Core Stability Exercise Lecture 5 PDF

Core stability exercise By Dr/ Heba Haridy core stability It is the ability of the core muscles to stabilize the lumbar spine and pelvic girdle also, other deep musculature in the cervical spine during static postures...

Core stability exercise By Dr/ Heba Haridy core stability It is the ability of the core muscles to stabilize the lumbar spine and pelvic girdle also, other deep musculature in the cervical spine during static postures and dynamic limb movement. NB- Core means lumbopelvic hip complex Core muscle mean other term ( motor control ) The core can be described as a muscular box: Floor – pelvic floor muscle Roof – Diaphgram Front – Abdominal muscle Posterior part – Multifidus factors affecting the core stability: Core muscle divided into 2 type of muscle 1- Local postural muscle ( intrinsic muscle ) 2- Global dynamic muscle ( externsic muscle ) Local postural muscle Global dynamic muscle Deep layer muscle Superficial layer muscle Slow twitch muscle fiber type 1 fast twitch muscle fiber type 2 Fatigue resistance ,endurance Force production , strength These muscles are shorter in length and are These muscles are long allowing them to suited for controlling intersegment motion and produce large amounts of torque and gross responding to changes in posture movements (Short lever arm) (Long lever arm) Give more stability Give more mobility Ms Rectus abdominis muscles , External oblique , Erector spinae, Quadratus Transversus abdominus , Multifidi lumborum,psoas major,glutious,erector spinae (longissimus and illiocostals muscle ) Internal oblique , Deep transversospinalis , The pelvic floor muscles, Diaphragm N.B: Multifidi have been found to atrophy in people with chronic low back pain (LBP). Mechanism of muscle in stability: a) The transverses abdominals and multifidi have been shown to contract 30 ms before movement of the shoulder and 110 ms before movement of the leg in healthy people, theoretically to stabilize the lumbar spine. b) The internal oblique and the transversus abdominis work together to increase the intra- abdominal pressure. Increased intra-abdominal pressure has been shown to impart stiffness to the spine. So these muscles work together to 1- produce maximum stability in the abdominal and lumbar (lower) back region. 2- coordinate the movement of the arms, legs, and spine. NB – In the cervical spine:  The core muscles are: longus colli and other deep musculature.  The goal is: To activate and control the muscles that control axial extension (cervical retraction).  This requires: Capital flexion, slight flattening of the cervical lordosis, and flattening of the upper thoracic kyphosis The core stability depends on : 1-Global musculature, in combination with local musculature. 2- Muscular strength. 3- Proper sensory input. Function of core muscle:  Efficiency of the core muscles enables each of the structural components to operate optimally through:  Distribution of weight.  Absorption of force ( shock absorption ).  Transfer of ground reaction forces.  Prevention injuries  Importance in performance  Inefficiency of the core muscles can results in:  Unstable body (because abnormal forces are distributed above and below misaligned segment).  Repetitive microtrauma.  Faulty biomechanics & injury So (Weak core lead to inefficient movements more injury).  Compensatory actions which can lead to deformity. Core Stability Exercises Training Goals:  Improves spinal and postural control.  Prevent deformities.  Improves athletic performance.  Maintains healthy and balanced muscles.  Improve balance and stability.  Enhances physical functioning in everyday activities (i.e. Functional Fitness).  Facilitates powerful movements such as those executed during sport.  Helps to protect joints and muscles and reduce risk of injury. What is the difference between core strength and core stability? Core strength is developed by performing exercises specific to the muscles of the abdomen, buttock, back and hips. Most of these exercises isolate a particular muscle group, in order to develop specific strength (e.g. back extensions, curl ups). Core stability, on the other hand, is the integration of strength and coordinated movement. More specifically, core stability is the interaction of coordination and strength of the abdominal, back and buttock muscles during activity to ensure the spine is  stabilized and provides a firm base to support both powerful and everyday movements of the arms and legs Specific tests listed 1) Prone instability test 2) Prone extension endurance test. 3) Side bridge endurance test (quadratus lumborum endurance strength) 4) Core flexor endurance test. There are different tests for assessing the core muscles, but the following are the most common tests: 1. Lateral musculature test ( Side bridge test): Failure occurs when person un able to hold position 20-30 second and loses the straight-back posture and hip returns to ground. Test performed on both sides of the body , Subject lying in full side bridge, legs extended, top foot is placed in front of the lower for support. Subject supported himself on one elbow and on feet. Uninvolved arm placed across the chest ,asked him to maintain the isometric contraction as much as possible. Failure occurs when person loses the straight-back posture and hip returns to ground. 2.Flexor endurance test: Failure occurs when person un able to hold position 20-30 second falls back and touches the back support. Begins with person in a sit-up posture with the back resting against aback support which angled at 60 degrees, both knees and hips flexed, Arms folded across chest and hands placed on opposite shoulders. Test begins by pulling back support ten centimeters away from the person, and we asked him to maintain the isometric contraction as much as possible, failure occurs when subject falls back and touches the back support. 3. Extensor endurance test (back extensors test): The subjects are horizontally positioned with the lower extremities fixed to an examination table (at the levels of pelvis, knees) while the upper body is extended over the edge of the table. The upper limbs are held across the chest with the hands resting on the opposite shoulders, and we asked him to maintain the isometric contraction as much as possible. Failure occurs when the upper body drops from the horizontal position. Prone instability test Prone instability test: In this test, the patient is prone, with legs off the table and feet on the floor. The clinician applies posterior-anterior pressure over the lumbar spine and assesses for pain. The patient then engages extensors and lifts feet off the floor. The test is positive if pain is elicited with pressure and relieved with active extension, as this is thought to indicate temporary pain relief through stabilization of the spine A core stability exercise should be done in stages with gradual progression in respect to the following:  Body position (easy to difficult positions).( spine ,prone then quadruped to kneeling ….  static to dynamic , both limb support to single limb , stable surface to unstable surface.  Range of motion (small to large range) to achieve mobility.  Loading low to high (weight vest, weights on hands or around lower limb) to achieve strength.  Amount of speed from slow to fast to atchive power.  Feedback (eyes open to eyes closed) to achieve proioception.  Static to dynamic.  Duration and frequency (sets, reps) to achieve endurance NB So Stability = endurance +strength+ sensory awareness+ power performance +mobility and flexibility Notes for practice for the local muscle system: 1-Use specific feedback techniques (as pressure biofeedback unit) to develop kinaesthetic awareness of local muscle. 2- Use repeated movements of the lumbopelvic region, in more comfortable and easy positions initially (prone, supine) to improve position sense, then can be graduated to quadruped and kneeling positions.  Core training 1- flexibility ex for extremities and core area 2-Core stability exercises a) Beginning core stability exercise. b) Progressing core stability exercise. c) Advanced core stability: challenging balance and motor control 1) flexibility Stretching of the core area a) Cobra Stretch Prayer position stretch. Prayer position stretch Benefits of Stretching the Core a) Reduced muscle tension b) Increased range of movement in the joints c) Enhanced muscular coordination d) Increased circulation e) Increased energy levels 2) Stretching of the upper and lower limbs Triceps Stretch 2) Posterior deltoid 3) Biceps and Anterior Capsule Stretch 4- Quadriceps Stretch Using a towel, or band, lie on your stomach,. Hold for 20- 30 seconds. Repeat 3 times. 7- Adductor Stretch 8- Hamstring Stretch 2) Core stability exercises a) Beginning core stability exercise. b) Progressing core stability exercise. c) Advanced core stability: challenging balance and motor control. A) Beginning core stability exercises 1- Lower Cervical and Upper Thoracic Activation. 2- Abdominal muscle activation. 3- Lumbar muscle activation. 1- Lower Cervical and Upper Thoracic Extensor Activation and Training Guidelines: NB-. Add extremity motions to load the global musculature while maintaining a stable neutral spine position (dynamic stabilization). - Increase repetitions to improve holding capacity (endurance) in the stabilizing musculature; increase load (change lever arm or add resistance) to improve strength while maintaining a stable neutral spine position. Patient position and procedure: Prone with forehead on the treatment table and arms at the sides. Have the patient lift the forehead off the treatment table, keeping the chin tucked and eyes focused on the table to maintain the neutral spinal position (reinforces the craniocervical flexion motion learned in the supine position). Lifting the head is a small motion Figure Axial extension (cervical retraction) exercises. 2- Abdominal Muscle Activation Two techniques for abdominal muscle activation have been described and used in clinical practice: abdominal bracing and posterior pelvic tilt. A- Abdominal bracing Occurs by setting the abdominal muscles. There is no head or trunk flexion, no elevation of the lower ribs, no protrusion of the abdomen, and no pressure through the feet. The patient should be able to hold the braced position while breathing in a relaxed manner or holding for 10 seconds for 10 repetitions with 2-5 seconds rest in-between. B- Posterior Pelvic Tilt Pelvic tilt exercises principally activate the rectus abdominis muscle, which is used primarily for dynamic trunk flexion activity. 1- Changing position of lower limbs with the patient crock lying  2- Limb loading 4- Lumbar Muscle Activation Activation of trunk extensor started from quadruped or supine lying position. Figure.Patient asked to raise his back upward as a hump then push the back downward Figure.Limb loading for basic stabilization progression of the lumbar extensors. Begin in the quadruped position and progress the intensity by (A) flexing one UE, (B) extending one LE with a leg slide, (C) extending one LE by lifting it off the mat, (D) flexing one UE while extending contralateral LE and then alternate to opposite extremities. Progress to prone: (E) extending one LE then the other. B) Progressing (intermediate) core stability exercises 1- Plank exercise 2- Bridging exercise