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Establishing Core Stability in Rehabilitation. Rehabilitation Techniques for Sports Medicine and Athletic Training William E. Prentice. Core Stabilization. A dynamic core stabilization training program should be key component of all comprehensive functional rehab. programs

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establishing core stability in rehabilitation

Establishing Core Stability in Rehabilitation

Rehabilitation Techniques for Sports Medicine and Athletic Training

William E. Prentice

core stabilization
Core Stabilization
  • A dynamic core stabilization training program should be key component of all comprehensive functional rehab. programs
    • Improve dynamic postural control
    • Ensure appropriate muscular balance
    • Affect arthrokinematics (physiology of joint movement: how one joint moves on another) around lumbo-pelvic-hip (LPH) complex
    • Allow dynamic functional strength
    • Improve neuromuscular efficiency throughout entire kinetic chain
what is the core
What is the Core?
  • Core defined as the lumbo-pelvic-hip (LPH) complex
    • Center of gravity is located
    • Where all movement begins
    • 29 muscles have attachments in this complex
      • Maintaining length tension and force-couple relationships will increase neuromuscular efficiency and provide optimal acceleration, deceleration and dynamic stabilization during functional movement
what is the core1
What is the Core?
  • Allows entire kinetic chain to work synergistically to produce force, reduce force and dynamically stabilize against abnormal force
    • Each structural component will distribute weight, absorb force and transfer ground reaction forces
  • Many terms:
    • Dynamic lumbar stabilization
    • Neutral spine control
    • “Butt and gut”
core stabilization training concepts
Core Stabilization Training Concepts
  • Development of muscles required for spinal stabilization is often neglected
    • Bodies stabilization system has to be functioning optimally to effectively use muscle strength, power, endurance, and neuromuscular control developed in S &C programs
    • A weak core is a fundamental problem of many inefficient movements that lead to injury
      • If extremities are strong, but core is weak optimal movement cannot be obtained
core stabilization training concepts1
Core Stabilization Training Concepts
  • Core musculature important for protective mechanism that relieves spine of harmful or unexpected forces
    • Greater neuromuscular control and stabilization strength through core program will offer a more biomechanical efficient position for kinetic chain
    • If neuromuscular system is not efficient it will be unable to respond to demands placed on it during fxal movement
      • Lead to compensation and substitution patterns as well as poor posture during fxal activities
      • Increase mechanical stress on contractile and non-contractile tissue thus leading to injury
review of functional anatomy
Review of Functional Anatomy
  • Lumbar spine, abdominal and hip musculature
    • Lumbar spine musculature includes the transversospinalis (TVS) group (including multifidi), erector spinae, lats, quadratus lumborum
      • TVS group: Small and poor mechanical contribution to motion
      • Mainly type 1 fibers therefore designed for stabilization
      • Provide CNS with proprioceptive info.
      • Compressive and tensile forces during fxal mvmt..
        • If trained adequately will allow dynamic postural stab. and optimal neuro-musc. Efficiency
        • Multifidus muscles most important in this muscle group
review of functional anatomy1
Review of Functional Anatomy
  • Erector Spinae Muscle
    • Provides dynamic intersegmental stab. and eccentric deceleration of trunk flexion and rotation
  • Quadratus Lumborum
    • Frontal plane stabilizer that works synergistically with glut med and TFL
  • Latissimus Dorsi
    • Bridge between upper extremity and LPH complex
review of functional anatomy2
Review of Functional Anatomy
  • Abdominal muscles: Rectus abdominus, external and internal obliques & most importantly transverse abdominus (TA)
    • Offer sagittal, frontal and transversus plane stabilization by controlling forces in LPH complex
    • TA: increases intra-abdominal pressure (IAP) thus providing dynamic stab. against rotational and translational stress in lumbar spine
      • Contracts before all limb movement and all other abdominals.
        • Active during all trunk movements suggesting important role in dynamic stab.
review of functional anatomy3
Review of Functional Anatomy
  • Key Hip Musculature
    • Psoas
    • Gluteus Medius
    • Gluteus maximus
    • Hamstrings
review of functional anatomy4
Review of Functional Anatomy
  • Psoas
    • Common to develop tightness
      • Increase shear force and compressive forces at L4-L5 junction
      • Lead to reciprocal inhibition of glut maximus, multifidus, deep erector spinae, internal oblique, and TA
        • Extensor mechanism dysfunction during fxal mvmt patterns.
review of functional anatomy5
Review of Functional Anatomy
  • Glut medius
    • During closed chain movements decelerates femoral adduction and internal rotation
    • Weak glut medius increase frontal and transversus plane stress at patella-femoral joint and tibiofemoral joint
      • Dominance of TFL and quadratus lumborum tightness in IT band & lumbar spineaffect normal biomechanics of LPH complex and PTF joint
        • MUST be addressed after lower extremity injury
review of functional anatomy6
Review of Functional Anatomy
  • Gluteus maximus
    • Open chain hip ext. and ER
    • In closed chain eccentrically decelerates hip flexion and IR
      • Major dynamic stabilizer of SI joint
      • Decreased activity can lead to pelvic instability, decreased neuromuscular control muscular imbalances, poor mvmt patternsinjury
review of functional anatomy7
Review of Functional Anatomy
  • Transverse Abdominus
    • Deepest abdominal muscle
    • Primary role in trunk stabilization
      • Bilateral contraction of TA assists in intra-abdominal pressure thus enhances spinal stiffness
      • Reduces laxity in SI joint
      • Attachment with thorocolumbar fascia adds tension w/ contraction and assist in trunk stability
review of functional anatomy8
Review of Functional Anatomy
  • Multifidi
    • Most medial of posterior trunk muscles (closest to lumbar spine)
    • Primary stabilizers when trunk is moving from flexion to extension
      • High percentage type 1 Muscle fiberspostural control
      • When TA contracts the multifidi are activated
review of functional anatomy9
Review of Functional Anatomy
  • LPH complex is like a cylinder
    • Inferior wall = pelvic floor muscles
    • Superior wall=diaphragm
    • Posterior wall=multifidi
    • Anterior and lateral walls=TA
      • Must all be activated together and taut for trunk stabilization to occur with static and dynamic mvmts
postural considerations
Postural Considerations
  • Optimal posture will allow for maximal neuro-muscular efficiency
    • Normal length tension relationship
    • Force-couple relationship
    • Arthrokinematics
      • Will be maintained during functional mvmt
      • Comprehensive core stabilization program will prevent patterns of dysfunction that will effect postural alignment
muscular imbalances
Muscular Imbalances
  • Optimal functioning core=prevention of the development of muscular imbalances
  • Pathologies develop through chain reaction of key links of kinetic chain
  • Compensations and adaptations develop
  • If core is weak normal arthrokinematics are altered
  • Muscle tightness has significant impact on kinetic chain
    • c
neuromuscular considerations
Neuromuscular Considerations
  • Strong, stable core can improve neuromuscular efficiency throughout entire chain by improving dynamic postural control
  • Optimal core function will positively affect peripheral joints
core stabilization training
Core Stabilization Training
  • Many individuals train core inadequately, incorrectly or too advanced
    • Can be detrimental
    • Abdominal training without proper pelvic stabilization can increase intradiscal pressure and compressive forces on lumbar spine
    • Core strength endurance must be trained appropriately
      • Allow individual to maintain prolonged dynamic postural control
      • **Also important to hold cervical spine in neutral to improve posture, muscle balance and stabilization
core stabilization training1
Core Stabilization Training
  • Time under tension
    • Improves intramuscular coordination which improves static and dynamic stabilization
  • Patient education is key
    • Must understand and be able to visualize muscle activation
    • Muscular activation of deep core stabilizers (TA and multifidi) w/ normal breathing is foundation of all core exercises
assessment of core
Assessment of Core
  • Activity based test
    • SL lowering test using biofeedback Stabilizer
  • Manual Test
    • Multifidi & TA
  • EMG
    • Surface electrodes
  • Ultrasound
    • Reliable tool in determining activation patterns of abdominal muscles
drawing in maneuver
Drawing In Maneuver
  • All core exercises must start with a “drawing in” maneuver, or abdominal brace
    • Different concepts on how to achieve
      • Maximal or submaximal contraction
      • Key is to allow normal breathing, proper muscular activation cannot be achieved if patient is holding breath
      • Exercises can start supine or standing in static position, but should not be abandoned as core exercises become more difficult
specific core stabilization exercises
Specific Core Stabilization Exercises
  • Progression of Core Exercises once abdominal bracing is perfected and able to be maintained through exercise
    • Static
    • Supine and Prone Exercises
    • Quadruped Exercises
    • Comprehensive Core Stabilization Program
      • Stabilization
      • Strength
      • Power
guidelines for core stabilization program
Guidelines for Core Stabilization Program
  • Systematic, Progressive and Functional
    • Manipulate program regularly
      • Plane of motion, ROM, resistance or loading parameters, body position, amount of control, speed, duration and frequency
      • Progressive functional continuum to allow for optimal adaptations