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Core Activation & the External Oblique Muscles

ActiveCare Physical Therapy is a specialty physical therapy clinic that uses Pilates based rehabilitation. We emphasize the core in all of our exercise prescriptions. The transverse abdominis is one of the muscles of the core and is the deepest of the four abdominal muscles. It sits horizontally around the trunk at the level of the waist or bellybutton. The fibers connect with the small spinal stabilizer muscles in the back known as the multifidi. People with low back pain have an issue activating the core musculature, especially the transverse abdominis. They have a difficult time isolating this muscle.

Exercises to promote muscle activation of the core typically start with the transverse abdominis. A common cue to patients is to ‘pull your navel into the spine’ or ‘brace with your abdominals’. Patients should be able to pull this deep abdominal muscle in towards the spine without holding their breath, shrugging their shoulders, flaring their ribs or tilting their pelvis. When a patient with core issues causing chronic low back pain and issues with other musculoskeletal joints (eg shoulder/hips/knees) starts this exercise, it is very common for muscle compensations to occur. That means, utilizing other muscles, like the diaphragm, obliques, and glutes.

When a patient uses the wrong muscle to activate their transverse abdominis, it will be demonstrated as movement everywhere else other than the abdominal region. True and isolated activation of the transverse abdominis means the anterior abdominal wall should move back directly toward the spine. The patient should be able to hold this, breathe and talk to you comfortably. If the patient uses the diaphragm, they will hold their breath or shrug their shoulders. If they use the obliques, you will see the ribs flare and pull down. If they use the glutes, you will see their buttocks tighten. When done correctly, you should look ‘skinny’ from the side!

Your physical therapist should have an eagle eye on you as a patient whenever you learn a new exercise. This type of exercise supervision helps to learn a technique correctly from the beginning. If not, it is easy to go back to your bad habits of not utilizing a muscle during movement activities, either during daily activities of life or those required during sports participation. This is usually the reason for injuries that come on gradually without any notice. Our patients demonstrate these muscle imbalances when they come in the door and core training can help you return to higher intensity activities without re-injury.

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If you’re interested in scheduling a core activation session to strengthen your core and external oblique muscles, email us at or call us (212) 777-4374