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Learn to isolate and contract the pelvic pyramid
This is an excerpt from Total Control by The Women’s Health Foundation.
Pelvic Pyramid Isolation Exercises
The objectives of the pelvic pyramid isolation exercises are to:
- Isolate and contract the pelvic pyramid (TVA, PFM, and multifidus), without the substitution of global muscles, while maintaining normal breath pattern.
- Sustain engagement of the pelvic pyramid muscles over a period of time and/or during integrated movement exercises.
- Contract the transversus abdominis (TVA), pelvic floor muscles, and multifidus as a unit in different positions, including supine, prone, sidelying, sitting, and standing.
Learning to Engage the Transversus Abdominis (TVA)
TVA activation feels very gentle, more like a subtle tightening, or "cinching," inward of the abdominal wall rather than a forceful contraction. The TVA muscle spans the torso like a corset, wrapping from the spine and the ribs forward to the midline of the body. This tightening action might be felt by using a particular landmark in the lower abdominal area (described in the following section). Activation of the TVA does not produce visible motion, so the pelvis and lower back remain still. The abdominal wall should not bulge outward, and the buttocks and thighs should stay relaxed. Remember, TVA muscle activation is meant to help stabilize the torso prior to limb movement.
Imagery may be the most helpful tool when attempting to activate this muscle. The images developed using ultrasound include the following:
- Visualizing a corset around the waist.
- Imagining the abdominal wall is a trampoline and people are standing on the trampoline. Now, imagine pulling the trampoline canvas away from their feet, just slightly.
- Imagining a resistance band around the torso tensing gently inward.
Finding the TVA Landmark
Touching a targeted area of the body sends a message to the brain to "go there." It helps establish and maintain a connection between the sensory and motor neurons. When you touch a certain area on the abdominal wall, you may increase the likelihood of proper TVA activation. This phenomenon is called touch training or touch cueing. Touch training using body landmarks is used to effectively teach the pelvic pyramid exercises.
Using the second and third fingers, locate the hip bones, or ASIS (anterior superior iliac spine). Move flattened fingertips 1 - 2 inches toward the midline and 1 inch down toward the pubic bone. If you move any further midline than 1 - 2 inches, you will likely palpate the rectus abdominis rather than the TVA.
Touching this landmark may also provide feedback about whether the muscle is properly activated. Because TVA activation produces an inward cinching of the abdominal wall, the abdominal wall should not press outward toward the fingers, nor should there be a sensation of bearing down. These are common mistakes, usually caused by overdoing it.
Concentrate and focus on the imagery previously described and not on "trying to feel my TVA with my fingers!" The fingers on the landmarks are primarily for the purpose of sending feedback to the brain about the region of focus. It can be discouraging to keep searching for the perfect contraction, so instead focus on the words: gentle, subtle, corseting, trampoline, and resistance band. Our experience with ultrasound imaging and reports from our physical therapy advisors show that these specific cues increase the chances of success. Breathe normally and be patient! Avoid moving the fingers around, which can be distracting. Continue to be mindful of the cues. TVA exercises often require days and weeks of diligent imagery practice before the brain gets reacquainted with this important neural pathway.