1. FUNCTION TRANSVERSUS ABDOMINUS
SUPPORT OF ABDOMINAL CONTENTS VIA CIRCUMFERENTIAL ARRANGEMENT
BILATERAL CONTRACTION CAUSES DRAWING IN OF ABDOMINAL WALL
CAN WORK WITH MULTIFIDUS VIA TENSION OF THORACOLUMBAR FASCIA
CONTRIBUTES TO BOTH SUPPORTING AND TORQUE ROLES

2. MULTIFIDUS ORIGINATES ON DORSAL SURFACE OF SACRUM
SACROTUBEROUS & POSTERIOR SACROILIAC LIGAMENT
PSIS & ERECTOR SPINAE APONEUROSIS
INSERTS ON SPINOUS PROCESSES OF SACRAL & LUMBAR VERTEBRAE
FILLS CHANNELS BETWEEN SACRUM & ILIUM & BETWEEN LUMBAR SPINOUS & TRANSVERSE PROCESSES

4. Multifidus

5. FUNCTION (MULTIFIDUS)
Provides control of shearing forces of intervertebral motion segments
Unique segmental arrangement of multifidus suggests capacity for fine control of movement
Control anterior rotation translation in trunk flexion
Continuously active in upright posture compared with recumbency
Provides anti gravity support
Active in both ipsilateral and controlateral trunk rotation
Stabiliser rather than prime mover

6. Gluteal Stabilizers

7. Hip Musculature Psoas Closed chain vs. open chain functioning
Works with erector spinae, multifidus & deep abdominal wall
Works to balance anterior shear forces of lumbar spine
Can reciprocally inhibit gluteus maximus, multifidus, deep erector spinae, internal oblique & transverse abdominus when tight
Extensor mechanism dysfunction
Synergistic dominance during hip extension
Hamstrings & superficial erector spinae
May alter gluteus maximus function, altering hip rotation, gait cycle

8. Gluteus medius: provides frontal plane stabilization, decelerate femoral adduction , assist in deceleration femoral internal rotation (during closed chain activity)

9. Gluteus Medius Provides frontal plane stabilisation in walking cycle
Prevents downward rotation of the pelvis (Trendelenburg)
Allows unsupported leg to swing clear of the ground
Decelerates femoral adduction and internal rotation
Anterior fibres assist the iliotibial tract to flex hip and stabilise the extended knee

10. Hip Musculature Gluteus medius Gluteus maximus
Frontal plane stabilizer
Weakness increases frontal & transverse plane stresses (patellofemoral stress)
Controls femoral adduction & internal rotation
Weakness results in synergistic dominance of TFL & quadratus lumborum
Gluteus maximus
Hip extension & external rotation during OKC, concentrically
Eccentrically hip flexion & internal rotation
Decelerates tibial internal rotation with TFL
Stabilizes SI joint
Faulty firing results in decreased pelvic stability & neuromuscular control

11. All muscles produce & control forces in multiple planes
Hamstrings
Concentrically flex the knee, extend the hip & rotate the tibia
Eccentrically decelerate knee extension, hip flexion & tibial rotation
Work synergistically with the ACL to stabilize tibial translation
All muscles produce & control forces in multiple planes

12. Neuromuscular efficiency
Ability of CNS to allow agonists, antagonists, synergists, stabilizers & neutralizers to work efficiently & interdependently
Established by combination of postural alignment & stability strength
Optimizes body’s ability to generate & adapt to forces
Dynamic stabilization is critical for optimal neuromuscular efficiency
Rehab generally focuses on isolated single plane strength gains in single muscles
Functional activities are multi-planar requiring acceleration & stabilization
Inefficiency results in body’s inability to respond to demands
Can result in repetitive microtrauma, faulty biomechanics & injury
Compensatory actions result

13. The CORE Functions & operates as an integrated unit
Entire kinetic chain operates synergistically to produce force, reduce force & dynamically stabilize against abnormal force
In an efficient state, the CORE enables each of the structural components to operate optimally through:
Distribution of weight
Absorption of force
Transfer of ground reaction forces
Requires training for optimal functioning!
Train entire kinetic chain on all levels in all planes

14. Core Stabilization Concepts
A specific core strengthening program can:
IMPROVE dynamic postural control
Ensure appropriate muscular balance & joint arthrokinematics in the lumbo-pelvic-hip complex
Allow for expression of dynamic functional performance throughout the entire kinetic chain
Increase neuromuscular efficiency throughout the entire body
Spinal stabilization
Must effectively utilize strength, power, neuromuscular control & endurance of the “prime movers”
Weak core = decreased force production & efficiency
Protective mechanism for the spine
Facilitates balanced muscular functioning of the entire kinetic chain
Enhances neuromuscular control to provide a more efficient body positioning

15. Postural Considerations
Core functions to maintain postural alignment & dynamic postural equilibrium
Optimal alignment = optimal functional training and rehabilitation
Segmental deficit results in predictable dysfunction
Serial distortion patterns
Structural integrity of body is compromised due to malalignment
Abnormal forces are distributed above and below misaligned segment

16. Neuromuscular Considerations
Enhance dynamic postural control with strong stable core
Kinetic chain imbalances = deficient neuromuscular control
Impact of low back pain on neuromuscular control
Joint/ligament injury  neuromuscular deficits
Arthrokinetic reflex
Reflexes mediated by joint receptor activity
Altered arthrokinetic reflex can result in arthrogenic muscle inhibition
Disrupted muscle function due to altered joint functioning

17. Optimum Dynamic Function
Integrated proprioceptively enriched multi-directional movement controlled by an efficient neuromuscular system
Optimum human dynamic function involves ……
From walking to more challenging sporting movment patterns.
All exercise is subject to forces saggital, frontal and transverse and therefore the system is also able to provide control against these forces, reduce the forces and stabilise the body.

18. PROPRIOCEPTION
“Nerve impulses originating from the joints, muscles, tendons and associated deep tissues which are then processed in the central nervous system to provide information about joint position, motion, vibration and pressure”. (Bruckner & Khan 1999)

19. WHY IS PROPRIOCEPTION IMPORTANT?
Sub-cortical systems are not under conscious control
Stabilization response needs to be second nature.
Sub-cortical systems act faster - rapid muscle reaction times.
More rapid reaction times can be learnt which may lead to increased stability of the lumbar spine.

20. To improve the proprioceptive system in dynamic joint stability it must be challenged.
Pain-free does not mean cured.
If the proprioceptive deficit has not been addressed a complete rehabilitation has not been accomplished.
Mechanically stable joints are not necessarily functionally stable ( eg. ACL reconstruction)

21. WHAT HAPPENS WHEN THE SYSTEM GOES WRONG?
The Theories

22. “MUSCLE PAIN SYNDROMES ARE SELDOM CAUSED BY ISOLATED PRECITATING FACTORS AND EVENTS BUT ARE THE CONSEQUENCES OF HABITUAL IMBALANCES IN THE MOVEMENT SYSTEM” (Sahrmann 1993)

23. REPEATED MOVEMENTS SUSTAINED POSTURES
ALTERS MUSCLE LENGTH
ALTERS STRENGTH
ALTERS STIFFNESS
ALTERS FLEXIBILITY
ALTERS CARTILAGE AND BONE STRUCTURE – BY OVERLOADING AT COMPENSATORY SITES OF MOVEMENT
Flexibility of the the hips and pelvis will influence alignment and therefore stability in the trunk. Mulligan refutes this in that mobilisation of either lumbar or hip joints can immediately effect soft tissue length. Therefore, could be neural inhibition.

24. STRUCTURAL/SEGMENTAL DYSFUNCTION
PAIN
POSTURAL DYSFUNCTION
MUSCULAR DYSFUNCTION
STRUCTURAL/SEGMENTAL DYSFUNCTION
“The body has the ability to adapt to minor stresses, but as you increase the number, the body has less room to adapt until you reach a point where the body cannot adapt any further”
“Sarhmann muscle pain syndromes are seldom caused by located precipitating factors and events”
“The body has the ability to adapt to minor stresses, but as you increase the number, the body has less room to adapt until you reach a point where the body cannot adapt any further”
“Sarhmann muscle pain syndromes are seldom caused by located precipitating factors and events”

25. POSTURE AND PAIN
Poor posture can lead to increased stress on the stabilising system of the joints (Chek P 1999)
Multifidus dysfunction occurs after first episode acute unilateral LBP (Hides et al 1994)
Multifidus dysfunction does not spontaneously restore following resolution of pain and disability (Hides et al 1996)
Specific retraining does restore dysfunction (Hides et al 1996)

26. TrA contraction is delayed during normal movements in subjects with low back pain (Richardson et al 1999)
Mulifidus function can be affected by spinal surgery
Atrophy of multifidus has been shown to be more prevalent in post operative patients (Jull, et al 1999)

27. Sherington’s Law of Reciprocal Inhibition:
Tight Muscles inhibit the functional antagonist.
Leads to Positive Cross Syndromes of the lower or upper limb
TIGHT MUSCLE WILL INHIBIT IT’S FUNCTIONAL ANTAGONIST. EXAMPLE: THIGH PSOAS (MOST ATHLETES) INHIBIT FUNCTIONAL ANTAGONISTS - DEEP ABDOMINAL WALL, TRANSVERSE ABDOMINIS, INTERNAL OBLIQUE, MULTIFIDI, DEEP TRANSVERSE SPINALIS MUSCLES AND GLUTEUS MAXIMUS. THUS THE STABILIZATION AND COUPLING PHASE WILL BE REDUCED INCREASING THE MOVEMENT PHASE & MUSCLE FORCES AND DECREASING EFFICIENCY.

28. Gluteus Maximus and minimus are inhibited in most athletes due to tight psoas (Summer, 1988).
ATTEMPTING TO GET EXTENSION DURING JUMPING, COULDN’T EXTEND THROUGH HIP USING GLUTEUS MAXIMUS DUE TO PSOAS TIGHTNESS
HYPEREXTEND AT THE KNEE AND DRIVE THE INFERIOR POLE OF THE PATELLA INTO THE FAT PAD CREATING THE INFLAMMATORY RESPONSE. (SUMMER, 1988).

29. Poor recruitment in the local stabilisers can lead to over- activity of the global stabilisers to compensate.