1. Establishing Core Stability in Rehabilitation
Chapter 5

2. Objectives Definitions Origins Benefits Theory/Posture and anatomy
Research
Practical

3. 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
Corrective high performance exercise kinesiologist

4. 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

5. CORE STABILITY
“The ability to maintain neutral spine using the abdominal, back, neck and shoulder girdle muscles as stabilisers rather than movers”

6. 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.

7. NOT A NEW CONCEPT STATIC Alexander Technique Pilates DYNAMIC
Tai-chi/Karate
Swiss ball training
2 types of stability training – Static and dynamic

8. 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

9. JOSEPH PILATES 1880-1967 PRINCIPLES CONCENTRATION ALIGNMENT BREATHING
CO-ORDINATION
STAMINA

10. FITNESS PARAMETERS CARDIOVASCULAR STRENGTH / POWER/SPEED ENDURANCE
FLEXIBILITY
CORE STABILITY
PROPRIOCEPTION / NEUROMUSCULAR CONTROL

11. 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).

12. 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

13. Adapted from Panjabi (1992)
Control subsystem
(Neural)
Spinal
stability
Passive subsystem
(spinal column)
Active subsystem
(spinal muscles)
Adapted from Panjabi (1992)

14. 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
Panjabi states that…….

15. 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

16. 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)

17. 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)
3 systems in the kinetic chain

18. 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.
Thus a comprehensive core stabilisation program should be integrated into all athlete training.

19. 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

20. Improved Posture Re-education of stabilisers Reduced stress on joints Reduced injury Increase function and sports performance.

21. 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
No good if athletes have functional strength and control in the prime movers but have poor stabilisation thru the chassis to transmit that power.

22. Functional Anatomy 29 muscles attach to core Lumbar Spine Muscles
Transversospinalis group
Rotatores
Interspinales
Intertransversarii
Semispinalis
Multifidus
Erector spinae
Iliocostalis
Longissimus
Spinalis
Quadratus lumborum
Latissimus Dorsi

23. 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

24. Abdominal Muscles Rectus abdominus External obliques Internal obliques
Transverse abdominus
Work to optimize spinal mechanics
Provide sagittal, frontal & transverse plane stabilization

25. STABILISING CORE MUSCLES
THE INNER CORE
Transversus abdominus
Multifidus
Pelvic Floor Muscles
Diaphragm
Muscles work in harmony.
Trans ab and multifidus form a cylinder and the pelvic floor and diaphragm form the base and lid

26. 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

27. TRANSVERSUS ABDOMINUS
DEEPEST OF THE ABDOMINAL MUSCLES
ORIGINATES FROM CARTILAGE OF LOWER 6 RIBS
THORACOLUMBAR FASCIA
ILIAC CREST & INGUINAL LIGAMENT
INSERTS INTO LINEA ALBA
PUBIC CREST

28. Transversus Abdominus