core stability and core strength are terms that are often used interchangeably when talking about the formation of the trunk muscles, whether in rehabilitation settings or performance. The fact is that they are quite different. Training for core stability required to withstand the movement of the lumbar spine by activation of the abdominal muscles as a whole. Training for core strength allows movements to occur through the lumbar spine in an attempt to work the abdominal muscles, often in isolation. I realize according to the definition of "heart" we could discuss a number of muscle groups, but the purpose of this article, I'll keep it for abs.
This land may not seem earth-shattering but it can the difference between success and failure regarding the return of athletes in sports. This applies to the return of customers to their normal daily activities as well. It is my feeling that core stability is the way forward with treatment for PT and ATC, and training methodology for the strength coach. Here's why.
Looking at the functional anatomy of the lumbar spine, it allows for movement in all three planes of motion, but overall it is quite limited.
- The lumbar spine can move a little by flexion and extension, but we know from experience to avoid the repetition of going to extremes, hanging out at one extreme or the other during prolonged periods, and avoid high charges while trying to move through the lumbar spine.
- rotation to the lumbar spine is only expected to contribute 13% of total turnover of the spine (Sahrmann, 02), which limits the rotation of the training would be a good idea.
- lateral bending occurs as well, but is limited. The total amount of lateral flexion permitted L1-S1 is 27 degrees, while the thoracic spine is able to contribute up to 75 degrees (Sahrmann 02). It also has a degree of rotation that is new not really designed to occur in the lumbar spine.
So really when you look at the joints of the lumbar spine, they were built more for stability than for mobility. The flexion / extension movements, lateral flexion, and rotation really need to happen at the hips and thoracic spine. Go after the rotation of the hip and range expansion, increase the extension and rotation spinal column and does leave the lumbar spine out of it.
The functional anatomy of the abdominal musculature also leads me to think that training to resist movement is the right way forward. According McGill (Ultimate Back Fitness and Performance BackFitPro Inc ;. 06), efforts to improving function of single muscles, especially the transverse abdominus, are defective and can actually cause more dysfunction. New research has shown that almost all the muscles show altered patterns of activation in the presence of back pain in athletes (Cholewicki, et al, 02) and among workers (McGill et al, 03). The abdominal muscles are not working in isolation in an attempt to educate in this way is asking for trouble. Training rectus abdominus through the use of lumbar flexion exercises such as crunches, sit-ups, etc., can actually lead to become dominant rectus abdominus and obliques on the cross! activation models are already out of sync when pain is present. Again the case is made for the relative stabilization of training allowing movement and isolation
Another quote from the book of Sahrmann (Diagnosis and Treatment of Movement Disorders Mosby depreciation;. 02). . the most important of the abdominal muscle performance aspect is to get control that is necessary to (1) properly stabilize the spine, (2) maintain the alignment and movement of the optimal relationship between the pelvis and the column spinal, and (3) avoid excessive stress and compensatory movements of the pelvis during the movements of the extremities. All three have to do with stability compared to strengthen and force production
Examples of base-building exercises include :.
- Crunches and rotational crunches
- Sit-ups
- Superman / return hyperextensions
- leg raises
- side bends
- many rotation exercises with medicine balls or resisted swings
Not all of the above are inherently poor choices. They are simply incorrectly executed most of the time without thinking about pre-stabilize and limit movement. Even McGill performs a variation of the crisis, but it is a very intense technical and does not lumbar movement. Sit-ups, side bends, and most fair rotation exercises do not have a place in rehab or training for athletics. They create more problems than they could ever solve.
basic stability exercises should resist movement through the lumbar spine and attempt to engage the abdominal muscle group as a whole in a "reactive sense." Ultimately, the goal is to create an environment through exercise that teaches the patient or athlete to initiate reflexive as they would in real life and in sport.
Before going into specific exercises, it should be discussed how best to engage the abdominals. Most of the debate revolves around 'digging' vs 'bracing'. According to McGill, digging engage the TA, but has the effect of stopping the other abdominal muscles stability for all is lost. He is a supporter of bracing that attempts to commit all of the abdominal wall and also has the effect of recruiting the extensors of the trunk to form a belt around the trunk. A corset is simply tightens as if someone was going to punch you in the stomach. This is often done at the expense of posture, which weighs and flexing the spinal column does, prolonging the cervical spine, etc. Cue for 'Stay Tall' the athlete braces to avoid a poor starting position.
This is a simple self test to feel the difference. Sit on the edge of your chair and get up as fast as possible (a "power squat" as called McGill). Do it first with the digging and braced. You will feel a difference in the stability and even the speed of movement. What technique would you rather teach your athletes and workers?
So where to start?
Many patients and athletes have poor awareness of body and struggle to engage the abdominal voluntarily leave one reflective at first. I will not go through the evaluation process, but will say that I want to get the supination of the first athlete just to see the ability to engage with simple movements. Athletes can be very good at hiding their faults so sometimes easier the task, the less they can cover. the athlete can lift a leg or arm to take a head without entering the lumbar extension? The athlete is able to contract the glutes and abs without bending through the lumbar spine? Can they remove without lateral bending leg, or rotate the hips separately spine? Many can not. If this is the case, then this is where we must begin by teaching a neutral lumbar spine and use some of the traditional lumbar stabilization exercises.
In supination, I feel very strongly perfecting the bridge for a few reasons. 1) As mentioned above, can abdominals and glutes fire to stabilize the spine but a rather controlled manner that the patient is not in a posterior pelvic tilt? 2) The patient must resist the lumbar extension to the top of the movement. It is more the attitude is better.. "If I get more must be better" They must learn quickly that control is king 3) Teach them to use their glutes to expand hips rather than using hamstrings. Synergistic dominance of the hamstrings is something I've written before about (see the prevention of hamstring injuries). that is why many patients have a cramp in his thigh during bypass surgery . the hamstring should be switched off during the entire movement.
Start with the traditional bridge, the progress of a bridge with walking, and finally simple bridge leg. Note that in the first image, a line could be drawn knees, hips and across the back shoulders. This is the maximum height. Allow the patient or athlete to pressure down by hand, do not help to raise, but to reflexive engage their abdominals. Shows walking (alternating hip flexion) that the pool not to drop or turn when a leg is lifted.
In supination, switch to a quadruped position. I should mention that I rarely work an athlete or a patient from a lying position more. I find too many of them are already at their end ranges for hip extension and shoulder flexion. It's too easy to go to a lordosis at that point. Get them in quadruped which is easier on the spine. reduced lumbar loads have been demonstrated in subjects vs quadruped extension exercises (including stability ball extension), but greater muscle activation in the thoracic extensors, oblique and latissimus (McGill, 02)
in quadruped, shoulder work flexion and hip extension separately first, and then combine them into the bird dog exercise. The fire hydrants are also excellent from that position to resist rotation. A great teaching technique to use is to place a towel roll in the lumbar spine and cuing the patient not to give up. As they progress, use bottled water to ensure greater stability.
Progress the bird dog by adding resistance in the shoulder and hip. Here I use a strip of Cook gray, but a regular band or a piece of pipe would work well too. Note the floor pad under my knee stationary. This is a little trick to prevent the transfer of weight on the hip that often results in pelvic rotation and loss of stability.
The second part of the stable core vs core strength, I will enter the progressions in the board and the push-up position.
Joe Heiler is a physiotherapist in sports medicine and orthopedics in Traverse City, Michigan. Joe is also a strength and conditioning coach working with athletes at all levels in football, baseball, hockey, track and power lifting highly sought after. He is also the owner of http://www.sportsrehabexpert.com. Feel free to contact him. Joe@sportsrehabexpert.com
- Shirley Sahrman. Diagnosis and Treatment of Movement Impairment Syndromes. Mosby; 02.
- Cholewicki J, Greene HS Polzhofer GK, Galloway MT Shah RA Radebold Function A. neuromuscular in athletes Following recovery from a recent acute Low Back injuries. J Orthop. Sports Phys. Ther. 02. 32: 568-575
- S. McGill Ultimate Back Fitness and Performance .. 3rd ed. Ontario, Canada: Backfitpro Inc; 06.
- McGill S. Low back pain - Evidence Based Prevention and Rehabilitation. 2nd ed. Human Kinetics; 02.
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Joe Heiler PT, CSCS
Joe Heiler MSPT is the owner and content manager SportsRehabExpert.com, a site dedicated to the advancement of education rehabilitation and performance professionals. The site focuses on orthopedic and sports physical therapy subjects through webinars, audio interviews, articles, manual therapy and exercise videos, and more.
Joe is also the owner of Elite Performance Physiotherapy and Sports in Traverse City, MI specializes in orthopedics and sports medicine, as well as training of athletic performance. It is Graston Technique (GT) and a certified instructor GT SFMA FMS and trained, and is passionate about a number of soft tissue and manual techniques, including Trigger Point Dry Needling and manipulation.
Latest posts of Joe Heiler PT, CSCS (view all)
- The Bird Dog - basic Classic stability - April 4, 2016
- Points triggering and pain shoulder - Part 2 - February 29, 2016
- trigger Points and shoulder pain - Part I - January 19, 2016
- basic stability vs core strength - Part II - April 1, 09
- basic stability vs core Force - March 1, 09
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