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Focus Attention First

Tips for Cueing Exercise Effectively

One of the first things I say when doctors and trainers ask me to explain what makes StrongPosture® exercise training unique is Attentional Focus.

The importance of connecting people to their body – accurately and correctly – was supported by a new study. And though not intended by the researchers, it also suggests some interesting conjectures on the importance of looking at the whole person’s pattern of motion.

Researchers investigated spinal stabilization exercise for low back pain rehab and used diagnostic parasagittal ultrasound (US) imaging to observe lumbar multifidus muscle contraction in response to various verbal instructions. The effect of three commonly used phrases to engage deep core muscles were compared in low back patients and normal controls:

  1. Swell the belly underneath the transducer
  2. Draw your belly button in towards your spinal column, and
  3. Think about tilting your pelvis but without really doing

Their conclusion:

“The results of the study suggest that both groups responded similarly to the three verbal instructions. Verbal instructions may increase lumbar multifidus muscle thickness by different amounts at L4-5, but by the same amount at L5-S1.”

Dr. Weiniger’s Observation:
Multifidus is segmentally innnervated. In other words, it’s a muscle that goes between spinal segments, AND it’s controlled by the motor nerve leaving from that spinal level.

So, in asymptomatic people, when the researchers measured the response of the same cue, there was no difference in multifidus function at one level, but different contraction one level up with “increase(d) lumbar multifidus muscle thickness by different amounts at L4-5, but by the same amount at L5-S1.”

People cannot CONSCIOUSLY or INTENTIONALLY isolate multifidus function of a single level (with the possible exception of yoga masters). And body motion is a whole-body phenomenon. If you had to consciously control each muscle to walk, you couldn’t take a single step.  Therefore…

Dr. Weiniger’s Conclusion & Conjecture: The cues they used affected one level more than the other in low back patients. Which makes me wonder what cues could affect other levels more?

Muscle stabilization is affected by how you say it, and how it is received by different people. And this is why it’s so important to assess accurately the subtle responses of an individual’s motion to a cue. Because even though the words are the same, errors in how they perceive their body means they will respond differently. Such errors in perception and/or motor control are at the base of aberrant motion patterns and the associated pain syndromes – which is why systematically focusing attention is so powerful in rehab, as well as performance.



Wang-Price, S., Zafereo, J., Brizzolara, K., Sokolowski, L., & Turner, D. (2015). Effects of different verbal instructions on change of lumbar multifidus muscle thickness in asymptomatic adults and in patients with low back pain. Journal of Manual and Manipulative Therapy. Retrieved from


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