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Core Stabilization with Abdominal Drawing-In Maneuver (ADIM)

Draft95%beginner⬤ strong evidence
View FHIR resourceFHIR R4 ActivityDefinition — the interoperable form of this exercise

How to Perform

Core stabilization exercise targeting deep trunk muscles (transversus abdominis, multifidus). Patient draws the navel toward the spine without moving the pelvis, then maintains the contraction during limb movements. Reduces lumbar segmental translation and pain more effectively than general strengthening. Fundamental for lumbar instability and chronic low back pain.

Watch on YouTube↗

Opens a YouTube search for “Core Stabilization with Abdominal Drawing-In Maneuver (ADIM)”

Starting position: supine

Coaching Cues

  1. 1

    Soft, quiet belly — deep abdominal hollows toward the spine

    (verbal)
  2. 2

    Zip up a tight pair of jeans below the navel

    (verbal)
  3. 3

    Hold the hollow while breathing into the lower ribs

    (verbal)
  4. 4

    Fingertips inside the hip bones feel a gentle tightening

    (tactile)

Evidence-Based Dosing & EMG Data

Recommended Dosing

8-10 reps every 2 hours initially; 30 min 3x/week, 4 weeks minimum

EMG Activation Data

Reduces sagittal translation at L4-L5/L5-S1 at 10 weeks [Puntumetakul 2021]. Bracing IAP 116.4 mmHg vs hollowing 9.9 mmHg [Tayashiki 2016]

Muscles Involved (4)

Primary Movers

Transversus Abdominis— Primary target — drawing-in activates TrA preferentially
Multifidus— Co-activates with TrA for segmental stabilization

Stabilizers

Diaphragm— Forms the top of the 'pressure canister' for intra-abdominal pressure

Synergists & Assistors

Internal ObliqueSynergist— Deepest oblique fibers co-activate with TrA

Easier Variations ↓

1

Supine ADIM Only

Lie on back with knees bent. Practice the drawing-in maneuver alone without any limb movement. Hold 10 seconds.

2

ADIM with Biofeedback

Place a pressure biofeedback unit under the lumbar spine. Maintain target pressure while performing the drawing-in.

Harder Variations ↑

1

ADIM + Heel Slides

Maintain ADIM while slowly sliding one heel along the surface to extend the leg. Challenges core stability with limb loading.

2

ADIM + Leg Lifts

Maintain ADIM while lifting one leg to 90° hip flexion. Progress to alternating legs (dead bug foundation).

3

ADIM in Quadruped

Perform ADIM in hands-and-knees position against gravity. Foundation for bird dog progression.

4

Progress to modified-curl-up-dead-bug

AUDIT: Maintain ADIM/neutral spine during single-leg lifts without lumbar motion, then progress to the dead bug (ADIM plus alternating arm+leg loading); ADIM's leg-lift progression is labeled the 'dead bug foundation'. Both are distinct supine core-stabilization nodes.

5

Progress to bird-dog

AUDIT: Sustain ADIM in quadruped against gravity with a neutral spine (the 'ADIM in Quadruped' step is described as the 'foundation for bird dog progression'), then add contralateral arm/leg extension. Same stabilization continuum, distinct roster nodes.

Target Movements (2)

Lumbar ExtensionLumbar Intervertebral Joints
Lumbar FlexionLumbar Intervertebral Joints

Why This Exercise Matters

Everyday activities this exercise helps you do — essential means it directly trains the capacity the task needs:

Posture MaintenanceWalkingCarrying and Lifting ObjectsGetting In and Out of Bed

Goals This Helps With

Rehab, performance, prevention, and mobility goals this exercise supports — essential means it's a cornerstone:

Low Back PainrehabImprove Core StrengthperformanceLow Back Injury Preventionprevention

Research Notes

ADIM produces significantly reduced sagittal translation at L4-L5 and L5-S1 at 10 weeks [Puntumetakul 2021]. Greater improvement in abdominal muscle activity ratio at 10 weeks and 12 months [Puntumetakul 2021]. Superior improvements in proprioception, balance, and muscle thickness of TrA and LM vs general strengthening [Hlaing 2021]. Dosing: 30 min, 3x/week, 4 weeks minimum; initially 8-10 reps every 2 hours [Hegmann 2020]. Note: abdominal bracing generates IAP 116.4 mmHg vs hollowing 9.9 mmHg [Tayashiki 2016] — both approaches have clinical utility.

Evidence Sources (5)