The role of intra-abdominal pressure in spinal unloading.

Previous studies on how an increase in intra-abdominal pressure (IAP) effects the loading of the lumbar spine during back extension show diverging results. From a critical review of the literature we deduce a simplified, but consistent, model of the mechanisms involved in IAP-induced unloading of the lumbar spine. The model is then expanded by explicitly incorporating equilibrium equations for the pressurised abdomen and the abdominal wall. It is shown that the unloading effect of IAP can be viewed as that of a pressurised column of fixed cross-sectional area, between the rib cage and pelvis. Different abdominal forms are examined and a form with zero longitudinal curvature is found to have some important mechanical benefits for the generation of IAP-induced alleviation of compressive loading of the lumbar spine.