Six Pack Abs Exercise

The Truth About Six Pack Abs

The Truth About Six Pack Abs e-book takes you through all kinds of things you need to know to digest how the system of your body works and why you still have the beer belly, even after all these fad diets happened and all the pain left the gym floor. Geary knows what he is talking about too, his excercise programmes are based on many years experience in the field. For those who are curious as to what the big secret is to getting the washboard look it's simply this: get your body fat down to 10% or less! Following the tips in this book will help you achieve this, you don't even need to join a gym. The book explains how one gets six pack without sit-ups or vigorous workouts. In the book, you will lean simple dieting and how you can carry out simple full body exercises. Workouts come in seven levels; level one as a beginner to level seven as an expert. He gives 60 meal plans for those looking to lose weight and get those inviting six packs. Read more here...

The Truth About Six Pack Abs Summary


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Upper Abdominal Muscles Testing And Grading

Double Limb Lowering Test

When the abdominal muscles are too weak to curl the trunk, the hip flexors tilt the pelvis forward and hyper-extend the low back as they raise the trunk to a sitting position. Some people cannot perform a sit-up unless the feet are held down from the start Usually, these subjects have marked weakness of the abdominal muscles. They should practice the trunk curl only and avoid doing the sit-up in the manner illustrated here. A subject with strong abdominal muscles and paralyzed hip flexor muscles can perform only the trunk curl. Flexing the trunk toward the thighs (i.e., hip joint flexion) requires action by muscles that cross the hip joint (i.e., the hip flexors). Because the abdominal muscles do not cross the hip joint, they cannot assist in the movement. It may be noted that the subject does not raise the trunk as high from the table with legs flexed as with legs extended. The pelvis moves more freely in posterior tilt with the legs flexed. As the abdominal muscles shorten, both the...

Abdominal Muscles

The abdominal muscles are the internal obliques, external obliques, rectus abdominis, and transversus abdo-minis. (See pp. 194-198.) These muscles are the chief expiratory muscles, but they are also active toward the end of inspiration. The most important muscles at the end of inspiration and the beginning of expiration are those with little or not flexor action. Specifically, the lower fibers of the internal obliques and transversus are most active, along with the lateral fibers of the external obliques.

Skeletal muscle structure

All the connective tissue within and around the muscle merges into the connective tissue of the periosteum of the bone to which the muscle is attached, forming a tendon (Fig. 4.10) or a fibrous sheet called an aponeurosis. Apo-neuroses are seen attached to the abdominal muscles and within the diaphragm.

Aging of ligaments and muscles

The trunk and pelvic muscles have a major role in both motion and stabilization of the spine. Their support stabilizes and modifies the load in static and dynamic situations. The postural dorsal and abdominal muscles are constantly active in a standing position. During motion, equilibrium and control of stability are assumed by the antagonist action of the extensor dorsal muscles and abdominal flexors 21 . Aging may induce a degenerative myopathy, compromising the spine dynamics, and generating a rupture of equilibrium. Camptocormia is a good example of destabilization caused by muscular insufficiency. In this case, fat tissue invades the erector spinal muscles inducing a kyphotic attitude of the lumbar spine.

Scoliosis Resulting From Neuromuscular Disease

Nal muscles with a pullover strap pulling in the direction of the right external oblique. Specific exercises were given to the weak muscles of the trunk in addition to the support from the pullover strap. Seven months after treatment was started, the strength of the abdominal muscles had improved, with the right external oblique showing an increase from a poor minus to a good grade.

Innervation Of The Anterior Abdominal Wall

The nerves of the anterior abdominal wall are the ventral rami of the T6-L1 spinal nerves. These nerves course downward and anteriorly between the internal oblique and the transverse abdominis muscles. They segmentally supply cutaneous innervation to the skin and parietal peritoneum and are the motor supply to the anterolateral abdominal wall muscles. The lower intercostal nerves and the subcostal nerve pierce the deep layer of the rectus sheath and course through to the skin to become the anterior cutaneous nerves of the abdomen. The first lumbar nerve bifurcates into the iliohypogastric and ilioinguinal nerves, which do not enter the rectus sheath. Instead, the iliohypogastric nerve pierces the external oblique aponeurosis superior to the superficial inguinal ring, whereas the ilioinguinal nerve passes through the inguinal canal to emerge through the superficial inguinal ring.

Inguinal Canal Structure

VWhen the anterior abdominal wall muscles contract, intra-abdominal pressure increases (e.g., forceful exhalation coughing). This increase in pressure pushes the diaphragm up, forcing air out of the lungs. The inguinal canal, with its openings in the anterior abdominal wall, serves as a potential weakness when intra-abdominal pressure increases. When the posterior wall the inguinal canal weakens (e.g., in the elderly), an increase in intra-abdominal pressure may force the small intestine into the inguinal canal, resulting in a hernia. To check for the presence of a hernia in males, the healthcare provider will insert a finger up into the scrotum to the superficial inguinal ring. The patient is instructed to increase intra-abdominal pressure by coughing. If the physician feels contact on the fingertip, a hernia is most likely present.

Physiologic Factors Of Spinal Stabilization

Finally, the prime movers, including the rectus abdominis, erector spi-nae, and latissimus dorsi, are strengthened. Traditionally abdominal exercises have been emphasized as part of a low back exercise program, as well as lower extremity strengthening because of their integral association with the trunk. This is particularly important during lifting, where education in proper bending and lifting techniques is stressed to prevent new-onset low back pain. Lower extremity muscular flexibility is extremely important for optimal physiologic lumbar motion. Hip flexors and extensors attach to the pelvis and will essentially dictate lumbar positioning, which can result in excessive stress on lumbar segments and the sacroiliac joint. If a patient has tight hip flexors, this will result in extension of the lumbar spine and subsequent shear forces on the intervertebral disc. A slight alteration in the kinetic chain biomechanics will promote pain and disability. Self-stretching techniques should...

Altered muscle function

Grieve (1981) suggested that dysfunction often involves muscle imbalance, which may give typical clinical patterns of postural disturbance. For example, there may be tightness of the erector spinae, iliopsoas, and hamstrings, with weakness of the abdominal muscles, glutei, and anterior tibial muscles. This produces increased lumbar lordosis, and limitation of hip and knee extension. He pointed out that postural and phasic muscles are often antagonistic. Slow fibers tend to become tight and shortened fast fibers tend to weakness. Hypertrophy and atrophy can occur at the same time in antagonistic muscles. Increased activity of the more postural muscle may mechanically limit the range of movement of its antagonist, and also inhibit that more phasic muscle. To exaggerate this, a sedentary lifestyle leads to overuse of postural muscles, while phasic muscles become weak with disuse. This may all lead to shortening of the postural muscles and stretching of the phasic muscle. Muscle imbalance...

Clinical Practice Guidelines Physician Evaluation and Prescription

While obtaining the history and physical the practitioner will pay special attention to factors that will make aquatic therapy uniquely beneficial, as well as to contraindications. Evaluation includes a focused neurologic and musculoskeletal examination with a focus on spinal range of motion, strength, sensation, and gait. A common example of an aquatic therapy regimen is that outlined by Dr. Andrew Cole.7 Static and dynamic exercises of progressive difficulty are used for development of spinal stabilization. Examples include sitting against the pool wall with neutral spine posture, walking forward and backward, abdominal crunches, a host of exercises designed for the facilitation of neutral spine posture, flexibility, conditioning and core strength.

Your Weekly Weight Training Routine

Go ahead and plug in your abdominal exercises whichever day you like. Chest and triceps are involved in pushing-type activities, and your back and biceps are involved in pulling activities therefore, they should be worked in pairs if you want to split up the upper-body workouts. One reason people prefer a split-routine workout is that they can devote more energy to the muscles worked on a particular day.

Adequacy of muscle relaxation

Clinical signs of return of muscle tone include retraction of the wound edges during abdominal operations and abdominal muscle, diaphragmatic or facial movement. An increase in airway pressure (with a time- or volume-cycled ventilator) may indicate a return of muscle tone. Quantitative estimation of neuromuscular status may be obtained with a peripheral nerve stimulator (see Ch. 38). Small increments (e.g. 25-35 of the original dose) of muscle relaxant may be given to maintain relaxation alternatively, an i.v. infusion may be a more convenient method of administration, but the use of a peripheral nerve stimulator is mandatory with this technique.

Painful Conditions Of The Upper Back

It is necessary to check whether opposing tightness limits the range of motion before attempting the exercises. Tests for length of the latissimus dorsi and teres major, pectoralis major, and pectoralis minor should be performed. (See pp. 306 and 309.) Tightness in the upper anterior abdominal muscles and restriction of chest expansion will also interfere with efforts to straighten the upper back.

Changes in Patients with Paraplegia

Lower abdominal muscles in the 1st month after SCI predicted hip flexor recovery at 1 year. Early hip flexor function anticipated strengthening of the knee extensors. In the second year, a few patients with lesions below T-11 showed slight motor improvement. Consistent with studies of recovery of the upper extremities, increases in muscle strength in patients with complete paraplegia tend to occur in the lowest muscle that has any residual strength and in muscles just below that neurologic level.

Clinicopathologic Correlations

There are four types of urinary incontinence stress, urge, overflow, and functional. In stress incontinence, urine leaks because of sudden pressure on the lower abdominal muscles, as during coughing, laughing, or lifting a heavy object. It is very common in women. Urge incontinence occurs when the need to urinate comes on too fast before the patient can get to a toilet. Urge incontinence is most common in elderly persons and may be a sign of an infection in the kidneys or bladder. Overflow incontinence is a constant dripping of urine caused by an overfilled bladder. This type of urinary incontinence often occurs in men and can be caused by an enlarged prostate gland or tumor. Diabetes or certain medicines may also cause this problem. Functional incontinence occurs when the patient has normal urine control but has trouble getting to the bathroom in time because of arthritis or other conditions that make it hard to ambulate.

Transversus Abdominis

Transverse Abdominis Muscle Shape

The terms upper and lower differentiate two important strength tests for the abdominal muscles. More often than not, there is a difference between the grades of strength attributed to the upper abdominals compared to those attributed to the lower abdominals. Because the oblique abdominal muscles are essentially fan-shaped, one part of a muscle may function in a somewhat different role than another part of the same muscle. Knowledge of the attachments and the line of pull of the fibers, along with clinical observations of patients with marked weakness and those with good strength, leads to conclusions regarding the action of muscles or segments of abdominal muscles. The trunk-raising movement, when properly done as a test, consists of two parts spine flexion (i.e., trunk curl) by the abdominal muscles and hip flexion (i.e., sit-up) by the hip flexors. During the trunk-curl phase, the abdominal muscles contract and shorten, flexing the spine. The upper back rounds, the lower back...

Corrective Exercises Posture

Wall-Standing Postural Exercise Stand with back against a wall, heels about 3 inches from wall. Place hands up beside head with elbows touching wall. If needed, correct feet and knees as in above exercise below, then tilt to flatten low back against wall by pulling up and in with the lower abdominal muscles. Keep arms in contact with wall and move arms slowly to a diagonally overhead position. Wall-Sitting Postural Exercise Sit on a stool with back against wall. Place hands up beside head. Straighten upper back, press head back with chin down and in, and pull elbows back against wall. Flatten low back against wall by pulling up and in with lower abdominal muscles. Keep arms in contact with wall and slowly move arms to a diagonally overhead position.

Rationale for Treatment

Pour groups of muscles support the pelvis in anteroposterior alignment. The low back extensors pull upward on the pelvis posteriorly, the hamstrings pull downward posteriorly, the abdominal muscles pull upward anteriorly, and the hip flexors pull downward anteriorly. With good muscle balance, the pelvis is maintained in good alignment. With muscle imbalance, the pelvis tilts anteriorly or posteriorly. With anterior pelvic tilt, the low back arches forward into a position of lordosis. In this position, there is undue compression posteriorly on the vertebrae and the articulating facets, and undue tension on the anterior longitudinal ligament in the lumbar area. The muscle imbalances that are associated with an anterior tilt may include all or some of the following weak anterior abdominal muscles, tight hip flexor muscles (chiefly the iliopsoas), tight low back muscles and weak hip extensor muscles. The figures above show these muscle imbalances. Figure A shows a marked lordosis. The...

Section Iv Painful Conditions

Because the faulty head position is usually compensatory to a thoracic kyphosis, which in turn may result from postural deviations of the low back or pelvis, treatment frequently must begin with correction of the associated faults. Treatment for the neck may need to begin with exercises to strengthen the lower abdominal muscles and with use of a good abdominal support that permits the patient to assume a better upper back and chest position.

The Use of Bedside Maneuvers and Vasoactive Agents Bedside Maneuvers

The Valsalva maneuver involves attempted forceful exhalation against a closed glottis. The effects occur in two phases one during the strain phase and the other during the post-strain-release phase (8-12). It is usually performed by asking the patient to take a medium breath and hold the breath and forcefully strain or bear down as if sitting on the toilet. One needs to ensure that the patient is in fact straining by placing one's hand on the patient's abdomen to see whether the abdominal muscles become tense. One can also instruct the patient to push the abdominal muscles against the hand. A controlled way of performing the Valsalva maneuver is to have the patient blow through a rubber tube attached to an aneroid manometer to keep the pressure around 40 mmHg during the period of straining. When performed appropriately, the intrathoracic pressure will become elevated together with elevations of the end-diastolic ventricular pressures. The pulmonary vessels empty into the left atrium,...

Upper Abdominal Strengthening

In back-lying position, tilt pelvis to flatten low back on table by pulling up and in with lower abdominal muscles. With arms forward, raise head and shoulders up from table. Do NOT attempt to come to sitting position, but raise upper trunk as high as back will bend. As strength progresses, arms may be folded across chest, and later placed behind head to Increase resistance during the exercise. 2. Guimaraes ACS, et al. The contribution of the rectus abdominis and rectus femoris in twelve selected abdominal exercises. J Sports Med Phys Fitness 1991 31 222-230. 4. Wickenden D. Bates S, Maxwell L. An electromyo-graphic evaluation of upper and lower rectus abdominus during various forms of abdominal exercises. N Z J Physiother 1992 August 17-21. 7. Staniszewski B, Mozes J. Tippet S. The relationship between modified sphygmomanometer values and biome-chanical assessment of pelvic tilt and hip angle during Kendall's leg lowering test of abdominal muscle strength. Proceedings of the Illinois...

Abdominal And Pelvic Surgery

Spinal anesthesia for abdominal surgery has the advantages of being easy to perform and requiring a small dose of drug, making systemic absorption unimportant. Protective airway reflexes are maintained, and cerebral and myocardial depression are avoided. Abdominal muscle relaxation is good, and the gut is contracted, making operating conditions easier. Most noxious reflexes are blocked, with the exception of those mediated by the vagus nerve. The disadvantages of spinal anesthesia include the intense sympathetic blockade, which, if high, may produce hypotension that is difficult to control. True motor block of the phrenic nerve is very unusual because of high spinal block, but a respiratory arrest resulting from hypotension and a brainstem hypoperfusion may occur. Furthermore, even if the blood pressure is satisfactory and the airway reflexes and phrenic nerve are intact, the patient who is paralyzed up to the neck may have difficulty in protecting the airway. The spinal block may...

Back Extensors Testing And Grading

Quadratus Lumborum Muscle Length Test

The extremity can be lifted in hip abduction, but without fixation by the lateral abdominal muscles, it cannot be raised high off the table. Because of the weakness of the lateral trunk muscles, the weight of the extremity tilts the pelvis downward. Fixation Hip abductors must fix the pelvis to the thigh. The opposite adductors also help to stabilize the pelvis. The legs must be held down by the examiner to counterbalance the weight of the trunk, but they must not be held so firmly as to prevent the upper leg from moving slightly downward to accommodate for the downward displacement of the pelvis on that side. If the pelvis is pushed upward or is not allowed to tilt downward, the subject will be unable to raise the trunk sideways even if the lateral abdominal muscles are strong. Note Tests of the lateral trunk muscles may reveal an imbalance in the oblique muscles. In sideways trunk raising, if the legs and the pelvis are held steady (i.e., not permitted to twist forward or backward...

Variations In Length Of Posterior Muscles

Motorpoint Adductor Muscles

The term weak back, as frequently used in connection with low back pain, mistakenly suggests a weakness of the low back muscles. The feeling of weakness that occurs with a painful back is associated with the faulty alignment the body assumes, and it is often caused by weakness of the abdominal muscles. Persons who have faulty posture with roundness of the upper back may exhibit weakness in the upper back extensors but have normal strength in those of the low back. Despite the fact that the low back muscles are the most important trunk stabilizers, relatively little space will be devoted to them in this chapter compared to the detailed discussion of the abdominal muscles. Testing back muscles is less complicated than testing abdominal muscles, and in the field of exercise, few errors occur regarding back exercises. Many misconceptions and errors, however, occur regarding proper abdominal exercises. Furthermore, in contrast to the back muscles, weakness of the abdominal muscles is more...

Weakness Testing And Grading

ABDOMINAL MUSCLE IMBALANCE AND UMBILICUS DEVIATIONS With marked weakness and imbalance in the abdominal muscles, it is possible, to some degree, to determine the extent of the imbalance by observing the deviations of the umbilicus. The umbilicus will deviate toward a strong segment and away from a weak segment. If, for example, three segments the left external and the left and right internal obliques are equally strong and the right external is markedly weak, the umbilicus will deviate decidedly toward the left internal. This happens not because the left internal is the strongest, but because it has no opposition in the right external. This shows deviations away from a weak segment. To obtain true deviations, the abdominal muscles should first be in a relaxed position. The knees may be bent sufficiently to relax the back flat on the table. Then, the patient may be asked to attempt raising the head or tilting the pelvis posteriorly (even though the back is already flat). If resistive...

Section Iii Neck Muscle Tests

Fixation Anterior abdominal muscles must be strong enough to give anterior fixation from the thorax to the pelvis before the head can be raised by the neck flexors. If the abdominal muscles are weak, the examiner can provide fixation by exerting firm, downward pressure on the thorax. Children approximately 5 years of age and younger should have fixation of the thorax provided by the examiner. Grading Because most grades of 10 are based on adult standards, it is necessary to acknowledge when a grade of less than 10 is normal for children of a given age. This is particularly true regarding the strength of the anterior neck and the anterior abdominal muscles. The size of the head and trunk in relation to the lower extremities as well as the long span and normal protrusion of the abdominal wall affect the relative strength of these muscles. Anterior neck muscles may have a grade of Fixation If the anterior abdominal muscles are weak, the examiner can provide fixation by exerting firm,...

Posterior Pelvic Till

Psoas Muscle Throat

In the past, the words lordosis and sway-back were used interchangeably in referring to the curvature in the low back and lower thoracic areas. The postural differences between the lordosis and the sway-back postures were recognized in Posture and Pain, but the name sway-back was not applied until the third edition of Muscles, Testing, and Function, published in 1983. Separating the use of these terms also differentiated the two postures, which are, in fact, distinctly different with respect to the an-teroposterior tilting of the pelvis, position of the hip joint, and accompanying muscle imbalances. Weakness of the iliopsoas is a constant finding in the sway-back posture, in contrast to being strong in the lordotic posture. As determined by the lower abdominal muscle test, the external oblique is usually weak in both the lordotic and sway-back postures. painful or if the upper back and lower abdominal muscles are too weak to maintain postural correction. Exercises to strengthen the...

Corrective Exercises Low Back And Abdominals

Lower Abdominal Exercise and Low Back Stretching Back-lying Position Bend knees and place feet flat on table. With hands up beside head, tilt pelvis to flatten low back on table by pulling up end in with lower abdominal muscles. Keep low back flat and slide heels down along table. Straighten legs as much as possible with back held flat. Keep back flat and return knees to bent position, sliding one leg back at a time. (Do NOT use buttock muscles to tilt pelvis and do NOT lift feet from floor.) Lower Abdominal Exercise Back-lying Position Place a rolled towel or small pillow under knees. With hands up beside head, tilt pelvis to flatten low back on table by pulling up and in with lower abdominal muscles. Hold back Hat and breathe in and out easily, relaxing upper abdominal muscles. There should be good chest expansion during inspiration, but back should not arch. (Do NOT use buttock muscles to tile the pelvis.)

Structure and Physiology

Because the kidneys, duodenum, and pancreas are posterior organs, it is unlikely that abnormalities in these organs can be palpated in adults. In children, in whom the abdominal muscles are less developed, renal masses, especially on the right side, can often be palpated.

Physical Examination

Genitalia Examination

The patient should be lying flat in bed, and the abdomen should be fully exposed from the sternum to the knees. The arms should be at the sides, and the legs flat. Frequently, patients tend to place their arms behind their heads, which tightens the abdominal muscles and makes If the patient has complained of abdominal pain, examine the area of pain last. If the examiner touches the area of maximal pain, the abdominal muscles tighten, and the examination is more difficult.

The Primary Motor Cortex and Locomotion

For voluntary tasks that require attention to the amount of motor activity of the ankle movers, Ml motoneurons appear equally linked to the segmental spinal motor pools of the flexors and extensors.49 This finding suggests that the activation of Ml is coupled to the timing of spinal locomotor activity in a task-dependent fashion, but may not be an essential component of the timing aspects of walking, at least not while walking on a treadmill belt. Spinal segmental sensory inputs, described later in this chapter, may be more critical to the temporal features of leg movements during walking. The extensor muscles of the leg, such as the gastrocnemius, especially depend on polysynaptic reflexes during walking modulated by sensory feedback for their anti-gravity function.50 Primary motor cortex neurons also represent the contralateral paraspinal muscles and may innervate the spinal motor pools for the bilateral abdominal muscles.5l Potential overlapping representations between paraspinal...

The pelvis and sacroiliac joints

The thoracolumbar fascia plays an important role in load transfer between the trunk and legs. It is part of a corset that surrounds the trunk. The erector spinae lies within its layers. Contractions of the latissimus dorsi, gluteus maximus, and abdominal wall muscles tense the fascia, which effectively links the actions of these muscles. The biceps femoris tendon tenses the sacrotuberous ligament below. This all acts as a muscle-tendon-fascia sling that provides a functional link between the trunk, the pelvis, and the legs. This fascia also has rich innervation for both proprioception and nociception.

Positioning The Patient

Many procedures are carried out with the patient in the lithotomy position. Care is needed to avoid damage to the common peroneal nerve because the legs may press against the lithotomy poles. The Lloyd-Davies position provides a variant of the lithotomy position. It is traditionally used for those with osteoarthritis of the hips or the lumbar spine. Before placing anaesthetized patients in these positions, they should be adequately anaesthetized, with good airway control, because it is impossible to turn them rapidly onto the side should they regurgitate or vomit stomach contents. During positioning, the patient's head must be supported, and the arms prevented from falling. The anaesthetic breathing tubes must be free to move and monitoring apparatus connected without unnecessary delay. These positions increase the pressure of the abdominal contents on the diaphragm, making spontaneous respiration more difficult and causing closure of basal alveoli. This may lead to a decrease in...

Field block for inguinal hernia repair

A needle is inserted 1.5 cm medial and inferior to the anterior superior iliac spine. Using a regional block needle,,.the external oblique aponeurosis is readily appreciated as the needle is advanced. Fifteen millilitres of local anaesthetic are injected deep to the aponeurosis, down to the inner surface of the ilium between the abdominal muscle layers. Another 5 ml of solution are deposited superficial to the external oblique aponeurosis medially from this point. Bupivacaine 0.5 is a suitable agent for postoperative analgesia.

Evaluate General Appearance

The general appearance of the patient often furnishes valuable information as to the nature of the condition. Patients with renal or biliary colic writhe in bed. They squirm constantly and can find no comfortable position. In contrast, patients with peritonitis, who have intense pain on movement, characteristically remain still in bed because any slight motion worsens the pain. They may be lying in bed with their knees drawn up to help relax the abdominal muscles and reduce intra-abdominal pressure. Patients who are pale and sweating may be suffering from the initial shock of pancreatitis or a perforated gastric ulcer.

What are flexion exercises Williams exercises When are they appropriate

Apple Pencil Poster

Examples of flexion exercises include knee-to-chest exercises (Fig. 14-1), abdominal crunches, and hip flexor stretches. Flexion exercises are commonly prescribed for facet joint pain, lumbar spinal stenosis, spondylolysis, and spondylolisthesis. Flexion exercises increase intradiscal pressure and are contraindicated in the presence of an acute disc herniation. Flexion exercises are also contraindicated in thoracic and lumbar compression fractures and osteoporotic patients.

Outline a treatment plan for patients with thoracic radiculopathy

Thoracic radiculopathy may be due to disc herniation or metabolic abnormalities of the nerve root (i.e. diabetes). Patients present with bandlike chest pain. Thoracic radiculopathy is not a common diagnosis, and other possible serious pathology should be excluded (malignancy, compression fracture, infection, angina, aortic aneurysm, peptic ulcer disease). Nonsurgical treatment options for thoracic radiculopathy include medication (NSAIDs, analgesics, oral steroids), modalities, TENS, spinal nerve root blocks, spinal stabilization exercises, strengthening of back and abdominal muscles, orthoses, and postural retraining.

Table 3410 Startle Syndromes

The hallmark of hyperexplexia is an exaggerated startle response to a sudden, unexpected stimulus. Children with hyperexplexia are born with continuous stiffness and demonstrate a flexor posture, both of which disappear with sleep. Severely affected children startle excessively to sudden stimuli, and infants characteristically flex rather than extend their arms as seen with the normal Moro response. Apnea and cardiorespiratory arrest can occur, perhaps due to stiffness of the chest wall. The increased tone gradually disappears during the first several months of life, yet the startle response can interfere with walking and may result in trauma from falls. Severely affected patients have startle attacks throughout life they often become worse during adolescence, and variable improvement occurs later in life. Other affected individuals may have infrequent attacks that may become worse with stress or illness. Violent bilateral flexion of the legs can occur during descent into slow-wave...

Muscle And Musculocutaneous Flaps

Deltopectoral Flap

The pectoralis major (PM) myocutaneous flap is the most frequently used pedicled flap for head and neck reconstruction.29,39-41 The PM muscle originates from the clavicle, the first five ribs, the xiphoid, and from the upper abdominal muscles. It inserts on the humerus. Its blood supply is provided by branches of the thoracoacromial trunk, which pierces the clavipectoral fascia medial to the tendon of the pectoralis minor muscle. Multiple perforators run through the muscle in the subcutaneous fat, supplying the overlying skin with direct cutaneous vessels. The skin paddle can be located anywhere over the muscle pedicle. However, the design used most often is a vertical paddle up to 8 x 17 cm raised over the sternal origin of the muscle, which provides thin skin and allows primary closure of the donor defect. The skin island may extend into the inframammary fold and multiple skin paddles can be carried on the same muscle pedicle.42


This arrangement accounts for the strictly unilateral nature of some types of headache. The pain is poorly localized because of large receptive fields, and is referred to somatic areas. In many respects, headache is little different from the pain experienced in association with inflammation of other viscera. Just as appendicitis is accompanied by referred pain to the umbilicus and abdominal muscle rigidity, so headache is generally referred to the frontal (ophthalmic) or cervicooccipital (C2) regions and is associated with tenderness in the temporalis and cervical musculature. It is because of this arrangement that tumours in the upper posterior fossa may present with frontal headache and why patients with raised pressure within the posterior fossa and impending herniation of the cerebellar tonsils through the foramen magnum may complain of neck pain and exhibit nuchal rigidity. Central projections of the trigeminal nerve to the nucleus of the tractus solitarius account for the...

Big Picture

Five paired anterior abdominal wall muscles are deep to the superficial fascia. The external oblique, internal oblique, and transverse abdominis muscles, with their associated aponeuroses, course anterolaterally, whereas the rectus ab-dominis and tiny pyramidalis muscles course vertically in the anterior midline. Collectively, these muscles compress the abdominal contents, protect vital organs, and flex and rotate the vertebral column. Each muscle receives segmental motor innervation from the lumber spinal nerves.

Pyramidalis Muscle

VThe Valsalva maneuver is performed by forcibly exhaling against a closed airway (closed vocal folds). When the maneuver is completed, the contraction of abdominal wall muscles increases the intra-abdominal pressure. Increased intra-abdominal pressure assists with vomiting, urinating, defecating, and vaginal birth, and, when the vocal folds are open, with exhaling.

Somatic Nerves

The somatic nerves of the posterior abdominal wall are the ventral rami of the subcostal and lumbar spinal nerves (Figure 11-3). Subcostal (T12), iliohypogastric (L1), and ilioinguinal (L1) nerves. These three nerves emerge along the lateral surface of the psoas major muscle and course between the internal oblique and transverse abdominis muscles, innervating these abdominal wall muscles.

How is BPH diagnosed

Uroflow A uroflow measurement is a totally noninvasive test. The patient, with a full bladder, voids into a special urinal that has a flowmeter, which measures both the urine flow in milliliters per second as well as the total volume voided. This is plotted onto a piece of paper, and there are nomograms available that allow the doctor to compare the patient's urine flow rate with accepted standards. The uroflow is typically done in the physician's office at the time of the patient's visit. A low urine flow rate is suggestive, but not definitive, for bladder outlet obstruction, which may be caused by BPH or a urethral stricture. However, in the individual whose bladder does not contract adequately, the urine flow rate may also be low. The urine flow rate can also look better than it really is if you push with your abdominal muscles while voiding. Thus, although helpful, it is not entirely accurate.

Spinal Cord Injury

Stimulation evoked larger motor responses in the abdominal muscles rostral to a thoracic spinal cord lesion and from a greater number of scalp positions than were evoked in the abdominal groups of normal subjects.133 This finding suggests that the cortical motor map had expanded after the injury. The investigators could not exclude a change at the level of the affected spinal motoneurons, such as an increase in their excitatory response to a descending volley or to sprouting of corticospinal axons. Another group of paraplegic subjects had PET studies with 15O -H2O as their hands moved a joystick in different directions. The investigators found enhanced bilateral activity in the thalamus and cerebellum and expansion of the hand region medially toward the activity-deprived leg representation.134 Mag-netoencephalography showed that 20 of 24 tetraplegic subjects and 9 of 20 paraplegic subjects, including all 5 who could move their toes, had a posterior displacement of the evoked motor...


The scalenes may become active during expiratory efforts as well. According to Egan, the expiratory function of the scalene muscles is to fix the ribs against the contraction of the abdominal muscles and to prevent herniation of the apex of the lung during coughing (39). (See also pp. ISO and 148-149.)

The Fetus

Labor pain, a form of acute pain, is perceived by many women as very severe or intolerable.113 Parturition pain has both a visceral and somatic component. Visceral stimulation occurs as the cervix and lower uterine segment dilate. Uterine contractions may result in myometrial ischemia, causing visceral pain. Early labor pain (latent phase and early active phase) is primarily visceral and occurs during uterine contractions. Afferent impulses are transmitted via sensory nerves (myelinated A delta and unmyelinated C fibers) that pass through the paracervical nerve plexus (Fig. 25-1 (Figure Not Available) ). These nerves accompany the sympathetic nerves to the inferior, middle, and superior hypogastric plexus, and then to the celiac plexus. They enter the lumbar sympathetic chain and then pass with T10, T11, T12, and L1 white rami communicantes to the posterior spinal roots, where they synapse with neurons in the dorsal horn of the spinal cord. Pain is often referred to other areas,...

Planes and regions

Although viscera are said to occupy certain regions of the abdomen, and surface markings can be stated, it must be remembered that surface markings of viscera are variable, particularly those organs that are suspended by a mesentery. The main factors affecting the position and surface markings of organs are (a) body build, (b) phase of respiration, (c) posture (erect or recumbent), (d) loss of tone of abdominal muscles, which may occur with age, (e) change of size due to pathology, (f) quantity of contents of hollow viscera, (g) the presence of an abnormal mass, and (h) normal variants within the population.


And labyrinthine pathways and higher centres, or through blood-borne chemicals. The output of the vomiting centre triggers reverse peristalsis in the upper part of the small intestine, returning its contents to the stomach, and also relaxation of the stomach wall, oesophageal sphincter and oesophagus. Expulsion of the stomach contents is achieved through contraction of the abdominal striated muscles, working in conjunction with fixation of the chest wall through cessation of breathing in mid-inspiration. Under these circumstances, contraction of the abdominal muscles rapidly increases intra-abdominal pressure, which is transmitted to the stomach, compressing it. The respiratory tract is protected from vomitus by closure of the glottis, and the soft palate rises to prevent vomitus entering the nose. The reflex also results in copious secretion of the salivary and lachrymal glands and activation of other autonomic pathways, producing pallor, slowing of the heart rate and sweating.

Pulmonary Causes

Two categories is important and is usually afforded by a thorough history, physical examination, and laboratory evaluation. Unlike motor unit disorders that produce hypoventilation, CNS disorders produce abnormal respiratory patterns, such as Cheyne-Stokes (forebrain and diencephalic damage), central neurogenic hyperventilation (hypothalamic and midbrain damage), apneustic (inspiratory breath holding related to pontine tegmental damage), cluster (irregular bursts of rapid breathing alternating with apneic periods), and ataxic (irregular breathing related to medullary damage) breathing patterns. The respiratory impairment associated with spinal cord disorders is predominantly a reflection of its location. Lesions at C3 affect diaphragmatic and intercostal function and spare only the accessory muscles of inspiration innervated by the eleventh cranial nerve. Lesions at C4 or C5 produce lesser degrees of diaphragmatic impairment. Low cervical and high thoracic lesions spare the diaphragm...

And Disability

The American Spinal Injury Association's (ASIA) Standards for Neurological and Functional Classification of Spinal Cord Injury, Revised 1992, has become the most widely used format for categorizing the motor and sensory examinations (Fig. 10-1). The motor score, which uses the British Medical Council scale for key muscles that each represent a root level, does not measure the strength of the abdominal muscles, which can act as hip flexors when the pelvis is tilted. The sensory scale specifies only appreciation of pin prick and light touch, not proprioception. The zone of partial preservation refers to the dermatomes and myotomes caudal to a complete injury that retain partial sensorimotor function. The zone is usually confined to several segments and in the region of the gray matter injury. The ASIA Impairment Scale describes the completeness of the level of injury (Table 10-1). The scale modifies the older Frankel classification by its emphasis on sparing or involvement of sacral...

Lumbar Plexus

Provides a portion of the motor innervation to the abdominal wall muscles and sensory innervation to the pubic region. Ilioinguinal nerve (L1). Provides a portion of the motor innervation to the abdominal wall muscles and sensory innervation to the superior medial thigh and pubic area. Genitofemoral nerve (L1-L2). Possesses two branches, the genital branch and the femoral branch. The genital branch provides motor innervation to the cremasteric muscle (male only) and sensory innervation to the skin of the anterior scrotum or labia majora. The femoral branch provides sensory innervation to the skin over the anterior region of the thigh.


Full relaxation of the abdominal muscles, as well as avoidance of coughing and straining during laparoscopic procedures is additional precautions to prevent abnormal thoracic gas collections during transperitoneal and retroperitoneal laparoscopy. Full relaxation of the abdominal muscles, as well as avoidance of coughing and straining during laparoscopic procedures is additional precautions to prevent abnormal thoracic gas collections during transperitoneal and retroperitoneal laparoscopy (13).

Internuncial Pool

Causes a reflex contraction of the abdominal muscles beneath the stimulus. Thus, stroking the upper abdomen causes contraction of the upper abdominal muscles, whereas stimulation of the lower abdomen causes contraction of the lower abdominal muscles. This relationship between the location of the stimulus and the muscles that contract is called a local sign. Other examples are contraction of the cremasteric muscles of the scrotum in response to stroking the skin of the inner thigh and the reflex contraction of the external anal sphincter when the perianal skin is stroked.

Generalized Seizures

Tonic-clonic seizures (TCS) are the most common type of seizure encountered in childhood, adolescence, and adulthood. The manifestations of generalized TCS can be divided into several phases beginning with vague prodromal symptoms that may occur hours to days before the actual convulsion. Common premonitory symptoms include headache, mood change, anxiety, irritability, lethargy, changes in appetite, dizziness, and lightheadedness. The tonic phase may be preceded by a series of brief, bilateral muscle contractions lasting a few seconds. The tonic phase begins with brief flexion of the trunk, accompanied by upward deviation of the eyes, mydriasis, and a characteristic vocalization as contraction of abdominal muscles produces forced expiration across a spasmodic glottis. This process is followed by a period of generalized extension lasting 10 to 15 seconds. With evolution of the clonic phase, tonic contractions alternate with periods of muscle atonia of gradually increasing duration...

Postural Examination

Postural Exam

Muscle strength tests should include back extensors (see p. 181), upper and lower abdominals (see pp. 202 and 212), lateral trunk (see p. 185), oblique abdominal muscles (see p. 186), hip flexors (see pp. 422, 423), hip extensors (see p. 436), hip abductors and Gluteus medius (pp. 426, 427), hip adductors (pp. 432, 433), and in the upper back, the middle and lower trapezius (see pp. 329 and 330). An essential part of examination is observation of the back during movement. The examiner stands behind the subject, and the subject bends forward and then returns slowly to the upright position. If there is a structural curve, some fullness (prominence) will be noted on the side of the convexity of the curve. The fullness will be on one side only if there is a single curve, (i.e. C-curve). In a double curve, (i.e. S-curve) as in a right thoracic, left lumbar, there will be fullness on the right in the upper back and on the left in the low back area. In a Junctional curve, however, there may...

Nerve entrapment

The ilioinguinal nerve transmits sensations from the proximal part of the external genitals and parts of the medial thigh. Pain in these areas should lead to suspicion of engagement of the nerve. These sensations may be elicited by e.g. intensive abdominal muscle training leading to entrapment of the nerve where it passes through the different layers of the abdominal muscles and their fasciae. The intensity and character of the pain vary. Hyperextension of the hip joint might augment the pain. It is usually possible to detect skin hyperesthesia, which is demonstrated by drawing a needle across the skin from a non-painful area to a painful area. The diagnosis is confirmed by a block of the nerve with local anesthetics that will promptly relieve the pain. If the pain is severe, surgical treatment may be considered.

Rectus Abdominis

Rectus Abdominis

Weakness Weakness of this muscle results in decreased ability to flex the vertebral column. In the supine position, the ability to tilt the pelvis posteriorly or approximate the thorax toward the pelvis is decreased, making it difficult to raise the head and upper trunk. For anterior neck flexors to raise the head from a supine position, the anterior abdominal muscles (particularly the rectus ab-dominis) must fix the thorax. With marked weakness of the abdominal muscles, an individual may not be able to raise the head even though the neck flexors are strong. In the erect position, weakness of this muscle permits an anterior pelvic tilt and a lordotic posture (i.e., increased anterior convexity of the lumbar spine).

Emergency repair

The principles of management are similar to those discussed above. However, the patient may be grossly hypovolaemic and often arterial pressure is maintained only by marked systemic vasoconstriction and the action of abdominal muscle tone acting on intra-abdominal capacitance vessels. Resuscitation with intravenous fluids before the patient reaches the operating theatre should be judicious, as hypertension may increase the extent of haemorrhage. The patient is prepared and anaesthetized on the operating table. While 100 oxygen is administered by mask, all monitoring catheters and two large-gauge i.v. cannulae are inserted under local anaesthesia. The surgeon then prepares and towels the patient ready for surgery and it is only at this point that anaesthesia is induced using a rapid-sequence technique. When muscle relaxation occurs, systemic arterial pressure may decrease precipitously and immediate laparotomy and aortic clamping may be required. Thereafter, the procedure is similar to...


Glutaeus Max Med Min

Good strength in the abdominal muscles is also important to counterbalance the back muscles and to stabilize the trunk in good postural alignment and during activities such as lifting. Unfortunately, abdominal muscles are often weak, especially the lower abdominals, and not enough attention is paid to appropriate exercises. Shoe corrections, for cases indicating irritation resulting from a stretched, rather than a contracted, piri-formis, consist of a straight raise (usually Vs to xk inch) on the heel of the unaffected side to relieve tension on the abductors of the affected side as well as an inner wedge on the heel on the affected side to correct the internal rotation of the leg. Heat, massage, and stretching of the low back muscles if they are contracted, abdominal muscle exercise if abdominal weakness is present, and correction of the faulty position of the pelvis in standing are used as indicated.

Basic Science

The aforementioned degeneration of the intervertebral disc leads to altered local and segmental mechanics, generating a cascade of compensatory changes within the facet complex, bones, and ligaments.2 Along with degenerative changes occurring with the normal aging spine, the surrounding support structures are also aging and thus degenerating. The most important of the surrounding structures are the core muscles, which include the paraspinal musculature and the abdominal muscles.3 As these supporting muscles lose tone, the spinal column stability depends more on the facet joints, ligaments, and intervertebral discs leading to compensatory hypertrophy of the ligaments, hypertrophied facet joints, and calcified annular-vertebral osteophytes (Table 14-1).3

Light Palpation

Images Palpation

During expiration, the rectus muscles usually relax and soften. If there is little change, rigidity is said to be present. Rigidity is involuntary spasm of the abdominal muscles and is indicative of peritoneal irritation. Rigidity may be diffuse, as in diffuse peritonitis, or localized, as over an inflamed appendix or gallbladder. In patients with generalized peritonitis, the abdomen is described as boardlike.''

Myopathic Syndromes

Comparison of the contraction of the upper and lower abdominal muscles yields another sign that is valuable in localizing thoracic cord lesions. This comparison is made by palpating the muscles while the patient lifts the head off the pillow, causing contraction over the abdominal muscles. In a patient with a mid to lower thoracic cord lesion, the upper abdominal muscles may contract while the lower ones remain flaccid. This maneuver may also result in an upward movement of the umbilicus, as noted by Lord Beevor, for whom this sign is named.

Colonic Motility

The sympathetic supply to the internal (involuntary) sphincter is excitatory, whereas the parasympathetic supply is inhibitory. The pudendal nerve innervates the external anal sphincter. Defaecation is a spinal reflex that may be inhibited voluntarily by contracting the external sphincter or facilitated by relaxing the sphincter and contracting the abdominal muscles. Distension of the stomach initiates contractions of the rectum and frequently a desire to defaecate (gastrocolic reflex) and this may be initiated by gastrin.

Deep Palpation

During deep palpation, the patient should be instructed to breathe quietly through the mouth and to keep arms at the sides. Asking the patient to open the mouth when breathing seems to aid in generalized muscular relaxation. The palpating hands should be warm, because cold hands may produce voluntary muscular spasm called guarding. Engaging the patient in conversation often aids in relaxing the patient's abdominal musculature. Patients with well-developed rectus muscles should be instructed to flex their knees to relax the abdominal muscles. Any tender areas must be identified.


Clinical Features and Associated Findings. The clinical course consists of early symptoms of chills, headache, restlessness, and pain at the site of injury. Tightness in the jaw and mild stiffness and soreness in the neck are usually noticed within a few hours. As symptoms develop, the jaw becomes stiff and tight (lockjaw). Muscular involvement then progresses to the throat and facial muscles. Muscular rigidity may then become generalized and may include the trunk and extremities. Rigidity in the abdominal muscles can result in a forward arching at the back. The tetanic contractions occur periodically and can cause severe pain. In the most severe cases, convulsions and marked dyspnea with cyanosis can occur, terminating in asphyxia and sudden death. Mental status remains intact. However, the patient suffers from anxiety and mental and physical agony.

The 6 Principles To Six Pack Abs

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