Alter Physio & Acupuncture

Introduction

Core training has long been emphasized in fitness, sports performance, and rehabilitation. Among these techniques, the “draw-in” method is widely recognized as a foundational approach to enhancing core stability. This technique, which involves contracting the transverse abdominis and drawing the abdomen inward to stabilize the core, may seem effective at first glance. However, I would like to sound a warning against this traditional thinking. The draw-in method can restrict core movement and breathing, ultimately reducing overall performance. If you’ve been doing core exercises at other clinics or studios without seeing lasting improvement, it may be time to reconsider the approach entirely.

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Topic 1: The Draw-in Method’s Issues

The traditional draw-in method claims to stabilize the core by contracting the transverse abdominis and pulling the abdomen inward. However, there are several well-documented problems with this approach. First, drawing in the abdomen does not sufficiently increase intra-abdominal pressure. Intra-abdominal pressure is a critical element for stabilizing the spine and pelvis by applying pressure inside the abdominal cavity. However, with the draw-in method, the volume of the abdomen decreases, causing a drop in pressure, making it difficult to maintain adequate intra-abdominal pressure.

Moreover, clinicians and researchers consistently report that performing the draw-in method tends to raise the shoulders. This is because tightening the abdomen restricts diaphragmatic movement, forcing the body to rely on chest breathing. Chest breathing, which underutilizes the diaphragm, places excessive strain on the shoulder and neck muscles. As a result, this can increase tension in these areas, leading to shoulder stiffness and posture deterioration. Breathing and core stability are deeply interconnected; without proper breathing mechanics, core stability will be insufficient, and overall movement performance will decline.

Additionally, the draw-in method often overactivates surface muscles like the rectus abdominis, which creates another problem. Surface muscles should primarily be used for generating power, but when they are recruited for stability, movements become rigid, and flexibility and fluidity suffer. In sports or everyday movements that require speed and power, this can lead to inefficient motion and an increased risk of injury.

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Topic 2: The Relationship Between Diaphragmatic Breathing and Intra-abdominal Pressure

In contrast, an approach that incorporates diaphragmatic breathing to expand the lower abdomen and increase intra-abdominal pressure is a highly effective method for improving core stability. With diaphragmatic breathing, the diaphragm moves downward as you inhale, causing the lower abdomen to expand and apply pressure inside the abdominal cavity. This increased intra-abdominal pressure supports the spine and pelvis from within, stabilizing the core.

As intra-abdominal pressure rises through diaphragmatic breathing, the spine and pelvis are better supported, allowing the core to maintain stability against external loads and movements. Moreover, as deep breathing activates the diaphragm, the lungs can take in more air, improving oxygen delivery to the entire body — a crucial factor for enhancing performance in sports and training. This is one of the reasons diaphragmatic breathing retraining is trusted by international patients and recommended by expats seeking evidence-based physiotherapy in Amsterdam.

A growing body of scientific evidence continues to confirm the importance of increasing intra-abdominal pressure through diaphragmatic breathing. Research has demonstrated that effective diaphragmatic function through diaphragmatic breathing reduces the load on the lumbar spine and pelvis, lowering the risk of injury (Danneels et al., 2001). More recent reviews published through 2026 further support the notion that increasing intra-abdominal pressure for internal stability is a safer and more effective approach than the draw-in method, which focuses on tightening the core.

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Topic 3: Pelvic Stability and Full-body Coordination

In clinical practice, it has been consistently observed that improving pelvic stability helps relieve excessive tension in the muscles of the limbs and enhances circulation. This occurs because, when deep muscles function correctly and the pelvis is stable, surface muscles no longer need to overwork to stabilize the joints. As a result, unnecessary tension in surface muscles is released, allowing for smoother movements.

Surface muscles, especially those responsible for power, are more responsive to signals from the brain and tend to tense up easily. This is a defense mechanism: when the body senses danger, surface muscles tighten to protect it. However, when deep muscles are functioning well and the pelvis is stable, surface muscles no longer need to overactivate, allowing the body to move naturally and in a more relaxed state.

When pelvic stability is achieved, the entire body’s muscles can work in a coordinated and efficient manner, leading to smoother, more powerful movements. For example, in actions like running or jumping, the muscles from the hips to the legs work together with the core to produce greater force while minimising the risk of injury. Additionally, when muscles like the latissimus dorsi and serratus anterior function properly, the movements of the upper limbs become smoother, and the load on the shoulders and elbows decreases.

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Patient Story

A 38-year-old expat working in Amsterdam came to Alter Physio after months of recurring lower back pain. He had tried core strengthening programmes at two other physiotherapy clinics, all of which focused heavily on the draw-in method and plank-based exercises. Despite consistent effort, his symptoms kept returning — especially during long work hours at his desk and weekend runs along the Amstel.

During his initial assessment, we identified poor diaphragmatic breathing patterns and insufficient intra-abdominal pressure during movement. By shifting his training away from superficial bracing and towards diaphragmatic breathing and deep muscle activation, his pain reduced significantly within four sessions. He reported feeling more stable during runs and far less tension in his neck and shoulders by the end of his treatment course. His case is a common example of how rethinking “core stability” can unlock lasting results.

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Conclusion

The traditional core training approach centered on the “draw-in” method fails to sufficiently increase intra-abdominal pressure, leading to inadequate core stability during training. This often results in excessive tension in the shoulders and neck, restricting movement and reducing performance.

In contrast, incorporating diaphragmatic breathing and expanding the lower abdomen to increase intra-abdominal pressure is a more natural and efficient way to secure core stability. When deep muscles are working effectively and the pelvis is stable, the overactivation of surface muscles is reduced, allowing the entire body’s muscles to work together to support movement. This approach not only reduces the risk of injury but also enables more powerful and sustainable performance.

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Related Articles

• Top Physiotherapy Exercises for Back Pain Relief in Amsterdam
• Core Stability Training: The Foundation of a Pain-Free Body
• The Key to Posture Improvement: “Diaphragmatic Breathing”! What is Truly Correct Posture?

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