Intra-Abdominal Pressure: Blending SFMA and DNS

Intra-abdominal Pressure (IAP)

Do you have low back pain? Neck pain? Hip impingement or tight hip adductors when running? How about shoulder or elbow pain when throwing a baseball?

Have you seen other physical therapists, or chiropractors, massage therapists, acupuncturists without relief? Maybe the missing link in getting you back onto the mound, field, court and performing at the top of your ability is Intra-Abdominal Pressure.

First things first.

What is it? Why is it so important? How does it differ than other common methodologies in physical therapy and fitness? If you want to learn more about IAP read on and watch the video.

The concept of IAP comes from the rehab school in Prague, Czech Republic and was developed by Dr. Pavel Kolar. He developed Dynamic Neuromuscular Stabilization (DNS) based on developmental kinesiology (aka studying how babies move and develop in the first 12-18 months of life). He then compared to how these normally developing infants moved and compared it to adults.

One of the basic foundations of DNS is establishing IAP. This is based on the principle that the core is the foundation of body for learning stability and mobility of the arms and legs. In order for there to be mobility, you need to first have stability. Furthermore, one of the first things babies develop within 3 months is IAP. If they do not properly learn how to establish IAP then the baby is less likely to reach for toys, play with his/her feet, learn how to roll, crawl, or sit upright. Basically, all subsequent baby development hinges on properly establishing IAP.

I like to blend another concept with DNS a lot called Selective Functional Movement Assessment, or SFMA. I have found the SFMA’s assessment and treatment of the ribcage and thoracic spine to be incredibly helpful in teaching my patients how to establish appropriate IAP. The diaphragm and abdominal muscle can’t work properly if the ribcage and spine is not moving properly or in a sub-optimal position. Using this approach I have seen much faster success with teaching proper IAP.

This method is very different than some of the more common or “traditional” approaches many are familiar with, such as drawing your belly button towards your spine (it is also what I was taught in PT school). This approach has fallen out of favor with me as I feel like the notion that the incredibly thin transverse abdominus is the key to supporting the spine a bit far-fetched, and it also turns off your obliques and rectus abdominus. It makes no sense to me to turn off your largest muscles in the lumbar spine.

Bracing is another common method taught. I think of bracing as you are tightening everything up and bearing down, like if someone was going to gut punch you. Everything stiffens up, you aren’t breathing, you can’t move easily in your spine. Intra-abdominal pressure allows for easy breathing and full mobility of the spine.

Let me know what you think about the video in the comments below 👇🏼