IAP vs Brace: Our Patients Need to Know the Difference

If you have taken a Dynamic Neuromuscular Stabilization (DNS) seminar lately you know the emphasis being placed on the difference between Intra Abdominal Pressure (IAP) and an abdominal brace.

The ability of the practitioner to differentiate and explain the dynamic nature of IAP may be the difference between successful at home exercise programs and non-compliant patients. Many clinicians leave a DNS course thinking they need to walk around with a maximal abdominal brace at all times and miss the distinction between an abdominal brace and IAP. Dr. Brett Winchester, DNS international instructor & cofounder of Gestalt Education, refers to the degree to which we are able to manipulate IAP, “The percentage of IAP depends completely on the load we are under. If I need to pick up the pen from my desk I need very little IAP. However, if I am trying to deadlift 500 pounds, I need maximal IAP to distribute force and protect my spine.”

IAP vs Brace Gestalt Education

So what is IAP?

DNS’s explanation of IAP involves co-activation of the entire abdominal wall including the thoracic and pelvic diaphragms. It should be noted that descension of the thoracic diaphragm drives this co-contraction of the abdominal musculature,  by creating outward pressure in a 360 degree fashion around the abdomen and in turn, the lumbar spine. The amount of IAP generated depends on the degree of initially eccentric, then isometric contraction of the abdominal wall along with amount of descension of the thoracic diaphragm. Teaching patients the adaptability of IAP allows them to better grasp the concept and apply it to their activities of daily life.

Open Scissor Gestalt Education

Issues with Abdominal Brace

Many times an abdominal brace is utilized in a non-ideal stereotype that involves massive concentric activity of the lumbar erectors or overdominance of the anterior abdominal muscles. This creates what Pavel Kolar, Founder of DNS, refers to as “Open-Scissor Position.” This non-ideal position of the rib cage and pelvis prevents efficient pressurization of the abdomen and in turn, non-ideal stabilization. This isn’t to say that an abdominal brace can’t be effective, it is simply less scalable for different loads when compared to IAP. However, the position of the ribcage and pelvis should remain neutral and the brace should come from activation of the thoracic diaphragm creating co-contraction of the abdominal wall musculature.

To summarize, Intra-Abdominal Pressure is dynamic and completely activity dependent. The more load/demand, the more IAP needed to stabilize the trunk. It can also be said that maximum IAP is equivalent to an abdominal brace, but the position of the ribcage in relation to the pelvis is essential in creating this maximal IAP in an ideal stereotype.

For more information about Dynamic Neuromuscular Stabilization visit: rehabps.com

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Dr. Taylor Premer

Dr. Taylor Premer is the Co-Founder of Gestalt Education and a Chiropractor at Winchester Spine & Sport in Troy, MO. Dr. Premer was the president of the Motion Palpation Club at CUKC where he fell in love with teaching and learning manual/rehabilitative skills. He and his fiance Taylor enjoy exploring new coffee shops and traveling to new destinations.