Lower Abdominal Muscles

Transversus Abdominis and its role in treatment for Lower Back Pain

Transversus Abdominis (also called transversus abdominus) is one of the lower abdominal muscles that play an important role in providing support to the lower back. It is a large corset like abdominal wall muscle that wraps around the trunk attaching to the pelvis, lower back and ribs.


The interest in transversus abdominus began with some research that showed a promising relationship between transversus abdominis and treatment of lower back pain 1,2. This led to a period of physiotherapy practice where we tried to teach exercises for the separate abdominal wall muscles 3.

lower abdominal muscles

It was felt that the rectus abdominus (the main sit-up muscle) was a bit of a ‘bad guy ’ as it was often the most dominant muscle in the abdominal muscle complex. The idea was that in order to get the best out of the deep core stabilising lower abdominal muscles then we needed to reduce the activity in rectus abdominis. Instead the plan was to try and increase the activity in the deeper abdominal wall muscles for effective back pain relief.

This led to a ton of complicated exercises that were a bit beyond most people as they needed an ‘expert’ to tell them what to do and when they had it right.

You need all your lower abdominal muscles to be in good shape to manage lower back pain

Apart from being impractical and complicated these exercises were not functional. By this I mean they were not things you would do in your everyday life. The exercises assumed that if you could recruit transversus abdominis in lying or on your hands and knees that you would be also be able to recruit it when you were order picking in a warehouse for 8 hour shifts or sitting at a computer all day. This was not always the case which is why this type of treatment was unhelpful for some people.

Since this pioneering research we have learned a lot more about transversus abdominis. We know that it is not the magic key to unlocking the problem of back pain and that its role is dependent on all the other muscles being in good shape too. So these days modern practice tends not to focus on isolating the muscle but on getting a good strong healthy core with all the lower abdominal muscles working together.

The latest thinking about lower abdominal muscles, transversus abdominis and treatment for lower back pain

Recent studies have demonstrated that the core muscles are at their most active when the spine is in a more ‘neutral’ position4, 5. So, for example, if you have just spent three hours in a slumped position on the sofa then the muscles are probably a bit ‘switched off’. Finding a comfortable neutral position and being able to support yourself in that position is essential when it comes to training the core.

In my own practice I have lost count of the number of people with lower back pain that I have seen who have very saggy and low toned lower abdominal muscles. It is almost universal. However, I don’t agree that this is the only reason they have lower back pain. I believe that core work is just one piece of the jigsaw puzzle that needs to be put together to get to the bottom of managing back pain.

However…and this may surprise you, I wouldn’t automatically start with isolated lower abdominal muscle exercises for core stability.

I often advise trying some Pilates exercises. I have some training in Pilates and also have attended both Pilates and yoga classes for years myself. I can say with confidence that both Pilates and Yoga exercises are fantastic to help you develop a nice strong core, whilst being functional and also teaching you an excellent awareness of the neutral spine and healthy posture. The only caveat here is make sure that the teacher is properly qualified, the best Pilates instructors insist on a few one to one sessions first so the exercise plan is individualised.

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1. O'Sullivan, P.B., Phyty, G.D., Twomey, L.T. & Allison, G.T. Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis. Spine 22, 2959-67 (1997).

2. Hides, J.A., Jull, G.A. & Richardson, C.A. Long-term effects of specific stabilizing exercises for first-episode low back pain. Spine 26, E243-8 (2001).

3. Richardson, C.A. & Jull, G.A. Muscle control-pain control. What exercises would you prescribe? Manual Therapy 1, 2-10 (1995).

4. Reeve, A. & Dilley, A. Effects of posture on the thickness of transversus abdominis in pain-free subjects. Man Ther 14, 679-684 (2009).

5. Suni, J. et al. Control of the lumbar neutral zone decreases low back pain and improves self-evaluated work ability: a 12-month randomized controlled study. Spine 31, E611-20 (2006).

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