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Integrated functional anatomy of the external obliques. Attachments, nerves, palpation, joint actions, arthrokinematics, fascia, triggerpoints, and behavior in postural dysfunction. Common exercises and stretches for the core and oblique muscles.

External Obliques

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Brookbush Institute

I have almost completed my CPT certification and am half-way through the Human Movement certification to inform my massage practice. The different modalities of reading, watching audiovisual materials, and attending live or recorded webinars have been important to my learning style and for review.

Brookbush Institute has the most detailed, specific and effective tools for online learning for movement and/or bodywork professionals. I love the combination of the videos as well as the text available online.

I recently completed the CPT course. It was demanding yet practical. I would highly recommend it for anyone wanting an education about human movement.

I have my personal trainer certificate through here and am almost finished my human movement specialist certification. Overall, the education that Brookbush has packaged together for clinicians and trainers is invaluable. I am a physio assistant so coming from more of a rehab background I appreciate that this education has been beneficial both as a trainer and in a rehab setting. I love that I have been able to do all learning at my own pace and able to work around my schedule. Thank you for setting up this platform! Highly recommend :)

I have been a massage therapist for 10 yrs and I feel like all the “pieces” I’ve learned throughout the yrs have been put into place and can see the full picture. I am also a member to tons of great content since I love to learn! I plan to get my CPT through them as well.

I have been following Brent Brookbush for nearly a decade- back when I was a personal Trainer and now as a Physical Therapist. BBI is an incredible resource for any movement nerds and corrective exercise specialists! The information is thorough with multiple real world applications. I am looking forward to an in-person Manual Therapist course the second they do one a little bit closer to Virginia ;)

I have taken both the Human Movement Specialist and Certified Personal Trainer certificate programs and have found the value in understanding the how and ways the body moves and functions and from evidence, non-biased, outcome, conceptual, theoretical, and practical approach to helping my clients/patients look better, feel better, and move better.

Over the last years I've returned time and again to Brookbush Institute for stellar coursework as I've worked toward a Human Movement Specialist certification. (I'm currently ACE CPT, and in training with Anatomy Trains for Structural Integration Manual Therapy.) Every Brookbush Institute module is fantastic and each one includes detailed informational videos, written descriptions of how to-do, and, more importantly, why to-do!

I am a 70 yr old chiropractor and no other healthcare provider was able to come up with an exercise protocol particular to my structural and balances and muscle deficits and keep me in the game. And as for continuing education on human skeletal movement, the website is phenomenal full of great exercises for particular mechanical dysfunction.

The H.M.S. is the most valuable certificate I have earned and was a fraction of the the cost of my others. Define the best bang for your buck!

Brookbush is the most efficient Personal Training Certification I have ever come across. All the lessons are well thought out and very straight to the point.

I am getting my Master's degree in Kinesiology, and I would like to say that I have benefited greatly from the rich, comprehensive, well-documented scientific content of Brookbush Institute that links theory to practical applications. Proudly I've got my CPT certificate, and I am on my way to get my HMS certificate.

Having courses count towards different certifications makes it so users can transition seamlessly from one certification to another. In my case, going from earning the BI CPT to earning the BI HMS was an easy decision and I am proud to have earned both certifications. I have also had the pleasure of going to a Live HMS workshop that was well taught by Instructor Boettcher and that was excellent to see how the methods and techniques are implemented.



I have been a member of BBI for years and every course I have taken has been incredibly informative. I learn more from these courses than I do at local CEU courses for my PTA license. I also earned my CPT and HMS certifications through the platform. It was so convenient and the content was top notch! Forever member.

We learn principles in academia, we learn cool new modalities via whatever specialty certification, but BBI really concentrates on the nuances of passive treatment and they do a fantastic job. The format in which BBI instructs soft tissue specialists (DPTs, Chiros, ATs) like myself feels like almost like an apprenticeship. You get a thoroughly detailed explanation of the “why’s”, and a visual comprehension of how to apply. Personally, I believe application is where the good and the great are distinguished.

Brookbush has been incredibly helpful since I was in massage school and now as I’m in my career! I run my own practice and it gives me the resources I need to not only improve what I already know, but also help me navigate better, more efficient ways of treatment.

Totally loving the convenience and affordability of this program with my crazy lifestyle! I feel like I am getting a quality education without a massive cost! My favorite part is the videos I can watch in the courses. I learn so much better that way. Once I really spent more time on the site, I figured out how to maneuver around a lot better! I enjoy the sense of humor, as well as the easy explanation, and short tests. And if I am really tired, I can have the computer read me the lessons. 😁

Challenging concepts are explained in very understandable terms without dumbing down the material, and I find this program to be superior in quality to other personal training programs.

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This course describes the anatomy and integrated function of the external oblique muscles (a.k.a. the obliques, external abdominal oblique, oblique muscle). The external oblique muscles originate on ribs 5-12 and insert into the abdominal fascia, linea alba, iliac crest, and inguinal ligament. This is the most superficial muscle on the lateral abdominal wall; the internal obliques and transverse abdominis lay beneath this muscle. Research is not available on the fiber type composition of the oblique muscles; however, it may be reasonable to suggest that the proportion of type I muscle fibers and type II muscle fibers is similar to the rectus abdominis and fairly even. The external oblique muscles cross the torso and pelvis, influencing motion of the pelvis, thoracic spine, lumbar spine, and ribs. The obliques are the primary rotators of the lumbar spine, will contribute to flexion and lateral flexion of the spine, as well as a posterior pelvic tilt, a lateral pelvic tilt, and increasing intra-abdominal pressure and spine/pelvis stability. This course also describes the role of the external obliques in facet joint arthrokinematics, fascial integration (integration of abdominal wall muscles), postural dysfunction, and subsystem integration. Sports medicine professionals (personal trainers, fitness instructors, physical therapists, massage therapists, chiropractors, occupational therapists, athletic trainers, etc.) must be aware of the integrated function of the oblique muscles for the detailed analysis of human movement, and the development of sophisticated exercise programs and therapeutic (rehabilitation) interventions. Further, this course is essential knowledge for future courses discussing injury prevention and physical rehabilitation/physical therapy (e.g. “weak core,” abdominal wall pain, diastasis recti, hip flexor strain, sports hernias, groin injury, anterior pubic ligament injury, low back pain), the synergistic function of the external obliques (e.g. increased intra-abdominal pressure with the transverse abdominis, internal obliques, rectus abdominis, diaphragm, and pelvic floor muscles) and oblique muscle specific exercises and techniques for enhancing sports performance (e.g. ensuring ideal oblique length for optimal core stability, strength, power, hypertrophy, etc.).

Brookbush Institute’s most recommended techniques for the External Obliques (see videos below):

The attachments of the external oblique muscles

 Course Description: External Oblique

Introduction

 - early 15c., from Middle French externe or directly from Latin externus "outside, outward" (

 - early 15c., from Middle French oblique (14c.) and directly from Latin obliquus "slanting, sidelong, indirect," from ob "against" (see 

 (n.1)). As a type of muscle, in reference to the axis of the body, 1610s (adj.), 1800 (n.). (

"the most external muscle that runs slanting"

The attachment of the external oblique muscles

External Obliques - By Henry Vandyke Carter - Henry Gray (1918) Anatomy of the Human Body (Image: Bartleby.com: Gray's Anatomy, Plate 392, Public Domain, https://commons.wikimedia.org/w/index.php?curid=287550)

Attachment and Innervation

Attachments & Innervations: External Obliques

Relative Location

Attachment of the external obliques on the pelvis

Where are the External Obliques Located?

Palpation

The attachment of the oblique muscles on the posterior side of the body

Palpating the External Obliques

Introduction to the External Obliques

Actions

 Flexion, contralateral rotation (prime mover), ipsilateral flexion

The external obliques behave like prime movers. That is, they are often recruited unilaterally, in a direction-specific manner, activity may not increase during low-intensity functional tasks, only increasing in activity when needed to accommodate larger external loads (22, 33) (similar to the 

). They do not exhibit the behavior associated with stabilizing muscles like the 

 and transverse abdominis; including "bilateral co-activation" during motion regardless of direction or load (19, 32).

 May contribute to bracing during heavy lifting.

Stabilization of the lumbar spine, thorax, sacroiliac joint, and pubic symphysis during "bracing".

Eccentric deceleration of ipsilateral rotation of the spine (33).

This has been referred to as "anti-rotation", and may be the most important function of the external oblique. The ability to decelerate and stabilize the spine against rotation, and/or rotation and extension forces is paramount to preventing injury.

Eccentric deceleration of extension of the spine.

Eccentric deceleration of contralateral flexion of the spine.

Eccentric deceleration of posterior tilting, sacral extension, and sacroiliac counter-nutation.

The external obliques are the primary rotators of the spine, assisted by synergists including the contralateral 

, and ipsilateral multifidus (1-2, 4-5, 15-16, 19-21).

Lumbar Flexion and Posterior Pelvic Tilting

 is the prime mover of lumbar flexion and posteriorly tilting of the pelvis (1, 4-5, 15-18). The external obliques are synergists along with the 

Lateral Flexion of the Spine and Lateral Tilt of the Pelvis

The external obliques may be the prime mover of lateral flexion of the spine and lateral tilting of the pelvis, assisted by synergists including the quadratus lumborum, 

Activity of the external obliques is not necessary to increase intra-abdominal pressure (drawing-in) (35); this is likely attributable to a lack of attachment to the thoracolumbar fascia (36). However, the external obliques may become an important stabilizer when the body resists significant external load (2, 22). The use of global trunk musculature to stabilize the spine is often termed "bracing", and includes isometric contractions from all stabilizers and prime movers of the spine.

During forceful exhalation, the external obliques may contribute to increasing intra-abdominal pressure along with the transverse abdominis, 

; and further, aid in depressing the ribs and costocartilage aiding in decreasing intrathoracic space (1-2, 15-18). The external oblique's contribution to forceful expiration may also imply that these muscles are part of a motor synergy that includes the posterior serratus inferior and the external intercostals.

A cross-sectional view of the abdominal core muscles of the trunk

By Henry Vandyke Carter - Henry Gray (1918) Anatomy of the Human Body (See "Book" section below) Bartleby.com: Gray's Anatomy, Plate 545, Public Domain, https://commons.wikimedia.org/w/index.php?curid=541410

Arthrokinematics

The attachment points of the obliques on the spine

External Oblique Actions

Fascial Integration

The superficial and deep layers of the external oblique fascia continue to become the superficial layers of the rectus sheath coursing over the two 

 muscles (5, 9). All layers of the rectus sheath converge at the linea alba and continue into an identical fascial sheath on the opposite side (5). The transverse inscriptions that run horizontally through the 

 are also continuations of the oblique fascia (37). In addition, the caudal fascia of the sternal fibers of the 

 are continuous with the cranial portion of the superficial fascia of the 

) (2, 6, 9, 38-39). It is unknown if the lateral edge of the external oblique fascia continues to invest in the fascia of the 

, serratus posterior inferior, and/or the external intercostals. However, research investigating the existence of a myofascial synergy that included the external obliques, serratus posterior inferior and the external intercostals may have implications related to breathing and forceful exhalation.

Image of the fascial system of the body connecting muscles

Subsystems

An image of the rectus sheath 

Behavior in Postural Dysfunction

, which is a behavior often exhibited by muscles acting as 

. Over-active synergists are usually addressed with release techniques but not lengthening techniques; release techniques for the external obliques are generally ineffective. This is likely due to the external obliques rarely presenting with active trigger points, the difficulty in attempting release techniques on a muscle that has nothing to press the muscle into (e.g. bone), and pincer release being difficult or impractical due to the closely packed layers of fascia and abdominal muscle. The external obliques do play a significant role in many of the recommended core strength and subsystem integration techniques.

 may result in the external obliques exhibiting altered behavior relative to changes in core subsystem recruitment. In those exhibiting signs of 

 may become over-active and synergistically dominant for relative inhibition of the 

. The altered activity of these subsystems, in particular the inhibition of the 

, leads to reliance on the prime movers for stability, including the 

. This can be illustrated using the Overhead Squat Assessment (OHSA). When an individual with 

 performs the OHSA with hands overhead, the 

 forward or adduct, and the spine may stay relatively neutral as the over-activity of the anterior trunk muscles are balanced by over-activity of the 

. If the OHSA is performed again with hands on the pelvis, the individual will usually exhibit signs of lumbar flexion or an 

 is no longer taut and resisting activity of the 

Lumbo Pelvic Hip Complex Dysfunction (LPHCD)

 and low back pain are correlated with external oblique activity that resembles the altered activity of the 

. Individuals with low back pain, exhibit less external oblique activity in sway standing (24), more activity (bilaterally) to stabilize the spine (bracing) during functional tasks, and are more active during exercises requiring more stability (ex. 

) (24, 44-45). Further, studies demonstrate that low back pain and fatigue increase external oblique activity, relative to a decrease in 

 and transverse abdominis activity (27-30, 43). These changes in behavior suggest the external obliques become over-active synergists (like the 

) to compensate for inhibition of the transverse abdominis and 

 may result in the external obliques exhibiting more over-activity on the side of sacroiliac joint stiffness. This behavior may be attributed to the relative posterior tilt of the pelvis on the stiff side, or rotation of the lumbar spine in the opposite direction to align the shoulder girdle despite pelvic asymmetry. Rotation of the spine is predominately controlled by the global core musculature, including the 

, external obliques, and psoas (19, 22, 32-33); however, the activity of the external obliques is likely best addressed by addressing sacroiliac joint, lumbar spine and pubic symphysis stiffness, and activating under-active muscles. Release techniques for the external obliques are not particularly effective.

, altered behavior of the external obliques may result relative to changes in core subsystem recruitment. Again, the 

 this altered behavior contributes to, or is correlated with an 

: Long/Over-active on side opposite shift

Brookbush/Grieve (51) Sacroiliac Joint Dysfunction Movement Assessment Cluster:

"Top tier exam" used to identify asymmetry and imply further SIJ assessment

Unilateral Pelvic Tilt: Posterior tilted innominate correlated with stiffer side

Costovertebral and costotransverse joint pain

Trigger Points and Referral Pain Patterns: 

Active trigger points in the external and 

 have the potential for referral pain patterns that extend into the chest, down toward the pelvis, obliquely across the 

, and/or lower abdominal trigger points can refer pain to the groin and testicles (2). Further, active trigger points in the external obliques can produce symptoms similar to heartburn, abdominal hernia, and deep epigastric pain (2). These visceral-like symptoms can easily confound or be correlated with visceral dysfunction (2, 46-49). Careful assessment and referral to a physician should be considered when a clear delineation cannot be made between visceral dysfunction and trigger points in the abdomen.

As mentioned above, release techniques for the external obliques are generally ineffective. This is likely due to the external obliques rarely presenting with active trigger points, the difficulty in attempting release techniques on a muscle that has nothing to press the muscle into (e.g. bone), and pincer release being difficult or impractical due to the closely packed layers of fascia and abdominal muscle.

The external obliques can be examined for trigger points using the palpation techniques described above, with the intent of identifying acute points of increased tissue density, acute points of pain pressure sensitivity, or points that result in referral pain and replication of the patient's symptoms.

Postural Dysfunction and the External Obliques

Techniques and Ending Info

Static Standing Chop from Chop Progressions

Reactive Plank (Modified Mountain Climber) from Plank Progressions

Exercises and Techniques for the External Obliques

Peterson Kendall, F., Kendall McCreary, E., Geise Provance, P., McIntyre Rodgers, M., & Anthony Romani, W. (2005). 

Muscles: Testing and Function with Posture and Pain

 (5th ed.). Baltimore, MD: Lippincott Williams & Wilkins.

Donnelly, J. M., Fernández-de-las-Peñas, C., Finnegan, M., & Freeman, J. L. (2019). 

Travell, Simons & Simons' Myofascial Pain and Dysfunction: The Trigger Point Manual

 (3rd ed.). Philadelphia, PA: Wolters Kluwer.

Diagnosis and Treatment of Movement Impairment Syndromes

Hollinshead's Functional Anatomy of the Limbs and Back

 (9th ed.). St. Louis, MO: Saunders/Elsevier.

Kinesiology of the Musculoskeletal System

Sanchez, E. R., Sanchez, R., & Moliver, C. (2014). Anatomic relationship of the pectoralis major and minor muscles: a cadaveric study. 

Brown, S. H., & McGill, S. M. (2009). Transmission of muscularly generated force and stiffness between layers of the rat abdominal wall. 

Folkow, B., Gelin, L. E., Lindell, S. E., Stenberg, K., & Thoren, O. (1962). Cardiovascular reactions during abdominal surgery. 

Vleeming, A., Mooney, V., & Stoeckart, R. (2007). 

Movement, stability & lumbopelvic pain: integration of research and therapy

 (2nd ed.). Edinburgh: Churchill Livingstone Elsevier.

Clinical anatomy of the spine, spinal cord, and Ans

Grays Anatomy: The Anatomical Basis of Clinical Practice

Allan, P. L., Baxter, G. M., & Weston, M. J. (2011). 

 (3rd ed.). Edinburgh: Churchill Livingstone.

Richardson, C., Hodges, P. W., & Hides, J. (2004). 

Therapeutic Exercise for Lumbopelvic Stabilization: a Motor Control Approach for the Treatment and Prevention of Low Back Pain

 (2nd ed.). Edinburgh: Churchill Livingstone.

Touch & movement: Palpation and kinesiology for massage therapists

Levangie, P. K., Norkin, C. C., & Lewek, M. D. (2019). 

Joint Structure & Function: A Comprehensive Analysis

 (6th ed.). Philadelphia, PA: F. A. Davis.

McGill, S. M. (1992). A myoelectrically based dynamic three-dimensional model to predict loads on lumbar spine tissues during lateral bending. 

McGill, S. M. (1996). A revised anatomical model of the abdominal musculature for torso flexion efforts. 

De, A. T., & Estenne, M. (1988). Functional anatomy of the respiratory muscles. 

Andersson, E. A., Grundström, H., & Thorstensson, A. (2002). Diverging intramuscular activity patterns in back and abdominal muscles during trunk rotation. 

McGill, S. M. (1991). Kinetic potential of the lumbar trunk musculature about three orthogonal orthopaedic axes in extreme postures. 

McGill, S. M. (1991). Electromyographic activity of the abdominal and low back musculature during the generation of isometric and dynamic axial trunk torque: implications for lumbar mechanics. 

Cholewicki, J., Panjabi, M. M., & Khachatryan, A. (1997). Stabilizing function of trunk flexor‐extensor muscles around a neutral spine posture. 

Hodges, P. W., & Richardson, C. A. (1997). Contraction of the abdominal muscles associated with movement of the lower limb. 

O’sullivan, P. B., Grahamslaw, K. M., Kendell, M., Lapenskie, S. C., Möller, N. E., & Richards, K. V. (2002). The effect of different standing and sitting postures on trunk muscle activity in a pain-free population. 

Fujitani, R., Jiromaru, T., Kida, N., & Nomura, T. (2017). Effect of standing postural deviations on trunk and hip muscle activity. 

Ng, J. K. F., Richardson, C. A., Parnianpour, M., & Kippers, V. (2002). EMG activity of trunk muscles and torque output during isometric axial rotation exertion: a comparison between back pain patients and matched controls. 

Ng, J. K. F., Richardson, C. A., Parnianpour, M., & Kippers, V. (2002). Fatigue-related changes in torque output and electromyographic parameters of trunk muscles during isometric axial rotation exertion: an investigation in patients with back pain and in healthy subjects. 

Cholewicki, J., Silfies, S., Shah, R., Greene, H., Reeves, N. Alvi, K., Goldberg, B. (2005). Delayed trunk muscle reflex responses increase the risk of low back injuries. Spine. 30(23), 2614-2620

Larsen, L. H., Hirata, R. P., & Graven-Nielsen, T. (2016). Effects of unilateral and bilateral experimental low-back pain on trunk muscle activity during stair walking in healthy and recurrent low-back pain patients. In 

O'Sullivan, P., Twomey, L., Allison, G., Sinclair, J., Miller, K., & Knox, J. (1997). Altered patterns of abdominal muscle activation in patients with chronic low back pain. 

Rizk, N. N. (1980). A new description of the anterior abdominal wall in man and mammals. 

Danneels, L. A., Vanderstraeten, G. G., Cambier, D. C., Witvrouw, E. E., Stevens, V. K., & De Cuyper, H. J. (2001). A functional subdivision of hip, abdominal, and back muscles during asymmetric lifting. 

Hodges, P., Cresswell, A., & Thorstensson, A. (1999). Preparatory trunk motion accompanies rapid upper limb movement. 

Drysdale, C. L., Earl, J. E., & Hertel, J. (2004). Surface electromyographic activity of the abdominal muscles during pelvic-tilt and abdominal-hollowing exercises. 

Cresswell, A. G., & Thorstensson, A. (1989). The role of the abdominal musculature in the elevation of the intra-abdominal pressure during specified tasks. 

Bogduk, N., & Macintosh, J. E. (1984). The applied anatomy of the thoracolumbar fascia. 

Willard, F. H., Vleeming, A., Schuenke, M. D., Danneels, L., & Schleip, R. (2012). The thoracolumbar fascia: anatomy, function and clinical considerations. 

Porterfield, J., & DeRosa, C. Mechanical Low Back Pain: Perspectives in Functional Anatomy. 1998.

Juker, D., McGill, S., Kropf, P., & Steffen, T. (1998). Quantitative intramuscular myoelectric activity of lumbar portions of psoas and the abdominal wall during a wide variety of tasks. 

Medicine and science in sports and exercise

. White Rock, British Columbia, Canada: Diane G. Lee Physiotherapist Corporation.

Lee, D. G. (2015). Biomechanics of the thorax–research evidence and clinical expertise. 

Richardson C, Jull G, Hodges P, Hides J. Therapeutic Exercise for Spinal Segmental Stabilization in Low Back Pain: Scientific Basis and Clinical Approach. Edinburgh: Churchill Livingstone: 1999.

Granata, K. P., Slota, G. P., & Wilson, S. E. (2004). Influence of fatigue in neuromuscular control of spinal stability. 

External Obliques

Related Courses:

Course Description: External Oblique

Introduction to the External Obliques
3 Sub Sections

External Oblique Actions
1 Sub Section

Fascial Integration
1 Sub Section

Postural Dysfunction and the External Obliques

Exercises and Techniques for the External Obliques
2 Sub Sections

Bibliography

Related Courses:

Comments

Guest

External Obliques

Related Courses:

Course Description: External Oblique

Introduction to the External Obliques3 Sub Sections

External Oblique Actions1 Sub Section

Fascial Integration1 Sub Section

Postural Dysfunction and the External Obliques

Exercises and Techniques for the External Obliques2 Sub Sections

Bibliography

Related Courses:

Comments

Guest

Introduction to the External Obliques
3 Sub Sections

External Oblique Actions
1 Sub Section

Fascial Integration
1 Sub Section

Exercises and Techniques for the External Obliques
2 Sub Sections