}}<ref>tendosport. How Abdominal Muscles Work. Available from: http://www.youtube.com/watch?v=4MeLHSjESlU[last accessed 20/5/2020]</ref>
Breathing role: Forced breathing involves active inspiratory and expiratory movements. In forced breathing exhalation involves contraction of the internal intercostal muscles and the abdominal muscles. During exercise the expira­tory muscles play an active role in breathing. During inspiration, while the rib cage muscles contract, the abdominal muscles gradually relax, and ''vice versa'' during expiration. <ref>Aliverti A. The respiratory muscles during exercise. Breathe. 2016 Jun 1;12(2):165-8.Available: https://breathe.ersjournals.com/content/12/2/165<nowiki/>(accessed 12.2.2022)</ref>
== Clinical Relevance ==
== Physical Therapy Relevance ==
The abdominal viscera can be palpated through the abdominal wall and their place can be visually marked, the umbilicus is the most marked it is fond usually midway between the xiphoid and symphysis pubis. The linea alba splits the rectus abdominis into two half and extends from a vertical groove that presented from xiphoid process.
'''Injury''': Abdominal muscle strain causes include overstretching, improper technique while playing sports that require running, turning, and jumping, lifting heavy objects, laughing, coughing, or sneezing.<ref name=":2" />
[[File:Ff0f58abafcce96cb166ffa150ff43 jumbo.jpeg|thumb|204x204px|Fig2. 9 regions of abdominal cavity]]
The abdomen is divided into 9 regions by two horizontal and two vertical plans, these regions are with benefit to describe the location of pain, identify the visceral organs, and in surgical procedures Fig2.


Transverse abdomimis as a deep abdominal muscle and one of the main important [[Core Stability|core muscle]] that contributes to supporting lumbopelvic stability and deficit in its function affects our back causing low back pain (LBP). We need to include it in our [[Lumbar Motor Control Training|rehabilitation program]]<ref>Selkow NM, Eck MR, Rivas S. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5717480/ Transversus abdominis activation and timing improves following core stability training: a randomized trial.] International journal of sports physical therapy. 2017 Dec;12(7):1048.</ref>
Treatment of an abdominal muscle injury is difficult. There's no way to splint the abdomen and it's nearly impossible to fully rest these muscles.. The below are basic things to advice clients.


As we mentioned before the abdominal muscles together participate to maintain your erect posture and prevent hyperlordosis pf vertebral column, hence the abdominal muscles have are flexors at the of the vertebral column. Weakness of lumbar extensors with insufficient abdominal muscle contraction in a way that can not oppose the lordosis participate in developing the hyperlordosis.
* Avoid exercise to allow the injured muscle to heal.
* Avoid activities that cause pain or spasm of the abdominal muscles.
* Practice gentle stretching. It should not be painful or excessive, as this may slow the healing process.
* Apply ice to the injured area in the acute phase, or during the first 48 hours after injury. It's also helpful to apply ice after activities.
* Apply heat before activities to loosen the muscle<ref>Very well health Pulled abdominal muscles Available:https://www.verywellhealth.com/abdominal-muscle-strain-2548831 (accessed 12.2.2022)</ref>.


Deficit in the abdominal wall muscles '''congenital''' from birth or '''acquired''' postoperatively as a result of a poor wound healing, wound infection, or acquired weakness after pregnancy and labor for example. can manifest in the form of hernia congenital or acquired.
'''Importance of Abdominal muscles in physiotherapy practice.'''[[File:Curl up.jpeg|thumb|Curl Up]]
[[File:Main-qimg-9a39c6fb91951e336833df4a9a0a1e62.jpg|thumb|240x240px|Fig3. acquired hernia]]
Transverse abdomimis as a deep abdominal muscle and one of the main important [[Core Stability|core muscle]] that contributes to supporting lumbopelvic stability and deficit in its function affects our back causing low back pain (LBP). This muscle is often used as part of a core stability, Pilates or rehabilitation program. See [[Core Strengthening]]  and [[Lumbar Motor Control Training|Lumbar motor control training]]<ref name=":1">Selkow NM, Eck MR, Rivas S. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5717480/ Transversus abdominis activation and timing improves following core stability training: a randomized trial.] International journal of sports physical therapy. 2017 Dec;12(7):1048.</ref>
'''Congenital hernia''' happens during infant development as a result of embryological malformations or weakness in the neonatal abdominal wall, it may be fatal in some cases and need urgent and surgical intervention as; gastroschisis, or resolve without need to surgical intervention as in umbilical hernia.
[[File:Plank exercise.jpg|thumb|Plank Exercise]]
 
Abdominal exercises need to be gradually progressed from how to activate muscles and maintain contraction to integrate them with functional movement.
'''Acquired hernia''' happens in the area of weakness and varies in its severity<ref>Flynn W, Vickerton P. [https://www.statpearls.com/kb/viewarticle/32123 <nowiki>Anatomy, Abdomen and Pelvis, Abdominal Wall. InStatPearls [Internet] 2019 Dec 9</nowiki>]. StatPearls Publishing.</ref>:
 
Umbilical hernia that is more serious and has a higher rate of morbidity in adult more than infants and may need surgical intervention. Inguinal hernia protrudes at the inferior border of anterolateral muscles. Epigastric hernia, above the umbilicus through the midline of the linea alba. Spigelian hernias, and incisional hernia as a result of postoperative incision.
 
[[Diastasis recti abdominis|Rectus diastasis]] happens due to prolong transverse stress on linea alba during pregnancy, or post-menopausal women.
 
Psoas sign, that indicates there is irritation to the iliopsoas muscle group and you can test it by passive flexion of thigh if there is pain in the lower abdomen the test is positive when it is presented on the right side may be an indication of appendicitis.<ref>https://en.wikipedia.org/wiki/Psoas_sign</ref>
 
== Physical Therapy Intervention ==
Abdominal exercises need to be gradually progressed from how to activate muscles and maintain contraction to integrate them with functional movement, but there's special considerations, precaution, and exercise modification that we will take these exercises for a patient with a hernia.
* Abdominal draw in exercise, easy to apply, target mainly transversus abdominis as well as the diaphragm it's an important respiratory exercise<ref>Oh YJ, Park SH, Lee MM. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7100066/ Comparison of Effects of Abdominal Draw-In Lumbar Stabilization Exercises with and without Respiratory Resistance on Women with Low Back Pain:] A Randomized Controlled Trial. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research. 2020;26:e921295-1.</ref>. Exercise can be progressed by adding external resistance, upper limb or lower limb movement while holding abdomen drawing in. Patients with lumbar hyperlordosis draw-in exercise from borne hip extension increase the activity of [[Gluteus Maximus|gluteus maximus]], weakness GM speed up lumbar hyperhidrosis, and increase the load on lumbar spine and pelvis so this exercise will be with benefit<ref>Kim TW, Kim YW. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4339143/ Effects of abdominal drawing-in during prone hip extension on the muscle activities of the hamstring, gluteus maximus, and lumbar erector spinae in subjects with lumbar hyperlordosis]. Journal of physical therapy science. 2015;27(2):383-6.</ref>.
* Abdominal draw in exercise, easy to apply, target mainly transversus abdominis as well as the diaphragm it's an important respiratory exercise<ref>Oh YJ, Park SH, Lee MM. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7100066/ Comparison of Effects of Abdominal Draw-In Lumbar Stabilization Exercises with and without Respiratory Resistance on Women with Low Back Pain:] A Randomized Controlled Trial. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research. 2020;26:e921295-1.</ref>. Exercise can be progressed by adding external resistance, upper limb or lower limb movement while holding abdomen drawing in. Patients with lumbar hyperlordosis draw-in exercise from borne hip extension increase the activity of [[Gluteus Maximus|gluteus maximus]], weakness GM speed up lumbar hyperhidrosis, and increase the load on lumbar spine and pelvis so this exercise will be with benefit<ref>Kim TW, Kim YW. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4339143/ Effects of abdominal drawing-in during prone hip extension on the muscle activities of the hamstring, gluteus maximus, and lumbar erector spinae in subjects with lumbar hyperlordosis]. Journal of physical therapy science. 2015;27(2):383-6.</ref>.


* Curl up exercise, target rectus abdominis, transverse abdominis, and obliques in addition to hip flexors, chest, and neck, start the exercise with slow movement, few repetitions and make sure the back is in contact with the floor and eccentric curl up is most effective at angle at 30∘.<ref>Ha SY, Shin DC. The effects of curl-up exercise in terms of posture and muscle contraction direction on muscle activity and thickness of trunk muscles. Journal of Back and Musculoskeletal Rehabilitation. 2020 Feb 28(Preprint):1-7.</ref>  
* [[Curl-ups|Curl up]] exercise, target rectus abdominis, transverse abdominis, and obliques in addition to hip flexors, chest, and neck, start the exercise with slow movement, few repetitions and make sure the back is in contact with the floor and eccentric curl up is most effective at angle at 30∘.<ref>Ha SY, Shin DC. The effects of curl-up exercise in terms of posture and muscle contraction direction on muscle activity and thickness of trunk muscles. Journal of Back and Musculoskeletal Rehabilitation. 2020 Feb 28(Preprint):1-7.</ref>
{{#ev:youtube|lsWQ0XpiNkE|300}}<ref>Health e-University. How to do a Curl Up: Health e-University. Available from: http://www.youtube.com/watch?v=lsWQ0XpiNkE[last accessed 25/4/2020</ref>
{{#ev:youtube|lsWQ0XpiNkE|300}}<ref>Health e-University. How to do a Curl Up: Health e-University. Available from: http://www.youtube.com/watch?v=lsWQ0XpiNkE[last accessed 25/4/2020</ref>
* Bridging, modified bridging with hip abduction or unstable surface show to increase core stability, trunk control. The activation of internal abdominis, rectus abdominis along with erector spine is greater in modified bridging when compared to standard bridging<ref>Yoon JO, Kang MH, Kim JS, Oh JS. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5883971/ Effect of modified bridge exercise on trunk muscle activity in healthy adults]: a cross sectional study. Brazilian journal of physical therapy. 2018 Mar 1;22(2):161-7.</ref>.
* Bridging, modified bridging with hip abduction or unstable surface show to increase core stability, trunk control. The activation of internal abdominis, rectus abdominis along with erector spine is greater in modified bridging when compared to standard bridging<ref>Yoon JO, Kang MH, Kim JS, Oh JS. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5883971/ Effect of modified bridge exercise on trunk muscle activity in healthy adults]: a cross sectional study. Brazilian journal of physical therapy. 2018 Mar 1;22(2):161-7.</ref>.
Line 111: Line 83:
** Hip flexor stretch and squat.
** Hip flexor stretch and squat.
{{#ev:youtube|757ucsakxoc|}}<ref>Ccedseminars. Williams Flexion Exercises for Lumbar Spine. Available from: http://www.youtube.com/watch?v=757ucsakxoc[last accessed 21/5/2020]</ref>
{{#ev:youtube|757ucsakxoc|}}<ref>Ccedseminars. Williams Flexion Exercises for Lumbar Spine. Available from: http://www.youtube.com/watch?v=757ucsakxoc[last accessed 21/5/2020]</ref>
* Plank and pilates exercises activate and strengthen core muscles along with abdominal muscles.
* [[Plank exercise|Plank]] and pilates exercises activate and strengthen core muscles along with abdominal muscles.
For more exercise descriptions see [https://physio-pedia.com/Core_stability Core stability] and [https://www.physio-pedia.com/Lumbar_Motor_Control_Training Lumbar motor control training]
For more exercise descriptions see [https://physio-pedia.com/Core_stability Core stability] and [https://www.physio-pedia.com/Lumbar_Motor_Control_Training Lumbar motor control training]
'''Related Abdominal Issues'''
* [[Diastasis recti abdominis|Rectus diastasis]]  is a stretching of the linea alba with abnormal widening of the gap between the two medial sides of the rectus abdominis muscle, often seen during pregnancy, or post-menopausal women. See link.<ref>https://en.wikipedia.org/wiki/Psoas_sign</ref>
* A [[Hernia]] occurs when there is a weakness or hole in the muscular wall that usually keeps abdominal organs in place.<ref>Flynn W, Vickerton P. [https://www.statpearls.com/kb/viewarticle/32123 <nowiki>Anatomy, Abdomen and Pelvis, Abdominal Wall. InStatPearls [Internet] 2019 Dec 9</nowiki>]. StatPearls Publishing.</ref>
== Viewing ==
This 13 minute video is titled "Muscles of the Anterior Abdominal Wall"
{| class="FCK__ShowTableBorders" width="40%" cellspacing="1" cellpadding="1" border="0" align="centre"
{{#ev:youtube|mxOajxO8mX0|}} <ref>Anatomy Zone. Muscles of the Anterior Abdominal Wall-3D Anatomy Tutorial. Available from: http://www.youtube.com/watch?v=mvOajxO8mXO [last accessed 11/07/15]</ref>
|}This 7 minute video is titled "Muscles of the Posterior Abdominal Wall"{{#ev:youtube|ovQYBAiv8cI|}}<ref>Anatomy Zone. Muscles of the Posterior Abdominal Wall - 3D Anatomy Tutorial. Available from: http://www.youtube.com/watch?v=ovQYBAiv8cI[last accessed 17/5/2020]</ref>


== References  ==
== References  ==

Latest revision as of 16:41, 11 April 2022

Original Editor - Anne Millar

Top Contributors - Anne Millar, Khloud Shreif, Lucinda hampton, Laura Ritchie, Kim Jackson, Admin, Joao Costa, Scott Buxton, Vidhu Sindwani and Evan Thomas

Introduction[edit | edit source]

Overview of the muscles of the abdominal wall (anterior view)

The abdominal muscles are the muscles forming the abdominal walls, the abdomen being the portion of the trunk connecting the thorax and pelvis. An abdominal wall is formed of skin, fascia, and muscle and encases the abdominal cavity and viscera[1].

The abdominal muscles support the trunk, allow movement, hold organs in place, and are distensible (being able accommodate dynamic changes in the volume of abdominal contents)[1].

The deep abdominal muscles, together with the intrinsic back muscles, make up the core muscles and help keep the body stable and balanced, and protects the spine.

Causes of abdominal muscle strains include overstretching, overuse or a violent, poorly performed movement of the trunk, improper technique while playing sports that require running, turning, and jumping, lifting heavy objects, laughing, coughing, or sneezing[2].

Image: Overview of the muscles of the abdominal wall (anterior view)[3]

Anatomy[edit | edit source]

Cross section abdominal muscles

When people think of abdominal muscles it is these four main muscles

  1. Transversus abdominis – the deepest muscle layer. Its main roles are to stabilise the trunk and maintain internal abdominal pressure
  2. Rectus abdominis – slung between the ribs and the pubis at the front of the pelvis. When contracting, this muscle has the characteristic bumps or bulges that are commonly called ‘the six pack’. The main function of the rectus abdominis is to move the body between the ribcage and the pelvis
  3. External oblique muscles – these are on each side of the rectus abdominis. The external oblique muscles allow the trunk to twist, but to the opposite side of whichever external oblique is contracting. eg the right external oblique contracts to turn the body to the left
  4. Internal oblique muscles – these flank the rectus abdominis and are located just inside the hipbones. They operate in the opposite way to the external oblique muscles. eg twisting the trunk to the left requires the left side internal oblique and the right side external oblique to contract together.

Structure and Function[edit | edit source]

Trunk muscles.jpeg

The abdominal muscles are more extensive than those listed above, and are be divided broadly into: Anterolateral; and Posterior walls. Anterolateral Abdominal Wall Muscles: consists of

  • 2 vertical muscles located on the midline (bisected by linea alba): Rectus abdominis; and pyramidalis
  • 3 flat muscles on the anterolateral side arranged from superficial to deep; external abdominal oblique, internal abdominal oblique, transversus abdominis.[4]
Muscles of the Abdomen Posterior

Posterior Wall Muscles

  1. Quadratus: One of the functions of QL is lateral flexion and extension of the vertebral column and during the inhalation assist with the diaphragm and fixes the 12th rib.
  2. Psoas major
  3. Psoas minor,
  4. Iliacus,
  5. Diaphragm, the posterior aspect of the diaphragm.

Muscle Actions[edit | edit source]

All the abdominal muscles have different muscle fibers orientation and act in all three planes during movements and are linked together by having a common site of connection or by fascia.

Actions associated with abdominal muscle control can be complex. A single muscle does not usually work in isolation but in harmony with others. Physical activity involves a nearly infinite number of variations all regulated by the brain. eg The abdominal muscles work together to control the movement of the spine, pelvis, and

Abdominal curl

rib cage during gait. Counter-rotation occurs between the upper and lower parts, and the arm and leg are moving in opposite direction to each other. During normal

gait, there is a time when:

  • Rectus abdominis and external obliques at one side act eccentrically to decelerate the anterior pelvis tilting created by the extension of the hip of that side
  • The RA and external obliques of the other side work eccentrically to control thoracic extension and rotation created by the extension of the shoulder.

Virtually all actions involve the abdominal muscles to some degree, from biking, running and walking, to swimming, swinging a golf club and playing chess. Even when the body is at rest, the abdominals (in concert with other core muscles) help keep it stable and balanced.

This an animated video is titled How Abdominal Muscles Work

[5]

Forceful breathing. Muscles: red contracting, blue relaxing.

The abdominals don’t bulk up to the degree of other muscles because they are relatively thin structures. Those with so-called "six-pack abs" look that way to a large degree because of low belly fat, showing muscle detail very well. But reducing this fat won’t happen by performing sit-ups. Burning off body fat is best accomplished by improving the metabolism, where diet plays a dominant role.[6][7]

Breathing role: Forced breathing involves active inspiratory and expiratory movements. In forced breathing exhalation involves contraction of the internal intercostal muscles and the abdominal muscles. During exercise the expira­tory muscles play an active role in breathing. During inspiration, while the rib cage muscles contract, the abdominal muscles gradually relax, and vice versa during expiration. [8]

Physical Therapy Relevance[edit | edit source]

Injury: Abdominal muscle strain causes include overstretching, improper technique while playing sports that require running, turning, and jumping, lifting heavy objects, laughing, coughing, or sneezing.[2]

Treatment of an abdominal muscle injury is difficult. There's no way to splint the abdomen and it's nearly impossible to fully rest these muscles.. The below are basic things to advice clients.

  • Avoid exercise to allow the injured muscle to heal.
  • Avoid activities that cause pain or spasm of the abdominal muscles.
  • Practice gentle stretching. It should not be painful or excessive, as this may slow the healing process.
  • Apply ice to the injured area in the acute phase, or during the first 48 hours after injury. It's also helpful to apply ice after activities.
  • Apply heat before activities to loosen the muscle[9].

Importance of Abdominal muscles in physiotherapy practice.

Curl Up

Transverse abdomimis as a deep abdominal muscle and one of the main important core muscle that contributes to supporting lumbopelvic stability and deficit in its function affects our back causing low back pain (LBP). This muscle is often used as part of a core stability, Pilates or rehabilitation program. See Core Strengthening and Lumbar motor control training[10]

Plank Exercise

Abdominal exercises need to be gradually progressed from how to activate muscles and maintain contraction to integrate them with functional movement.

  • Abdominal draw in exercise, easy to apply, target mainly transversus abdominis as well as the diaphragm it's an important respiratory exercise[11]. Exercise can be progressed by adding external resistance, upper limb or lower limb movement while holding abdomen drawing in. Patients with lumbar hyperlordosis draw-in exercise from borne hip extension increase the activity of gluteus maximus, weakness GM speed up lumbar hyperhidrosis, and increase the load on lumbar spine and pelvis so this exercise will be with benefit[12].
  • Curl up exercise, target rectus abdominis, transverse abdominis, and obliques in addition to hip flexors, chest, and neck, start the exercise with slow movement, few repetitions and make sure the back is in contact with the floor and eccentric curl up is most effective at angle at 30∘.[13]

[14]

  • Bridging, modified bridging with hip abduction or unstable surface show to increase core stability, trunk control. The activation of internal abdominis, rectus abdominis along with erector spine is greater in modified bridging when compared to standard bridging[15].

[16]

  • William protocol of spine flexion has a positive effect on lumbar hyperhidrosis, back pain, increased flexibility of hip flexor and back extensions, abdominal muscle strength, and hamstring flexibility, examples of William exercises[17]:
    • Pelvic tilt, from flat position and knees in flexion try to flatten your back without pushing down with your leg
    • Single and double knee to chest
    • Partial sit-up, with maintaining the pelvic tilt curl your head and shoulder off.
    • Hamstring stretch
    • Hip flexor stretch and squat.

[18]

  • Plank and pilates exercises activate and strengthen core muscles along with abdominal muscles.

For more exercise descriptions see Core stability and Lumbar motor control training

Related Abdominal Issues

  • Rectus diastasis is a stretching of the linea alba with abnormal widening of the gap between the two medial sides of the rectus abdominis muscle, often seen during pregnancy, or post-menopausal women. See link.[19]
  • A Hernia occurs when there is a weakness or hole in the muscular wall that usually keeps abdominal organs in place.[20]

Viewing[edit | edit source]

This 13 minute video is titled "Muscles of the Anterior Abdominal Wall"

[21]

This 7 minute video is titled "Muscles of the Posterior Abdominal Wall"

[22]

References[edit | edit source]

  1. ↑ 1.0 1.1 Flynn W, Vickerton P. Anatomy, Abdomen and Pelvis, Abdominal Wall. Available:https://www.ncbi.nlm.nih.gov/books/NBK551649/ (accessed 11.2.2022)
  2. ↑ 2.0 2.1 Better health Abdominal muscles Available: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/abdominal-muscles(accessed 12.2.2022)
  3. ↑ Overview of the muscles of the abdominal wall (anterior view) image - © Kenhub https://www.kenhub.com/en/library/anatomy/anterior-abdominal-wall
  4. ↑ Flament JB. Functional anatomy of the abdominal wall. Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen. 2006 May;77(5):401-7.
  5. ↑ tendosport. How Abdominal Muscles Work. Available from: http://www.youtube.com/watch?v=4MeLHSjESlU[last accessed 20/5/2020]
  6. ↑ MAF The Abdominals Available:https://philmaffetone.com/abdominal-muscles/ (accessed 12.2.2022)
  7. ↑ McGill S. Core training: Evidence translating to better performance and injury prevention. Strength & Conditioning Journal. 2010 Jun 1;32(3):33-46.
  8. ↑ Aliverti A. The respiratory muscles during exercise. Breathe. 2016 Jun 1;12(2):165-8.Available: https://breathe.ersjournals.com/content/12/2/165(accessed 12.2.2022)
  9. ↑ Very well health Pulled abdominal muscles Available:https://www.verywellhealth.com/abdominal-muscle-strain-2548831 (accessed 12.2.2022)
  10. ↑ Selkow NM, Eck MR, Rivas S. Transversus abdominis activation and timing improves following core stability training: a randomized trial. International journal of sports physical therapy. 2017 Dec;12(7):1048.
  11. ↑ Oh YJ, Park SH, Lee MM. Comparison of Effects of Abdominal Draw-In Lumbar Stabilization Exercises with and without Respiratory Resistance on Women with Low Back Pain: A Randomized Controlled Trial. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research. 2020;26:e921295-1.
  12. ↑ Kim TW, Kim YW. Effects of abdominal drawing-in during prone hip extension on the muscle activities of the hamstring, gluteus maximus, and lumbar erector spinae in subjects with lumbar hyperlordosis. Journal of physical therapy science. 2015;27(2):383-6.
  13. ↑ Ha SY, Shin DC. The effects of curl-up exercise in terms of posture and muscle contraction direction on muscle activity and thickness of trunk muscles. Journal of Back and Musculoskeletal Rehabilitation. 2020 Feb 28(Preprint):1-7.
  14. ↑ Health e-University. How to do a Curl Up: Health e-University. Available from: http://www.youtube.com/watch?v=lsWQ0XpiNkE[last accessed 25/4/2020
  15. ↑ Yoon JO, Kang MH, Kim JS, Oh JS. Effect of modified bridge exercise on trunk muscle activity in healthy adults: a cross sectional study. Brazilian journal of physical therapy. 2018 Mar 1;22(2):161-7.
  16. ↑ Physio Fitness | Physio REHAB | Tim Keeley. Glute Bridges and back pain - Don't flex the spine! | Feat. Tim Keeley | No.70 Physio REHAB. Available from: http://www.youtube.com/watch?v=SwyDMwpcW38[last accessed 25/4/2020
  17. ↑ Fatemi R, Javid M, Najafabadi EM. Effects of William training on lumbosacral muscles function, lumbar curve and pain. Journal of back and musculoskeletal rehabilitation. 2015 Jan 1;28(3):591-7.
  18. ↑ Ccedseminars. Williams Flexion Exercises for Lumbar Spine. Available from: http://www.youtube.com/watch?v=757ucsakxoc[last accessed 21/5/2020]
  19. ↑ https://en.wikipedia.org/wiki/Psoas_sign
  20. ↑ Flynn W, Vickerton P. Anatomy, Abdomen and Pelvis, Abdominal Wall. InStatPearls [Internet] 2019 Dec 9. StatPearls Publishing.
  21. ↑ Anatomy Zone. Muscles of the Anterior Abdominal Wall-3D Anatomy Tutorial. Available from: http://www.youtube.com/watch?v=mvOajxO8mXO [last accessed 11/07/15]
  22. ↑ Anatomy Zone. Muscles of the Posterior Abdominal Wall - 3D Anatomy Tutorial. Available from: http://www.youtube.com/watch?v=ovQYBAiv8cI[last accessed 17/5/2020]


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