The Somatic Connection  |   January 2014
Abdominal Muscles Are the Front Side of the Low Back
Author Affiliations
  • Hollis H. King, DO, PhD
    University of Wisconsin School of Medicine and Public Health, Madison
Article Information
The Somatic Connection   |   January 2014
Abdominal Muscles Are the Front Side of the Low Back
The Journal of the American Osteopathic Association, January 2014, Vol. 114, 61-62. doi:
The Journal of the American Osteopathic Association, January 2014, Vol. 114, 61-62. doi:
Arab AM, Rasouli O, Amiri M, Tahan N. Reliability of ultrasound measurement of anatomic activity of the abdominal muscle in participants with and without chronic low back pain. Chiropr Man Therap. 2013;21:37. doi:10.1186/2045-709X-21-37.  
I frequently tell my patients with low back pain—particularly those carrying extra weight in the abdominal area—that the abdominal muscles are the front side of their low back, and that they need to do abdominal strengthening exercises to reduce their low back pain. This perspective is a mainstay of physical therapy; core strengthening exercises have been prescribed for every patient I have referred to a physical therapist for low back pain (I also provide these patients with osteopathic manipulative treatment, of course, as appropriate). 
Interestingly, in my 20 years of cumulative experience on the faculty of 3 different osteopathic medical schools, I had never seen this notion presented in osteopathic manipulative medicine curriculum. Recently, however, I attended an osteopathic conference where Frank H. Willard, PhD, presented his work on the anatomy related to this concept.1,2 I selected this article by Arab et al because it relates to the practical application of Dr Willard's work and may further the process of “thinking osteopathically” in regard to low back pain. 
Researchers in Iran used ultrasonography to measure abdominal wall thickness with participants in 4 positions: (1) lying supine, (2) sitting on a chair, (3) sitting on a gym ball with both feet on the ground, and (4) sitting on a gym ball with both feet on ground and then lifting 1 foot off the floor. The study included 10 healthy participants and 10 participants with low back pain of more than 6 weeks duration. Ultrasonography of the abdomen was performed with participants in each of the 4 positions. Each image was frozen at the end of expiration. 
The reliability of ultrasonography as a measure of absolute abdominal muscle thickness was found to be very high. Intraclass correlation coefficients ranged from 0.88 to 0.95 for within-days comparisons and from 0.85 to 0.94 for between-days comparisons. A clinically useful finding was that the minimal detectable change measure showed a much thicker abdominal muscle wall in low back pain participants compared with that of healthy participants when 1 foot was lifted. The authors suggested, and I agree, that such an easily obtained measurement can be used to assess progress in the management of low back pain, as well as for research purposes. 
Willard FH. Anatomy and neurology of the lumbar spine: overview. Lecture presented at: International Congress of Osteopathy: Structure & Function—Principles, Models, Evidence; November 15 , 2013; Milan, Italy.
Schuenke MD, Vleeming A, Van Hoof T, Willard FH. A description of the lumbar interfascial triangle and its relation with the lateral raphe: anatomical constituents of load transfer through the lateral margin of the thoracolumbar fascia [published online May 15, 2012]. J Anat. 2012;221(6): 568-576. doi:10.1111/j.1469-7580.2012.01517.x. [CrossRef] [PubMed]