Transversus abdominis muscle
|Transverse abdominal muscle|
Muscles of the trunk.
|Latin||Musculus transversus abdominis|
|Origin||Iliac crest, inguinal ligament, thoracolumbar fascia, and costal cartilages 7-12|
|Insertion||Xiphoid process, linea alba, pubic crest and pecten pubis via conjoint tendon|
|Nerve||Thoracoabdominal nn. (T6-T11), Subcostal n. (T12), iliohypogastric nerve (L1), and ilioinguinal nerve (L1).|
|Actions||Compresses abdominal contents|
|Anatomical terms of muscle|
The transversus abdominis muscle (TVA), also known as the transverse abdominus, transversalis muscle and transverse abdominal muscle, is a muscle layer of the anterior and lateral (front and side) abdominal wall which is deep to (layered below) the internal oblique muscle. It is thought[by whom?] to be a significant component of the core.
The transversus abdominis, so called for the direction of its fibers, is the innermost of the flat muscles of the abdomen, being placed immediately beneath the internal oblique muscle.
The transversus abdominis arises as fleshy fibers, from the lateral third of the inguinal ligament, from the anterior three-fourths of the inner lip of the iliac crest, from the inner surfaces of the cartilages of the lower six ribs, interdigitating with the diaphragm, and from the lumbodorsal fascia. It ends anteriorly in a broad aponeurosis, the lower fibers of which curve inferomedially (medially and downward), and are inserted, together with those of the internal oblique muscle, into the crest of the pubis and pectineal line, forming the inguinal aponeurotic falx, also called the conjoint tendon. In layman's terms, the muscle ends in the middle line of a person's abdomen.  :248-250
Throughout the rest of its extent the aponeurosis passes horizontally to the middle line, and is inserted into the linea alba; its upper three-fourths lie behind the rectus muscle and blend with the posterior lamella of the aponeurosis of the internal oblique; its lower fourth is in front of the rectus abdominis.
The transversus abdominis helps to compress the ribs and viscera, providing thoracic and pelvic stability. This is explained further here. The transversus abdominis also helps pregnant women deliver their child.
Without a stable spine, one aided by proper contraction of the TVA, the nervous system fails to recruit the muscles in the extremities efficiently, and functional movements cannot be properly performed. The transversus abdominis and the segmental stabilizers (e.g. the multifidi) of the spine are designed to work in tandem.
While it is true that the TVA is vital to back and core health, the muscle also has the effect of pulling in what would otherwise be a protruding abdomen (hence its nickname, the “corset muscle”). Training the rectus abdominis muscles alone will not and can not give one a "flat" belly; this effect is achieved only through training the TVA. Thus to the extent that traditional abdominal exercises (e.g. crunches) or more advanced abdominal exercises tend to "flatten" the belly, this is owed to the tangential training of the TVA inherent in such exercises. Recently the transversus abdominis has become the subject of debate between kinesiologists, strength trainers, and physical therapists. The two positions on the muscle are (1) that the muscle is effective and capable of bracing the human core during extremely heavy lifts and (2) that it is not. Specifically, one recent systematic review has found that the baseline dysfunction of TVA cannot predict the clinical outcomes of low back pain.  Similarly, another systematic review has revealed that the changes in TVA function or morphology after different nonsurgical treatments are unrelated to the improvement of pain intensity or low back pain related-disability.  These findings have challenged the traditional emphasis of using TVA-targeted intervention to treat low back pain.
The most well known method of strengthening the TVA is the vacuum exercise. The TVA also (involuntarily) contracts during many lifts; it is the body's natural weight-lifting belt, stabilizing the spine and pelvis during lifting movements. It has been estimated that the contraction of the TVA and other muscles reduces the vertical pressure on the intervertebral discs by as much as 40%. Failure to engage the TVA during higher intensity lifts is dangerous and encourages injury to the spine. The TVA acts as a girdle or corset by creating hoop tension around the midsection.
- Drake, Richard L.; Vogl, Wayne; Tibbitts, Adam W.M. Mitchell ; illustrations by Richard; Richardson, Paul (2005). Gray's anatomy for students (Pbk. ed.). Philadelphia: Elsevier/Churchill Livingstone. ISBN 978-0-443-06612-2.
- Aruin S.A., Latash M.L. Directional specificity of postural muscles in feed-forward postural reactions during fast voluntary arm movements. Exp Brain Res (1995) 103:323-332.
- Dart R.A. "The Double-Spiral Arrangement Of The Voluntary Musculature In The Human Body". Surgeons' Hall Journal Vol. 10, No. 2. March 1947.
- Wong A.Y., Parent E.C, Funabashi M, Stanton T.R., Kawchuk G.N. Do various baseline characteristics of transversus abdominis and lumbar multifidus predict clinical outcomes in nonspecific low back pain? A systematic review. Pain (2013) 154:2589-2602.
- Wong A.Y., Parent E.C., Funabashi M, Kawchuk G.N. Do changes in transversus abdominis and lumbar multifidus during conservative treatment explain changes in clinical outcomes related to non-specific low back pain? A systematic review. J Pain (2013) Oct 31 pii: S1526-5900(13)01317-5.
- Hodges P.W., Richardson C.A., Contraction of the Abdominal Muscles Associated With Movement of the Lower Limb. Physical Therapy. Vol. 77 No. 2 February 1997.
- 718274638 at GPnotebook
- Origin, insertion and nerve supply of the muscle at Loyola University Chicago Stritch School of Medicine
- Anatomy figure: 35:07-04 at Human Anatomy Online, SUNY Downstate Medical Center - "Incision and reflection of the internal abdominal oblique muscle."
- Anatomy photo:35:17-0100 at the SUNY Downstate Medical Center - "Anterior Abdominal Wall: The Transversus Abdominis Muscle"
- Anatomy figure: 40:07-06 at Human Anatomy Online, SUNY Downstate Medical Center - "Muscles and nerves of the posterior abdominal wall."
- SUNY Anatomy Image 7183
- SUNY Anatomy Image 7194
- SUNY Anatomy Image 7209
- SUNY Anatomy Image 7311
- Exercising the Transversus Abdominis
- TVA vs. Weight Belt Debate