Core Stability Exercise PDF

Core Stability Exercise Dr. Alaa Abdelraheem, PT, DPT, PhD Basic Science Department Faculty Of Physical Therapy Sphinx University  ❑The core muscles are involved in maintaining spinal and pelvic stability ❑The core is also known as the lumbope...

Core Stability Exercise Dr. Alaa Abdelraheem, PT, DPT, PhD Basic Science Department Faculty Of Physical Therapy Sphinx University  ❑The core muscles are involved in maintaining spinal and pelvic stability ❑The core is also known as the lumbopelvic-hip- complex (LPHC) ❑The core is the center of our body and it functions to stabilize the trunk while the arms and legs move What is during functional movements the Core? ❑The strength of the muscles is not so much important as their ability to fire and activate during specific movement sequences to stabilize the low back and pelvis giving a stable base from which force can be generated through the limbs to run, jump, kick etc  ❑The core muscles can be divided into two groups, according to function. ❑ The first group of muscles is the inner or deep core muscles. This group of muscles is also Core known as the local stabilizing muscles Muscles ❑The second group: The outer core muscles or the global muscles are also referred to as the “movers” ❑The inner core should activated and fire before the global muscles are activated.  The inner (Local) core muscles ❑They attach directly to the lumbar vertebrae. ❑Deepest m with primary role in trunk stability ❑Responsible for providing segmental (or intersegmental, intervertebral) stability and work to limit excessive compressive, shear, and rotational forces between spinal segments. The inner ❑These muscles consist primarily of type 1 (slow twitch) muscle fibers with a high density of muscle core muscles spindles. ❑include: Transversus abdominis (Key local stabilizing muscles) Multifidus (Key local stabilizing muscles) Pelvic floor Internal Obliques Diaphragm  ❑The outer core muscles also called Global Stabilization System ❑They are the large, torque-producing muscles. ❑Link the pelvis to the thoracic cage and provide general trunk stabilization as well as movement ❑These muscles provide stability between the pelvis The outer and the spine(Lumbopelvic) ❑These muscles provide stabilization and eccentric core muscles control of the core during functional movements. Rectus abdominis External obliques Erector spinae Quadratus lumborum Hip muscle groups   The core is a box structure made up of Core the abdominal muscles in Muscles the front and the sides, the paraspinal and gluteal muscles at the back, the diaphragm at the roof, and the pelvic floor and the hip girdle muscles as the floor.  ❑The pelvic floor is a dome-shaped muscular sheet Pelvic floor separating the pelvic cavity above from the perineal region below. This cavity encloses the pelvic viscera - bladder, intestines, and uterus(in females). ❑The main function of the pelvic floor muscles are: To support the abdominal and pelvic viscera To maintain the continence of urine, defaecation, sexual activity, and childbirth  The increased effort by the abdominal muscles Pelvic floor can only increase intra-abdominal pressure during spinal movement if there is co- contraction of the pelvic floor musculature.  ❑The activity of the Transversus abdominis is recorded during the Transversus entire range of flexion abdominis and extension of the spine. This co-activation of the abdominal muscles during spinal movement is needed to maintain spinal stability. ❑It maintain abdominal tension and support abdominal viscera ❑It increase intraabdominal pressure that is helpful in forceful expiration, coughing, defecation. ❑It creates tension in the thoracolumbar fascia Internal Abdominal Obliques  Internal Abdominal Obliques: It helps maintain the abdominal pressure and movements of the trunk along with the other and muscles. Multifidus  Multifidus. The multifidus, which is deeper, has direct attachments to the spinal segments, and allows stabilization of the motion segment during lifting and rotational movements of the spine. The deeper uni segment muscles being close to the axis of the spine act as force transducers. Higher concentrations of muscle spindles are located in the smaller uni-segmental muscles  ❑When one inhales, the diaphragm moves caudally and anteriorly while the pelvic floor muscles relax, allows the creation of pressure in the lumbar area, which is sufficient to stabilize the lumbar Diaphragm vertebrae. Moreover, the paraspinal musculature tends to relax due to the creation of this pressure. ❑Thus, diaphragmatic breathing techniques may be an important part of a core strengthening program Rectus ❑Rectus abdominis. Tense the anterior wall of the abdominis abdomen and assist in compressing the contents of the abdomen and External  It exerts an upward pull on the anterior, inferior surface of obliques the pelvis to maintain a neutral pelvic position, or posterior pelvic tilt ❑External obliques: Involved in rotational movements. Do not have a direct attachment to the spinal segment, unable to stabilize the individual segments. Erector spinae  Erector spinae: Involved in lifting. ❑It is a global muscle of the core on the posterior aspect of the body ❑Do not have a direct attachment to the spinal segment, unable to stabilize the individual segments. ❑Contraction of the erector spinae and hip flexor muscles creates anterior pelvic tilt in the sagittal plane  ❑quadratus lumborum muscle as an extensor of the lumbar spine, Quadratus a stabilizer of the lumbar area, capable of pelvic tilting laterally lumborum and capable of acting as an inspiratory accessory muscle. ❑Functions primarily as a frontal plane stabilizer that works synergistically with the gluteus medius and tensor fascia lata. ❑During extension, the QL exerts a force of 10 N, compared to 100 N and 150 N of the erector spinae muscles and the multifidus. It seems unlikely that it can extend the lumbar area on a sagittal plane with such a small force (10 N).   Psoas ❑connect the upper body to the lower body ❑Works with erector spinae, multifidus & deep Hip muscle abdominal wall ✓Works to balance shear forces of lumbar groups ❑Can reciprocally inhibit gluteus maximus, multifidus, deep erector spinae, internal oblique & transverse abdominus when tight ✓Extensor mechanism dysfunction ❑ Assists with flexion of the lumbar vertebral column ❑Stabilizes the lumbar spine during the sitting position  Gluteus medius ❑Frontal plane stabilizer Hip muscle ✓Weakness increases frontal & transverse plane stresses (patellofemoral stress) groups ❑Controls femoral adduction & IR ❑Weakness results in synergistic dominance of TFL & quadratus lumborum  Gluteus maximus ❑Essential for maintaining an erect posture ❑contraction of the deep abdominal muscles may assist with the contraction of gluteus maximus to assist with the control of anterior pelvic rotation. ❑As a powerful extensor of the hip joint, the Hip muscle gluteus maximus suited to powerful lower limb groups movements eg stepping onto a step, climbing or running but is not used greatly during normal walking. ❑Gluteus maximus and the hamstrings work together to extend the trunk from a flexed position by pulling the pelvis backwards, eg standing up from a bent forward position. Eccentric control is also provided when bending forward. ❑Individuals with low back pain often have a strength deficit in Gluteus maximus   Hamstrings Hip muscle ❑The hamstrings are muscles which groups extend the hip and flex the knee. ❑Act with rectus abdominis to create force couple (posterior pelvic rotation) ❑During the swing phase of walking, the hamstrings decelerate the forward motion of the tibia  ❑Maintenance of normal length-tension relationships ❑Maintenance of normal force couples Efficient ❑Maintenance of optimal arthrokinematics ❑Optimal efficiency in entire kinetic chain during core allows movement for: ✓ Acceleration, deceleration, dynamic stabilization ❑Proximal stability for movement of extremities  When the inner and outer (or local and global) core muscles function normally, Efficient segmental spinal stability is maintained, the spine and pelvic area is protected and the core stress or load that may influence the lumbar vertebrae and intervertebral discs are reduced  ❑In the case of dysfunction, such as a weak inner core (the transverse abdominis and multifidus), the outer core compensates for this weakness. Although the Inefficient outer core muscles’ main function is movement and not stability it is able to contribute to stability with core unexpected tasks or overload. As a result of this, splinting occurs and this leads to neuromusculoskeletal issues such as muscle spasms, neural compression and pain.  ❑In patients with low back pain there is decreased activity and atrophy of the multifidus muscle (due to impaired proprioceptive deficits) which compromises the spinal stability. The spinal control is compensated for by the increased activity of the erector spinae Inefficient muscle to stabilize the lumbar spine. eg erector spinae contract to compensate for the delay in increasing the core stiffness of the lumbar spine. (multifidus and rector spinae ) ❑This increased activity of erector spinae increases the compression load on the vertebral column, stimulating the nociceptors of the spinal structures continuously which may increases the risk of injury ❑Due to pain there is further proprioceptive deficit leading to a vicious cycle of pain and disability  ❑ If the pelvic floor is not functioning properly )e.g previous surgery may created adhesions) , one of the symptoms is back pain, as it limits the adequate Inefficient descent of the diaphragm muscle and results in less core lumbar pressure creation. The paraspinal musculature (pelvic floor, diaphragm, is forced to intervene if the pressure in the lumbar rector spinae ) area is insufficient. This is accompanied by hypertrophy and myofascial pain. A vicious cycle of altered motor patterns and pain is created.   There are different tests for assessing the core muscles, but the following are the most common tests: Assessment ❑Prone Bridge Endurance Test of core ❑Lateral Bridge Endurance Test muscles: ❑ Torso Flexor Endurance Test ❑Torso Extensors Endurance test ❑Single-legged Squat Test Prone Primarily assesses the Bridge anterior and posterior core muscles. Endurance It is performed by supporting the body's weight between the forearms and toes Test The pelvis in the neutral position and the body straight Failure occurs when client loses neutral pelvis and falls into a lordotic position with anterior rotation of the pelvis.  It assesses the lateral core muscles. Legs are extended and the Lateral top foot placed in front of Bridge the lower foot for support. Endurance Support themselves on one elbow & feet while lifting hips off the floor to create a straight line over their body Test length. The uninvolved arm is held across the chest with the hand placed on the opposite shoulder Failure occurs when the patient loses the straight posture and the hip falls towards the table.  It is time based test, how long the patient can hold Torso Flexor a position of seated torso Endurance flexion at 60°. Test The client sits at 60° with both hips & knees at 90°, arms folded across chest with the hands placed on the opposite shoulder & toes secured under toe straps or by examiner Failure occurs when the athlete's torso falls below 60°.  The test is performed Torso in prone position of Extensors the client. Endurance The client is at the edge with upper body test out of the table while securing pelvic & leg. Failure occurs when the upper body falls from horizontal into a flexed position  The test is used as an indicator of Single- lumbo-pelvic-hip stability. legged It is functional test, requires Squat Test control the body over a Single weight-bearing lower limb It is frequently used clinically to assess hip and trunk muscular coordination and/or control Abdominal  1. The Prone Test for Transversus Abdominis and Neuromuscular Internal Oblique Place pressure cuff under the abdomen and inflate to Control baseline of 70 mmHg. Draw abdominal wall up and in without moving the spine or pelvis. Pressure should decrease 6-10 mmHg. Hold 10-15 seconds, breathe normally. Perform 10 repetitions. Abdominal 2. Training the Corset Action of Transversus Neuromuscular Abdominis in Supine Place the pressure cuff under the lumbar spine and inflate to a Control baseline of 40 mmHg Draw in the abdominal wall without moving the spine or pelvis. Pressure should remain at 40 mmHg (i.e. no movement of the spine). Hold for 10-15 seconds; breathe normally. Perform 10 repetitions.  ❑Improves spinal and postural control. ❑Prevent deformities. Goals of ❑Improves athletic performance. core ❑Maintains healthy and balanced muscles. stability ❑Improve balance and stability. exercises: ❑Enhances physical functioning in everyday activities (i.e. Functional Fitness). ❑Helps to protect joints and muscles and reduce risk of injury.  Body position (easy to difficult positions). Range of motion (small to large range). Loading (physioball, weight vest, weights on Stages of hands or around lower limb). core stability Amount of speed (slow to fast). exercises: Feedback (eyes open to eyes closed). Static to dynamic. Duration and frequency (sets, reps).  ❑All core exercises must start with a "drawing in" maneuver, or abdominal brace to activate deeper local core muscles (the pressure biofeedback unit may be Stages for used). Once the patient can do a perfect abdominal bracing and able to be maintained it through exercise, core we can start the progression of core exercises. stability ❑All exercises should be repeated 12-15 times, and the isometric contraction for each repetition should be training hold for 5 sec, except the plank exercises should be repeated for 3 times and isometric contraction for about 20-30 sec.   Activating the Core in a Static Position (Level 1) Static core activation can be performed in various Abdominal positions, for example: Supine, prone, 4-point kneeling, half-kneeling, standing[ “Draw In” Maneuver  Lower stomach to spine  Aim To use the correct muscles in response to command “draw in” your abdominal without moving spine or pelvis & hold for 5 to 10 sec while breathing normally. To activate Transversus abdominis + lumbar multifidus   The 4-point kneeling position  Procedure ❑Ask the patient to take a relaxed breath in & Abdominal out & then draw the abdomen up towards the “Draw In” spine without taking a breath. Maneuver ❑The contraction must be performed in a slow and controlled manner. ❑At the same time contracts the pelvic floor and slightly anteriorly rotates the pelvis to activate the multifidi. Activating the Core in a Dynamic Position (Level 2) Alternate arm reaches Alternate knee lifts Combine opposite arm Alternate straight leg raise and leg  (Level 3) Adding alternate arms Alternate arms and legs 4-point kneeling ½ kneeling Standing  Higher-level Exercises (Level 4) Modified blank Blank Side-plank  With SLR and Glutei contraction Bridge on unstable surface Single leg bridge Hundreds Hundreds - Lie on your back with your legs straight and your arms by your sides. Then lift both legs so that they form a right angle in the hip and knees. Lift your arm straight a few inches off the ground. Focus on keeping your hips and legs completely still and your back flat. Progress to whole-body movements, agility, and balance (Level 5) Stepping Side squats