Suck, Squeeze, and Squeeze

If you would be so kind to provide your opinion (and perhaps rebuttal) to the following technique “Suck, Squeeze and Squeeze)”.

I recently encountered a patient who, through a clinical history and physical examination demonstrated a significant lack of “core competency” as others would call it. Through a recent encounter with a physical therapist, she was instructed to suck, squeeze and squeeze to kickstart a core strengthening rehabilitation program. While I assumed the “referred” to the navel and one of the squeezes referred to the pelvic floor, I was unaware of this “technique”.

So after googling it, I encountered the following post and video and was not surprised to see that this technique has been advocated by a world renowned professional (whom I greatly respect) that is local. http://selfhealth.blogspot.com/2009/01/core-matters.html

Some of my concerns pertained to no mention of the diaphragm as well as a purely volitional act of contraction. I was hoping you would provide me with an educated response (aka professional rebuttal) that I can turn into a blogpost.

In no way am I attempting to create (for lack of a better term) enemies…especially in my backyard, I simply would like to get the point across that there may be a better way to achieve “core competency”. And since you are WELL versed in both the Prague and FM Systems methods, I thought you would be the perfect professional to ask.

She's gone from Suck to Blow.

I’ve watched the video, and I can make some assumptions and thoughts.  But just based off the video, there appears to be a lot more information that I would like to see and learn before passing judgement.

At this small glance, it appears these folks believe that establishing an isolated contraction of magnitude of these major players in the core, then it will automatically add up to appropriate function.  Sometimes this works.  Sometimes it does not.  And when there is a more reliable approach to get the key muscles’ activation and within a meaningful movement indicator, I think it would cast an aspersion on this approach.

So the Suck is the draw-in of the navel.  We’ve talked about this before, and I believe it to be completely unacceptable.  The reliable approach to “reset” the core is the diaphragmatic breath and unyielding to IAP.  It is humanly impossible to deliver this quality of breath in the presence of a draw-in.

There is no disputing the TA activation of the draw-in or its role in spinal stability, but its isolated activation, which is not functional, at the expense of a valuable indicator of function, the circumferentially expanding breath, is not valuable.

The 1st Squeeze is of the Pelvic Floor.  This is interesting because the literature of training methods of each of the inner core muscles, the pelvic floor has the 2nd best results behind training the diaphragm.  I believe this to be the case as it is still in the sagital plane, and sagital stabilization appears to be the priority in repatterning.

I often try to explain the inner core/IAP as a function of a parachute.  This will be explained better on my DVD, but the very small part of the parachute is the DNF.  The large parachute itself is the diaphragm.  The strings in front are the TVA, in back the multifidus, and the jumper is the pelvic floor.  In a normal jump, the chute opens, and when there is enough air under the parachute, it tensions, and all the other components tension.

Now if you jumped with the chute already opened, the jumper would tension first, then the strings, then the chute.  This could still lead to a safe flight, and it was the jumper/pelvic floor that started the feedforward mechanism.

This is why I think there can be good results with the pelvic floor, but it is also dependent on the symmetry of the multifidus who is often discussed as an issue.  I believe that symmetry is attenuated when the diaphragm drives the mechanism given its lateral span of the body and more direct connections of the thorax.

This is why I think there can be good results with the pelvic floor, but it is also dependent on the symmetry of the multifidus who is often discussed as an issue.  I believe that symmetry is attenuated when the diaphragm drives the mechanism given its lateral span of the body and more direct connections of the thorax.

The 2nd Squeeze is of the Glutes.  This is a very underrated approach to acute back pain, and it is really quite simple.  In the presence of pain and/or dysfunction, there is a guide towards an anterior pelvic tilt and approximation of lumbar vertebrae.  This is form closure.  When you posteriorly pelvic tilt with an aggressive glute squeeze, the lumbar vertebrae traction and gap.  This is very good because I believe the zygopophyseal casules send signals to the brain to guide more towards force closure through the core.  I think this is an excellent choice to add in to remediate acute low back pain and begin to restore mobility.  If extension patterning has ERP, a glute squeeze can gap th/e impingement and allow for a successful extension technique.

Anteriorly, the posterior pelvis yields reciprocal inhibition of the hip flexors, which is another environmental keyhole into appropriate force closure through the spine.

So each of the components of Suck, Squeeze, and Squeeze have varying levels of merit.

I like the glute squeeze the best.  Selective activation of the pelvic floor has merit as well, and I have read Stuart McGill ask that we focus on holding in a fart rather than “squeezing the pelvic floor.”

Sucking in the navel is a very poor choice and should be avoided.  Again, it changes the punctum fixum of the diaphragm and inhibits its ability to descend during contraction.

If the volitional training gets you to a reflexive success, then this can work.  I am not just not sure it’s the best way to get it done.  Breathing techniques, for my money in developmental positions described by Vojta, get you a lot more mileage.


  • November 28, 2010

Leave a Reply 2 comments

Nuno Gusmao Reply

Hi Charlie,
As it was said, the strategy presented Suck, Squeeze and Squeeze, was to kickstart a core strengthening rehabilitation program. And what about afterwards, when core stability is restored, would you still advise the same strategy to start movement (in training)? I’m specially thinking about glutes squeeze during motion that takes the pelvis out of alignment.
Thank you
Nuno

Charlie Reply

Nuno – I think the butt squeeze is a good tool in anti-extension movements like pushups, planks, and overhead presses.
I don’t think this strategy has much call in other phases. I can see the sense of it, but I do not recommend it over breathing.

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