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Breathing Strategies: Intra-abdominal Pressure

In this blog post, we had the opportunity for Calvin Wong from Woodland Physiotherapy to come in to present to us once again. In this post, we will be going over different breathing strategies to improve intra-abdominal pressure to reduce low back pain discussed by Calvin.

Intra-abdominal pressure (IAP) can be defined as:

➢Steady-state pressure within the abdominal cavity is created by Interaction between the abdominal wall and viscera

➢This changes when breathing normally and bracing within the abdominal trunk

➢Initially measured in an acute care setting: post-op see it ➢Movement studies indirect measure through movement

Methods to Measure IAP:

Direct: standard consensus for direct measurement is intra-visceral IAP and Performance:

➢Increases spinal stiffness with IAP

➢During lifting tasks, that require spinal extension from a flexed forward position (deadlifts, squats)

➢Increases in IAP unloads and decompresses the lumbar spine by pressing the thorax upward and indirectly by generating an extensor moment that reduces the activation of the lumbar

Appropriate intra-abdominal pressure has been shown to be beneficial in:

➢Young athletes

➢Hip extensors were greatest in the IAP increased condition (inhale and hold)

IAP and Spinal Loading:

Increases in IAP during spinal flexion tasks have been shown to reduce compression through the lumbar spine. In upright positions, 40 degrees and 65 degrees of flexion have shown to be about 40lbs of the load onto the lumbar spine. Therefore:
➢Co-activation of the pelvic floor, transverse abdominis, and diaphragm are important to produce IAP in flexion positions when standing
➢Higher TrA elasticity = greater trunk muscle tension = greater spinal stability during loading tasks
Motor control training and improving bracing strategies are important to improve optimal lifting and tolerance towards load to the lumbar spine when standing or during lifting tasks.

When working to improve an individual’s ability to produce IAP, it is important to considerwhat breath control strategies are being utilized to efficiently produce IAP.

Breathing control strategies that can be utilized include:

Inhalation prior to exertion with hold during exertionExhalation prior to exertion with hold during exertionInhalation prior to exertion with exhalation during exertionInhalation prior to exertion and ½ way exhalation with hold during exertion Each individual can vary in which strategy is most effective and can be used alongside an ultrasound to see which strategy promotes the most optimal activation and production of intra-abdominal pressure. In our in-service, we had the chance to demo these different strategies while observing which strategy was able to produce the most optimal activation in the abdominal trunk! We’d like to thank Calvin Wong once again for returning and presenting another in-service! He has been very kind to share his extensive knowledge on pelvic floor health and training with us, and I would definitely recommend seeing him at Woodland Physiotherapy if you are someone who has pelvic floor-related dysfunctions or issues!

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