International SportMed Journal, 2000, Volume 1, Issue 4

Human Kinetics Publishers, Inc.

A Clinical Palpation Test to Check the Activation

of the Deep Stabilizing Muscles of the Lumbar Spine
Julie Hides, Quentin Scott, Gwendolen Jull, and Carolyn Richardson
Segmental stabilization training (SST) is an exercise approach that has been developed to target muscles
associated with the control of stability of the spinal segments. The basis of the concept is to teach patients to
co-contract the transversus abdominis and multifidus muscles independently of the global muscles, with the
aim of decreasing low back pain, disability, and recurrence. A clinical palpation test can be used to monitor
co-contraction of the deep muscles during SST.
Key Words: stabilization, multifidus muscle, transversus abdominis muscle, low back pain, rehabilitation,
therapeutic exercise

Introduction
Recent years have witnessed an increasing emphasis on more specific exercises for the spinal muscles. Segmental
Stabilization Training (SST) was developed to target the muscles associated with the control of stability of the spinal
segments, with the aim of developing more effective and efficient exercise programs for low back pain (LBP).1
SST targets the local, stabilizing muscles of the lumbo-pelvic region,2 including the transversus abdominis (TrA) and
the lumbar multifidus (LM). Research indicates that these muscles have motor control deficits4,5 and/or undergo
inhibition6,7 in LBP patients. The global muscle system encompasses the larger, superficial muscles of the trunk,
which control trunk movement (e.g., external oblique and erector spinae muscles). These muscles may even be more
active in the LBP population.1
The concept, which has become the basis of SST, is the ability to co-contract TrA and LM independently of the
global muscles.1 The active co-contraction of the deep muscles is performed slowly at a low level of muscle activity
and has been described as forming a deep muscle corset. Clinical assessment is an essential element for the
accuracy and efficiency of the exercises. Three types of clinical assessment have been developed to monitor the cocontraction of TrA and LM and any increased contribution of the global muscles. These include the prone test with
the Stabilizer (Chattanooga),1 a newly developed test using real-time ultrasound8,9 and the clinical palpation test.

The Clinical Palpation Test

Clinicians and clients can use a simple palpation test to monitor the co-contraction of TrA and LM while the corset
action is being performed (Figures 1a and 1b). To palpate TrA, place the tips of two fingers (or proximal pads of
the thumb) just medial and distal to the anterior superior iliac spines (Figures 2 and 3). To recognize first a poor
muscle pattern, ask the client to cough and feel a bulging under the fingers. This occurs with increased global muscle
activation and accompanying increase in intra-abdominal pressure.
For the correct action, the client is instructed to slowly and gently draw in the abdominal wall. The lower abdomen
should draw in (Figure1b) and a gentle deep tension should be felt under the fingers equally on each side. A change
to a feeling of pushing out under one or both sides indicates increased activation of the global muscles rather than the
independent contraction of the TrA. Clients can use palpation for self checks during exercises. These palpation tests
also aid the clinician in interpretation of the prone test using the Stabiliser (Figure 4).

For palpation of the isometric contraction of LM in the co-contraction, place the index finger and thumb on each side
of the lumbar spinous processes. Tests are performed separately at each level. Use gentle deep palpation, as it is the
deep parts of LM, which are important (Figures 57). Ask the client to slowly gently swell underneath my fingers,
and feel the gentle expansion under the fingers, equal on each side as the isometric contraction occurs. This should
be achievable without spinal movement and minimal global muscle activation.

Conclusion
The simple palpation test can be used by athletes to self monitor the co-contraction of the deep muscles during SST.
Up until now, no formal studies had been done on the palpation test, but there is one presently in progress.

References
1. Richardson CA, Jull GA, Hodges PW, Hides JA. Therapeutic Exercise for Spinal Segmental Stabilization in Low
Back Pain. Edinburgh: Churchill Livingstone; 1999.
2. Bergmark A. Stability of the lumbar spine. A study in mechanical engineering. Acta Orthop Scand.
1989;230(suppl.):20-24.
3. Hodges PW, Richardson CA. Inefficient muscular stabilisation of the lumbar spine associated with low back pain:
a motor control evaluation of transversus abdominis. Spine. 1996;21:2640-2650.
4. Hodges PW, Richardson CA. Delayed postural contraction of transversus abdominis in low back pain associated
with movement of the lower limbs. J Spinal Disorders. 1998;11:46-56.
5. Hodges PW, Richardson CA. Altered trunk muscle recruitment in people with low back pain with upper limb
movements at different speeds. Arch Phys Med Rehabil. 1999;80:1005-1012.
6. Hides JA, Stokes MJ, Saide M, Jull GA, Cooper DH. Evidence of lumbar multifidus muscle wasting ipsilateral to
symptoms in patients with acute/subacute low back pain. Spine. 1994;19:165-172.
7. Hides JA, Richardson CA, Jull GA. Multifidus muscle recovery is not automatic following resolution of acute first
episode low back pain. Spine.1996;21:2763-2769.
8. Hides JA, Richardson CA, Jull GA, Davies SE. Ultrasound imaging in rehabilitation. Aust J Physiother
1995;41(3):187-193.
9. Hides JA, Richardson CA, Jull GA. Use of real-time ultrasound imaging for feedback in rehabilitation. Manual Ther.
1998;3(3):125-131.

Appendix: Figures

Figure 1(a) Relaxed

abdominal wall in standing.

Figure 1(b) Observation of

posterior displacement or
drawing in of the anterior
abdominal wall while corset
action exercise is performed.

Figure 3 Palpation of the TrA

using pads of therapists thumbs
during the corset action exercise.

Figure 2 Client self-palpating

the TrA during the corset
action exercise. The tips of two
fingers are placed just medial
and distal to the anterior
superior iliac spines.

Figure 4 Prone test using the Stabiliser. Palpation of

the anterior abdominal wall is performed to detect
correct contraction of the TrA and to monitor for
bulging of the abdominal wall (incorrect performance).
The hand and forearm can be used to detect spinal
movement during the test (incorrect performance).

Figure 5 Palpation of the isometric

contraction of LM in the co-contraction, using
the index finger and thumb on each side of the
lumbar spinous process. The other hand can be
used to palpate the TrA anteriorly.

Figure 7 Palpation of the co-contraction of TrA

and LM in the sidelying position.

Figure 6 Hand position for palpation

of the isometric contraction of LM. Each
segment is palpated individually.

Copyright of International SportMed Journal is the property of International Federation of Sports Medicine and
its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's
express written permission. However, users may print, download, or email articles for individual use.