Christopher Chapleau, DAc, LAc, Dipl. Ac., AIT, IMT, MSHP, CES, HMS
Editor’s note: Takeaway One of the articles in this two-part series was published in the April 2024 issue.
My primary needle position is TrA-2, which I needle 95% of the time and find to be the most effective. You’ll know you’re at the right point when you notice your muscles twitch when you apply electrical stimulation.
Note: This area is a little creepy to put the needle in because it is the deepest part of your abdominal muscles and the liver is just below it. If it is too tense, needle the most caudal point below the iliac crest, TrA-3. This is a good alternative. It can almost reach the origin of the muscle (anterior two-thirds of the iliac crest) and is also close to some of the nerves that innervate the muscle. Insert and boot the distal needle into the GB and/or LR channels, and/or the two His TCM points provided below.
Patient positioning
The patient will lie on their back or side. The supine position is suitable for TrA-1, which is one point I don’t want to use. For the other two people, a side-lying position is recommended. When the patient assumes a lateral position, the contents of the peritoneal cavity move medially, facilitating safe needle insertion.
How to insert a needle
Use a 0.25-0.30mm x 30-40mm needle. It depends on the amount of tissue.
How to needle TrA-2: Insert the needle vertically. Do not go deeper than the depth of the muscle. With the patient lying on their side, place the needle vertically just above GB 26 and at the same height as GB 25. Uses electrical stimulation.
How to drive the TrA-3: Oblique needle insertion; do not go deeper than the muscle depth. With the patient lying on their side, insert the needle tangentially below the iliac crest between the ASIS and the highest point of the iliac crest, caudally toward the ischium. Uses electrical stimulation.
prevention: Because the abdominal cavity is deep within the abdominal musculature and the liver is located, care must be taken to keep the needle depth accurate.
If you’re nervous about this abdominal needle stick (and I get it), here are some distal points that may help activate the TrA using electrical stimulation. Hua Tuozi T7-T12, especially points along L1. The location of another point is at an oblique angle along the bone, 3 cm above GB 27 on the ASIS. The third position is to insert the needle along the iliac crest just below GB 26 (free end of 11).th rib). Again, it is inserted laterally along the crest.
Additional information about the transversus abdominis
TrA innervation and arterial control: It is innervated by the ventral branches of the thoracic nerves T7-T12, the lower 5 intercostal nerves from L1, the subcostal nerve, the ilioinguinal nerve and the iliohypogastric nerve.3 The TrA receives blood supply from the lower posterior intercostal and subcostal arteries, the epigastric and hypogastric arteries, the superficial and deep circumflex iliac arteries, and the posterior lumbar artery.1
Myofascial TrP pain: Pain is felt throughout the upper abdomen, centered on the xiphoid process.3 Patients may also experience significant enthesitis along the lower costal margin.3 Suprapubic attachment refers to pain inferiorly and medially. If trigger points are present, the patient may develop a painful cough.1,3 TrPs of TrA are typically found along the ribs and anterior iliac crest.
The TrA works with other trunk muscles to support lumbopelvic alignment during movement, and its unilateral movement is a rotation of the ipsilateral trunk.1
Palpation of TrA: The patient lies in a bent position (on his back with his knees bent and his feet flat on the table). Find the ASIS, move him 2 inches towards the midline, then move him 1 inch down and apply light pressure. Feel the tension in the muscles snapping under your fingers as they contract.1
Activation exercises: The draw-in technique is the most effective technique to activate and strengthen TrA.1,5 Below is an excellent explanation of basic draw-in operations, courtesy of Physiopedia.
Lie on your back with your knees bent and feet flat on the floor. Place your finger on the muscle just below your belly button and contract the muscle by pulling downward from your finger (that is, pull your belly button down towards the floor without holding your breath during this movement). Relax your upper abdominal muscles, back muscles, and hip muscles. He holds this position for 5 seconds, making sure to continue breathing.
The point of this direct transversus abdominis exercise is to stimulate the transversus abdominis without stimulating the rectus abdominis.1 This exercise should graduate from holding static contractions to more dynamic, functional activities and application with other core exercises.1 (Watch this great video demonstration by Dr. Deborah Rikuzo: https://www.youtube.com/watch?v=MGvQNzhxBWo.) Other exercises we use in my clinic include: There are insects and quadrupeds/bird dogs.
Author’s note: I hope you liked my first post Lucrentus axpanctula series. Stay tuned: I plan on building more muscle soon. Check out my references, especially #6. The full text is available by searching online for the title. Also, if you have any questions or just want to know, feel free to contact us at acusport555@gmail.com.
References (both parts)
- Transversus abdominis. Physical Therapy: https://www.physio-pedia.com/Transversus_Abdominis
- Sahlman S. Diagnosis and treatment of movement disorder syndromes. Mosby, 2002.
- Ziegler J. Trigger Point Therapy – Transversus Abdominis. Neil Asher Education, May 24, 2021.
- Asher A. “Transverse Abdominal Muscle: A deep abdominal muscle that influences core strength.” Verywell Health, July 13, 2020: https://www.verywellhealth.com/transverse-abdominal-muscle-297289 .
- Riczo D. “Learn the easiest way to activate your transversus abdominis (TVA).” YouTube, June 17, 2021: https://www.youtube.com/watch?v=MGvQNzhxBWo.
- Lynders C. The important role of transversus abdominis muscle development in the prevention and treatment of low back pain. HSS Journal2019;15(3):214-220.
