Pressure Biofeedback: The Secret Tool for Core Strength and Stability

Pressure Biofeedback: The Secret Tool for Core Strength and Stability

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By Phil Alwitt


Flex your bicep. Go ahead and flex it really hard.

By flexing your bicep you just asked your brain to make the connection between the thought of flexing your bicep and activating the muscle. But not all our muscles are so easy to control.

Consider the transverse abdominis (TVA) muscle for instance. It’s an incredibly important muscle for core stability. Without it you would not be able to stand erect and the downward pressures would be absorbed directly by your spine. Hiding behind the well-publicized 6-pack, a healthy and strong TVA is an absolutely critical muscle.

Now flex your TVA.

For most people this is more easily said than done. Unless you are already familiar with how to activate your TVA, you may have no idea how to start. If that’s the case, your brain has not yet made the connection between wanting to activate your TVA and actually doing it. And you can’t actively strengthen your TVA until you make the connection between your brain and the muscle.

So how do you start?

Physical therapists discovered a solution over two decades ago that is now a valuable tool for fitness trainers too. It’s called pressure biofeedback. But before discussing pressure biofeedback, let’s define biofeedback.

Biofeedback uses an intermediary device to enable a conscious connection between the brain and a subsequent action. Some common biofeedback devices include electromyography (EMG) biofeedback to measure muscle tension as it changes to help relieve muscle spasms and electroencephalography (EEG) to measure brain wave activity to resolve headaches.

A simple form of biofeedback is a common oral thermometer. It is difficult to know your exact temperature without a thermometer. Once you take your temperature, the reading on the thermometer enables you to take action such as taking medicine or not. The thermometer is a biofeedback device to guide you to make a conscious action.

Pressure biofeedback devices are very simple analog tools that consist of an air pillow and a sensitive pressure gauge similar to a blood pressure gauge. Pressure biofeedback merely uses a change in pressure as visually indicated on the gauge to identify and monitor TVA muscle activation, a body function otherwise difficult to target.

Pressure biofeedback device


Pressure biofeedback was popularized by Professors Richardson and Jull in 1993 while in the Department of Physiotherapy at the University of Queensland, Australia. It was later incorporated by Paul Chek into the Check Institute programs. Many studies have since been published validating the efficacy of pressure biofeedback to evaluate, activate and strengthen the TVA.

Richardson and Jull discovered that when laying supine with knees bent and the air pillow under the lumbar spine, proper activation of the TVA was identified when a target was reached. When the TVA muscle is not active, the pressure will not increase appropriately. (A similar test is often performed when laying prone as well.)

By receiving the visual feedback from the gauge, the brain makes the connection between wanting to activate the muscle and actually activating it. It then becomes second nature. At that point the pressure biofeedback device is used to strengthen the TVA using progressively more difficult exercises. Watching the gauge and getting the visual feedback during these exercises enhances the efficacy of the exercise. The resulting increase in strength provides a great base for all fitness activities from weightlifting to running. It’s this base that makes pressure biofeedback an important tool for fitness trainers of all types.

After the brain and the TVA muscle make the connection, continued use of the pressure biofeedback device is recommended. Even though the TVA muscle is active at this point, proper strengthening is enhanced by using the visual cues from the gauge to coach proper form. It is found that when the device is not used, most people quickly revert to using compensatory muscles.

Considering the importance of the TVA and the difficulty of consciously targeting the muscle, pressure biofeedback is an ideal tool. By using the gauge to coach proper TVA activation, clients will be able to workout with less chance of injury. Since pressure biofeedback devices are small and portable and require just a few minutes of use a day, they are ideal for clients to use at home in preparation for their training and more vigorous fitness routine.

Low impact TVA strengthening exercise using pressure biofeedback

More intense TVA/lower abdominal exercise by focusing on pressure biofeedback gauge

Now that you know what pressure biofeedback is and a little bit about how it works, I’ll tell you a success story as a result of using pressure biofeedback. It happens to be mine.

I used to be very active; biking, windsurfing, skiing, running or ultimate frisbee almost every day. That all changed when I was 31 and herniated my first disc. Fast forward 20 years. I am now 51 with three herniated discs, spondylosis and I’m two inches shorter due to disc degeneration. Needless to say, my active lifestyle took a big shift.

I saw all kinds of Eastern and Western practitioners over the years. I stretched and worked my core every morning without fail. But my back still ached and I was beaten down with back spasms for 2-3 months every year.

Then, in 2015 I visited a physical therapist when in the midst of a back spasm. She introduced me to two things: first, she introduced me to my TVA, a muscle that after twenty years of visiting practitioners I knew little about. Then she pulled out a pressure biofeedback device. It turned out that my TVA was not active and I did not have good control of the muscle. My twenty years of plank and crunches and core exercises were not properly building my core.

Within 10 minutes my brain connected with my TVA.

I started to use the device daily. After a few days I felt sturdy and more upright. Soon I was mountain biking without taking ibuprofen. I got back into windsurfing. Just 6 months later I hiked Half Dome in Yosemite, a feat I would not have previously attempted for fear that my back would have gone out in the midst of the trek. But best of all, I have not had a single back spasm since I started—none!

Pressure biofeedback completely changed my life. Without it I would never have made the conscious connection between my brain and the transverse abdominis muscle. It enabled me to get back to the activities I love and, as I later learned, has done the same for thousands of other people too. And as an advocate of pressure biofeedback I have partnered with hundreds of fitness trainers, physical therapists and fellow weekend warriors to spread the word that the TVA is king of the core and pressure biofeedback is a key to a healthy TVA.

Check out AAHF specialty CEC programs to learn more about exercise and nutrition for special populations!


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