Download B A C K S”

Establishing Core Stability in
Rehabilitation
Chapter 5
Objectives

Definitions
 Origins
 Benefits
 Theory/Posture and anatomy
 Research
 Practical
WHAT IS CORE STABILITY?
“The system the body uses to give spinal support and
maintain muscular balance while at the same time providing
a firm base of support from which other muscles can work to
enable the body to undertake its daily tasks. It is through
this system of joint integrity and support that the body is
able to maintain its posture – the position from which all
movement begins and ends”
Chek P. 2000
What is the CORE?

Lumbo-pelvic-hip complex
 Location of center of gravity (CoG)

Efficient core allows for
 Maintenance of normal length-tension relationships
 Maintenance of normal force couples
 Maintenance of optimal arthrokinematics
 Optimal efficiency in entire kinetic chain during movement

Acceleration, deceleration, dynamic stabilization
 Proximal stability for movement of extremities
CORE STABILITY
“The ability to maintain neutral
spine using the abdominal, back,
neck and shoulder girdle muscles
as stabilisers rather than movers”
Orthopaedic view
“That state of muscular and skeletal
balance which protects the supporting
structures of the body against injury or
progressive deformity, irrespective of the
attitude in which these structures are
working or resting”
Academy of Orthopaedic Surgeons 1947.
NOT A NEW CONCEPT
STATIC
• Alexander Technique
 Pilates
DYNAMIC
 Tai-chi/Karate
 Swiss ball training
ALEXANDER TECHNIQUE
1869-1955
PRINCIPLES
– RE-EDUCATION OF KINAESTHETIC SENSE
– QUIETING THE MIND TO FOCUS ON THE
MIND/BODY CONNECTION
– ESTABLISHING A GOOD HEAD AND NECK
POSITION
JOSEPH PILATES
1880-1967
PRINCIPLES
–
–
–
–
–
CONCENTRATION
ALIGNMENT
BREATHING
CO-ORDINATION
STAMINA
FITNESS PARAMETERS






CARDIOVASCULAR
STRENGTH / POWER/SPEED
ENDURANCE
FLEXIBILITY
CORE STABILITY
PROPRIOCEPTION / NEUROMUSCULAR
CONTROL
Paradigm Shift: No longer looking to
improve strength in one muscle but
improvement in multidirectional
multidimensional neuromuscular
efficiency (firing patterns in entire
kinetic chain within complex motor
patterns).
The Theories
Spinal Stability
 The passively supported spine (bone and
ligament will collapse under 20lb (9kg) of
load.

Muscular components that contribute to
lumbo-pelvic stability which take up the
slack
Control subsystem
(Neural)
Spinal
stability
Passive subsystem
(spinal column)
Active subsystem
(spinal muscles)
Adapted from Panjabi (1992)
Neutral Zone Concept
Every joint has a neutral zone or position
Overall internal stresses and muscular efforts
are minimal
A region of intervertebral motion around the
neutral position where little resistance is
offered by the passive spinal column (Panjabi
1992)
•Movement outside this region is limited by
the ligamentous structures providing restraint
Control of the Neutral Zone
Ligaments - support end of range only
- Can be unstable/over-stretched
Muscle -
Can compensate for instability
Increase the stiffness of the spine
Decrease the neutral zone
Form basis for therapeutic intervention
in treatment of spinal stability
Clinical instability
• A significant decrease in the capacity of the
stabilising system of the spine to maintain
the internal neutral zones within
physiological limits which results in pain
and disability (Panjabi)
Patho-Kinesiological model





Muscular system
Articular system
Neural system
All three must work as an integrated unit
The movement system requires optimum function
of the core stabilisers resulting in precise
arthokinematics and osteokinematics (Sarhmann
2000)
Spinal Stability

Demonstrated that submaximal levels of
muscle activation adequate to provide
effective spinal stabilisation

Continuous submaximal muscle activation
crucial in maintaining lumbopelvic stability
for most daily tasks.
Benefits of Spinal Stability







Improve Posture and prevent deformities
More stable Centre of Gravity and control during
dynamic movements
contribute to optimal movement patterns
breathing efficiency
Distribution of forces and absorption of forces
Reduce stress on joint surfaces and pain
Injury prevention and rehabilitation
Improved Posture
Re-education of stabilisers
Reduced stress on joints
Reduced injury
Increase function and sports performance.
For Sporting Performance
•Forces transmitted - trunk to the limbs
•Core muscles support the spine to transmit
power from the trunk.
•Power is transferred for kicking and
throwing activities
•If the peripheral limbs are too heavy this will
cause stress on the chassis


29 muscles attach to
core
Lumbar Spine
Muscles
 Transversospinalis
group





Rotatores
Interspinales
Intertransversarii
Semispinalis
Multifidus
 Erector spinae
 Iliocostalis
 Longissimus
 Spinalis
 Quadratus lumborum
 Latissimus Dorsi
Functional Anatomy

Transversospinalis group
 Poor mechanical advantage relative to movement production
 Primarily Type I muscle fibers with high degree of muscle spindles
Optimal for providing proprioceptive information to CNS
 Inter/intra-segmental stabilization


Erector spinae
 Provide intersegmental stabilization
 Eccentrically decelerate trunk flexion & rotation

Quadratus Lumborum
 Frontal plane stabilizer
 Works in conjunction with gluteus medius & tensor fascia latae

Latissimus Dorsi
 Bridge between upper extremity & core

Abdominal
Muscles
 Rectus abdominus
 External obliques
 Internal obliques
 Transverse
abdominus
 Work to optimize
spinal mechanics
 Provide sagittal,
frontal & transverse
plane stabilization
STABILISING CORE MUSCLES

THE INNER CORE
 Transversus abdominus
 Multifidus
 Pelvic Floor Muscles
 Diaphragm
The Outer Core Systems

Anterior Oblique – ext and int obliques and
contralateral hip adductors connected by anterior
abdominal fascia

Posterior Oblique – Lat Dorsi and contralateral
Glut Max connected by T/L fascia

Deep Longitudinal – Erector spinae and c/l
sacrotubrous ligament and biceps femoris
(connected by T/L fascia)

Lateral – Glut med and min and c/l adductors
TRANSVERSUS ABDOMINUS
Transversus Abdominus