We talked about proprioception recently, and how enhancing it can help your back feel better with most activities. In part two of “The CORE Is Sexy, But Are We Missing Something?” we are talking about BRACING. You may have been told to squeeze this or tense that at some point in your life. Get your mind out of the gutter… Let’s discuss the advantages and misconceptions around “bracing”, or tensing of the trunk muscles.
Bracing is NOT something that needs to be done on a regular basis with routine activities. One of the most common faults that I see in clinic is patients that consciously brace their abdomen with any and all activities. Bending over to tie a shoe, putting their socks on, walking, and picking their nose. Even worse is when people avoid bending at the spine to pick up something as light as a tissue. They adopt a squat pattern with a misconception that all bending at the spine is bad. These were recommendations once made to help avoid injury with lifting of heavy objects. Not a new habit to be adopted with all activities.
Often times, people are moving in this manner to guard themselves from unexpected jolts of pain while moving about their day. Bracing is a protective instinctual compensation pattern following acute back injury, but it is one that can hinder progress if used for an extended period of time.
Much of my time in clinic is actually spent getting people to relax their trunk muscles. Especially if they have been dealing with back pain for a long period of time. You can spot it right away when someone first walks through the door. They are rigid and often performing very shallow breathing patterns into the neck and chest. We need to get your muscles to relax and move freely again. A great analogy I once heard from Peter O’Sullivan really drove this in. If you had wrist pain would you clinch your fist all day? In a sense, this is what you are doing when you brace your spine. Realistically, this is more compression on the spine and way more work.
Sometimes rejection of these habits requires you to dig a little deeper to eliminate any underlying fear or avoidance behaviors related to pain. Fear of unexpected pain and poor understanding of the body is often the cause of these compensatory habits.
Are you saying that bracing is always bad?
Absolutely not. Cues for muscle contractions can be a great way to help people appreciate a feeling of neutral alignment. One cue that tends to be helpful is use of a gluteal contraction with a posterior pelvic tilt to help someone find neutral. Being able to somewhat isolate certain muscles of the body is another great way to enhance proprioception.
Bracing is also a great way to help with a more efficient transfer of energy with lifting activities and sport. Often times, 10-20% max volitional contractions (as recommended by Stuart McGill) can help improve proximal and distal joint stability. Most olympic weight lifters, sprinters, javelin throwers, pitchers, etc. will have some cue that they use to transfer weight or themselves through space more efficiently. This could be bracing of the spine in the “catch” position of a squat snatch or a strategic gluteal contraction during hip extension while running. A cue is only a cue, use the one that floats your boat or finds your lost remote.
Bracing is not evil. It just needs to be properly understood to help you achieve the best results. Bracing to eliminate pain is not the answer. Everyone has a story about how a friend got better doing core exercises. However, for every person that got better from core exercises another got better with general exercise. I see this often, but don’t neglect the importance of the main pillars of health when trying to reduce pain. Sleep, Physical Activity, Nutrition and Mental Resilience.
Dr. Michael Infantino, DPT, CMTPT, TPI
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