The dangers of becoming Rectus Abdominis -dominant

[hailtotheking]

I have recently found this out the hard way.

After following some of the advice on Westside / EliteFTS, my abdominal program over the last few months consisted predominantly of lots of extremely heavy standing cable crunches. This worked to an extent - my outer abdominals have become extremely dense and tough, and i feel it has helped alot with getting my squat and deadlift up over the same time period.

However, a few months ago after a lower body session i was at home sitting on the couch, and i got up to get a glass of water and i felt a sharp pain in my right testicle / inguinal area. Alarmingly it immediately began to swell and became tender and painful for a few days, esp. when sitting or lying down. I took some painkillers and NSAIDS and it went away, and, idotically, i carried on heavy training (inc. heavy ab crunches).

Last night, again after a heavy upper body workout, the same thing happened again, except this time it significantly more painful, swollen, and a hard lump had appeared on my right testicle. I hardly slept at all through the night from pain and paranoia as to what it was. After doing some research on the symptoms this morning, it sounds very much like a small inguinal hernia. I read from several 'sufferers' blogs that it is actually possible to push the intestinal bulge back into the hole it ripped through if it is small enough. Being petrified of surgery, i thought i'd dose up on Tramadol and Ibuprofen and give it a go. Once the painkillers and NSAIDs kicked in i laid supine on the floor, relaxed my abdomen as much as i could (which was very difficult due to how tight my overactive RA was), and pressed hard on the lump to push it back into my abdominal cavity. Amazingly, it worked, and the hard lump went, with only a bit of swelling and aching remaining. However, i am now convinced i have a hole in my inguinal cavity that will herniate again the next time i lift.

Ehy tell this tale? Well, i think the reason it happened is that hammering my RA with heavy weight at the expense if TVA or internal oblique work is just stupid, esp. for men who are statistically very prone to hernia due to weak TVA anyway. Making the RA so overdominant compared to the TVA, i'm convinced, led to my hernia, and i think it would do the same in alot of other men as well. So do your damn TVA work as well!

[Powerlifter0]

TVA work being....?

[NU_nutrition_TS]

Excellent post, HTTK. Hope you don't have any further recurrences.

I thought this site had some interesting info on the whole abdominal region and exercises that are effective/ineffective etc.:

http://www.unm.edu/~lkravitz/Article...abdominal.html

[Martin Brown]

Wait a minute, has anyone ever proved herniations are caused by a weak TVA? Im not so sure it is black and white in that sense. People argue it could cause it. I doubt you can overtrain abs to get a hernia, it is caused from internal pressure on a weak area of the ab wall, normally caused by genetic defect (around the belly button for example)

I have had an umbilical hernia a few years back, before I started PL'ing. It had nothing to do with ab training, but probably caused by squatting.


I really hope it isn't mate, they can be nasty. Easily operated on, just can be rather painful on recovery and need a fair few weeks off training.

M

[NU_nutrition_TS]

M: In the case of an inguinal hernia, which what HTTK was describing, I believe the answer is yes! As this quote from Trusted.MD blog seems to indicate:

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Do you have an inguinal hernia or did you have one repaired?

These health issues may be due to or partially due to "chest gripping", a term coined by physiotherapists, Diane Lee and Linda-Joy Lee, referring to the common faulty stabilization strategy of tightening the upper abdominals (external oblique and rectus abdominis) by drawing the navel in towards the spine when stabilizing one's trunk against the forces put through it while standing, walking, lifting and carrying, or sitting and lying down.

I believe that the reason so many hockey players suffer from inguinal hernias and tears in the abdominal wall is that they are constantly using this faulty chest gripping and bearing down strategy to stabilize their backs rather than the more appropriate transversus abdominis, pelvic floor and multifidus stabilization strategy, not only while on the ice, but also as they go through their daily lives outside the rink. The cue to "tighten one's abs" may be appropriate when one is about to be punched in the gut, but not while skating or walking down the street.

[Martin Brown]

Could an imbalance in TVA/RA stength actually cause a hernia though?

Maybe weakness in the TVA could contribute, but I cant see how a strong RA could. It isn't as though they contrast each other.

I mentioned in my log I felt an inguinal hernia whilst deadlifting last week. Fingers crossed it was only a pull of the lower abs. Nothings popping out

Actually thinking about it inguinal repairs are alot easier to recover from and alot less immobilising than umbilical hernias as you can still flex your trunk.

Either way, I hope it isn't needed HTTK, its a pain!

M

[Sam962]

I'm afraid you will have to get that seen to! I got a hernia a few years ago, and the lump dropped down into my scrotum. I left it for quite a while and it just got bigger and bigger. I could push it back in, no problem. Mine only occasionally caused pain too, only a dull ache from time to time. But the hole it was coming out of wouldn't heal by itself. No problems now, just a 3 inch scar!

[Gareth83]

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TVA work being....?

Transverse Abdominis
http://en.wikipedia.org/wiki/Transve...dominis_muscle


Paul Chek is the master of the TVA, just google some of his articles.

Another good article:

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POSTURE - Why it is important and how to improve yours!
What is GOOD Posture? (Aside from looking better, feeling better, functioning better, and having less associated pain):

(The technical explanation) Proper posture ensures that the muscles and joints of the body are aligned optimally, and at the proper “Length-tension” relationships necessary for EFFICIENT FUNCTIONING of “force couples” of muscles, as well as associated joint motions. This means the nervous system can properly recruit all muscles in all planes of motion necessary.

Why it is GOOD posture important? (just a few points on the lumbar spine regarding posture)
-Lumbar disk compression while seated: 30-40% more pressure on disks than standing (with ideal posture) - mainly because the pelvis is immobilized
SO if you sit a lot (have a desk job?) Maintaining optimal spinal alignment seated is critical!
-Flexion of the spine in standing decreases disk integrity by 50%-Adding rotation to flexion decreases disk integrity by another 25%.
-This is a 75% reduction in disk integrity during combined flexion and rotation!

Next, what is "core" stabilization and why is it important?
The core is often defined as an "inner core", which stabilize the pelvis and spine. They are the "deep" muscles that provide stability to the spine/pelvis/hips, etc, while we "use" our body, arms, legs, etc. While the inner core works directly with the "outer core" muscles, they are under separate neurological control. Therefore doing crunches/low back exercise DOES NOT strengthen these inner core muscles (this is proven in many Peer-reviewed studies!!!).

Specifically, the inner core is composed of: Transversus Abdominis (TVA), which is the deepest ab muscle, diaphragm, mulifidus (segmental spine stabilizers), and pelvic floor muscles.

Then there is the "outer core" or "global movers", which move the body in gross movements/large motions (i.e. "abs, erector spinae, external obliques, hip flexors, etc).

Both the Inner Core and Outer Core MUST work together effectively to control posture and stabilize the spine. If the inner core is not working effectively (which is common with postural deviations, low back pain, and is statistically linked more to females (see below))... then pain, dysfunction, altered structure, and even dreaded "paunch belly" can result!
Many people have weak "inner core" muscles, and thus experience back pain, dysfunctional postural patterns, and altered movement in not only the spine and back... but the extremities, feet, head, shoulders, and entire body. This is because the body is connected as an "integrated unit"... so that movement in one area, affects movement in another area. Sometimes however, is there is a "weak link" in the chain, compensation will occur, and as the saying goes, the strong get stronger and the weak get weaker".

Therefore it is necessary to first assess if one has a weak "foundation" for the spine and pelvis... which is the true "core" of the body. As the saying goes, you can't fire a cannon from a canoe! So it is with our core...

Testing the TVA/inner core....

Assess movement: Hand-on (literally), string/forward bend test (string should loosen), prone TVA draw (cuff to 40mm/hg draw decrease 10mm/hg)
Testing inner core/outer core integration... TVA activated, spinal stabilizers (posterior pelvic tilt held), legs up/down with pressure of spine still on fingers

After testing, if you have a weak/dysfunctional core, you need to work on "activating" it!!! This should be done BEFORE working on outer core intensely, and other posture work, as it is a very important key to avoiding injury!

http://posture-jasonmaggard.blogspot.com/

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There are many ways to determine if someone’s inner unit is working properly. One is assessment of the TVA using the TVA strength and coordination tests, a prone TVA test with a BP cuff, the forward flexion activation test, as well as observing in supine and standing if a client can breathe with proper dynamics (Proper breathing is essential for proper TVA activation. Just having an inverted breathing pattern alone can create faltered inner unit dynamics. For more on this, read the Breathing for Optimal Health article series by JP Sears and the article series by Matt Walden called The Core). After assessing your client from there you can decipher whether or not they have proper inner unit function. From there you can use various supine exercises such as:
1. 4 Point TVA
2. Lower Abdominal #1-#4 with BP cuff
3. Basic breathing education drills
4. As well as proper inner unit activation during all exercise routines

http://www.cttherapy.com/resources_tva.html

and another good article:

http://www.unm.edu/~lkravitz/Article...abdominal.html

[hailtotheking]

To clarify, what i was getting at was that alot of people seem to have weak TVA, multifidus, and internal obliques anyway (esp. men), and just hammering away with heavy RA work is not only going to do much to resolve the weak internal core problem, but will also cause such an imbalance that the RA will become the dominant muscle in trunk stability. Why is this an issue? Well, all the RA does is flex the spine - it is not ideal for stabilising the spine, or holding in internal structures. That is the job of the TVA, multifidus, and internal obliques (in additon to other smaller internal core muscles).

[hailtotheking]

Well, i went to the doctors this morning because the swelling and lump flared up again, and after a fairly intimate examination, he said that he can see no sign of an external hernia, and the solid lump i have on my nut is not actually on my teste and probably scar tissue on the external outlying structure (maybe the cremaster muscle?). However, he feels that there is a significant possibility of it being an internal hernia in my groin, but until the swelling goes down he cant tell. I have to go back in a months time, and in that time he told me i cannot lift anything heavier than a tin of baked beans! That basically throws out my prep for the Greater London Championships at the end of October . He told me that i can take ibuprofen to help bring the swelling down quicker.

I'm not entirely happy with this, as if it is any kind of hernia i want to find out now, because if it isnt i want to get back into training ASAP. I might go to hospital and ask for another opinion, and hopefully get a CT scan which will tell straight away.