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The Mystery surrounding Core Strength?

by Drew Singleton (BPhty MScMedPainManagement)

We all know core exercise is desirable when thinking about Spinal Health. (Brumagne et al 2000) (Hodges & Richardson, 1996)

Ever wonder why planking, crunches and squats in fact cause you back pain, when you thought these were perfect for building your Core?

Early conceptions associated “Core strength” with global muscle strength of the external abdominal muscles – Rectus Abdominus, and the Obliques pair.​ This has since been proven inaccurate many times over. (Arokosi et al, 1999) (Hodges & Richardson 1996) (Hodges et all 2006)

For decades Yoga has been associated with flexibility and improving our Core; In the early 2000’s Clinical Pilates was seen as a more advanced method again for improving same in a clinical and class setting.

These days there are so many hybrids and exercise rig modifications, its difficult to believe what actually helps as opposed to hinders our “Core”?

From my own clinical and personal experience, I can tell you it doesn’t have to be this difficult!

At a clinical level, Core Stability is associated with slow twitch postural muscles that work together harmoniously to provide bracing around our body’s many joint complexes!

The most common one known is Transverse Adbominus, and is also most often mistaken for being strengthened through inappropriate exercises which target other global abdominal muscle as mentioned.

Other examples of Core muscle include Pelvic Floor, Inner quadriceps and gluteal muscles, scapular stability muscles between our shoulder blades, deep neck muscles under our chin, supinator muscles around our elbow; and intrinsic wrist and foot muscles. Even our body’s breathing muscle our Diaphragm has core stability functions. (Richardson et al, 2010)

​Whats fascinating about these muscles is that they ​only have to work at a very low levels to provide effective core stability to their joint structures, and in the process allowing them to work all the time.

The best way I have found to think of them is to liken them to our body’s heart and lung muscle – i.e. muscles which work at very low rates but all the time. Core muscles are not like our larger Pectoralis and Hamstrings which are more readily used for explosive movement and power! i.e. Squats and Presses.

The best practice way to get these muscles working after injury is to isolate them in very easy, non-weight bearing positions to essentially “wake them up”, before training their resilience against more difficult postures and combined body movements. (Kuriyama & Ito, 2005)

Often the degree of difficulty for these types of exercises requires far more mental concentration, as opposed to cardio-vascular fatigue and muscles soreness.

If you haven’t gone through the appropriate rationale to recruit these muscles in their infancy, then attempting to strengthening their tolerance in more challenging and more difficult exercise regimes will only magnify your postural problems over time – eventually leading you to inferior performance, and greater susceptibility to injury. (Brumagne et al 2000) (Cholewicki et al 2002) (Jones & Knapcik 1999) (Kaufman et al, 2000)

If you are finding you are still weak in one area of your body even long after overcoming a painful injury, or you still suffer pain through these areas then consult with your Physio at Core or email me directly for advice regarding our Spine Physio & Exercise program – a comprehensive, tailored initiative to get these muscles re-firing on all cylinders, and get you improving your function with daily activities to live pain free!

References:
​​1. Adams, A. and P. Dolan (2005). “Spine biomechanics.” Journal of Biomechanics 38: 1972-1983.

2. Arokoski, J. P. A., Kankaanpaa, M., Valta, T., Juvonen, I., Partanen, J., Taimela, S., et al. (1999). Back and hip extensor muscle function during therapeutic exercises. Archives of Physical Medicine & Rehabilitation, 80(7), 842-850.

3. Barker PJ, Guggenheimer KT, Grkovic I, Briggs CA, Jones DC, Thomas DL, Hodges PW: Effects of tensioning the lumbar fasciae on segmental stiffness during flexion and extension. Spine 2006;31:397-405.

4. Brumagne, S., Cordo, P., Lysens, R., Verschueren, S., & Swinnen, S. (2000). The role of paraspinal muscle spindles in lumbosacral position sense in individuals with and without low back pain. Spine, 25(8), 989-994.

5. Cholewicki, J., Greene, H. S., Polzhofer, G. K., Galloway, M. T., Shah, R. A., & Radebold, A. (2002). Neuromuscular function in athletes following recovery from a recent acute low back injury. Journal of Orthopaedic & Sports Physical Therapy, 32(11), 568-575.

6. Hides, J. A., Stokes, M. J., Saide, M., Jull, G. A., & Cooper, D. H. (1994). Evidence of lumbar multifidus muscle wasting ipsilateral to symptoms in patients with acute/subacute low back pain. Spine, 19(2), 165-172.

7. Hodges, P., Holm, A. K., Hansson, T., & Holm, S. (2006). Rapid atrophy of the lumbar multifidus follows experimental disc or nerve root injury. Spine, 31(25), 2926-2933.

8. Hodges, P. W., & Richardson, C. A. (1996). Inefficient muscular stabilization of the lumbar spine associated with low back pain. A motor control evaluation of transversus abdominis. Spine, 21(22), 2640-2650.

9. Hodges, P. W., & Richardson, C. A. (1997a). Contraction of the abdominal muscles associated with movement of the lower limb. Physical Therapy, 77(2), 132-142; discussion 142-134.

10. Hodges, P. W., & Richardson, C. A. (1997b). Feedforward contraction of transversus abdominis is not influenced by the direction of arm movement. Experimental Brain Research, 114(2), 362-370.

11. Jones BH, Knapik JJ (1999) Physical training and exercise-related injuries. Surveillance, research and injury prevention in military populations. Sports Med Feb 27 (2): 111-25.

12. Kaufman KR, Brodine S Shaffer R (2000). Military training-related injuries: surveillance, research and prevention. Am J Prev Med Apr 18 (3 Suppl) 54-63

13. Kuriyama, N., & Ito, H. (2005). Electromyographic functional analysis of the lumbar spinal muscles with low back pain. Journal of Nippon Medical School = Nihon Ika Daigahu Zasshi, 72(3), 165-173.

14. Matejka, J., Zuchova, M., Koudela, K., & Pavelka, T. (2006). Changes of muscular fibre types in erector spinae and multifidus muscles in the unstable lumbar spine. Journal of Back & Musculoskeletal Rehabilitation, 19(1), 1-5.

15. McGill, S. M., R. L. Hughson, et al. (2000). “Changes in lumbar lordosis modify the role of the extensor muscles.” Clinical Biomechanics 15(10): 777-80.

16. Richardson C, Hodges P and Hides J (2010). Therapeutic exercise for Lumbopelvic Stabilisation. Churchill Livingston. 2nd edition.

17. Richardson, C. A., C. J. Snijders, et al. (2002). “The relation between the transversus abdominis muscles, sacroiliac joint mechanics, and low back pain.” Spine 27(4): 399-405.

18. Rivera JC, Anderson ER, Jenne JW, Topp RF (2014) Spine related disability following combat injury. J Surg Orthop Adv 23 (3) 136-9.

19. Roy TC, Knapikk JJ, Ritlnad BM et al (2012) Risk factors for musculoskeletal injuries for soldiers deployed to Afghanistan. Aviation Space Enviorn Med Nov 83 (11): 1060-6

20. San, J. J. G., Yaggie, J. A., Levy, S. S., Mooney, V., Udermann, B. E., & Mayer, J. M. (2005). Effects of pelvic stabilization on lumbar muscle activity during dynamic exercise. Journal of Strength & Conditioning Research, 19(4), 903-907.

21. Solomonow, M., Zhou, B. H., Harris, M., Lu, Y., & Baratta, R. V. (1998). The ligamento-muscular stabilizing system of the spine. Spine, 23(23), 2552-2562.

22. Yoshihara, K., Nakayama, Y., Fujii, N., Aoki, T., & Ito, H. (2003). Atrophy of the multifidus muscle in patients with lumbar disk herniation: histochemical and electromyographic study. Orthopedics, 26(5), 493-495.

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