PT414 8 Core Stability and Motor Control

What is back pain mostly caused by?

dysfunction in core

What is the Eular model?

large (global) muscles create large compressive forces in the spine

List the 4 outer (global) core muscles

• external oblique
• rectus abdominis
• latissimus dorsi
• erector spinae

What is the high threshold strategy?

adaptive strategy mediated by the CNS in response to pain where there is increased neural drive to the global muscles and designed to be short-term

When does the high threshold strategy become detrimental?

when global core muscles are inappropriately active during activties

What does the high threshold strategy increase the risk for?

ligament tear and more back [ain

What is the motor control model?

local inner core muscles control vertebrae at a small scale and have reactive control with less muscle activation and is anticipatory

What type of muscle fibers are used by the inner core?

slow twitch fibers at submaximal contraction

List the 4 muscles that make up the inner core

• diaphragm
• transverse abdominis
• pelvic floor
• multifidus

What is apical breathing?

breathing mostly through the upper chest

What is paradoxica;l breathing?

during inhalation, abdomen goes in and inferior
during exhalation, abdomen goes out and anterior

What is the progression for diaphragmatic breathing?

• hooklying
• hooklying at 90/90
• prone
• quadruped
• half-kneeling

How would a patient perform a rib grab for diaphragmatic breathing?

rotate to the barrier and take a breathe, then exhale when rotating further into the motion

How would a patient perform cat cow for diaphragmatic breathing?

extend neck on inhalation and flexion spine and neck on exhalation

What is the origin of the TrA?

deep lumbar fascia

What muscle has decreased thickness if a patient has chronic back pain?

TrA

What muscle is activated before the deltoid when lifting the arm?

TrA

What is the abdominal drawing-in manuever?

slowly draw in lower stomach toward spine via volitional training and contract TrA with as little internal oblique activity as possible

What does RUSI determine?

if there is a global or local muscle contraction and can provide biofeedback
- looking for presence/absence of external oblique

List 3 things that are being assessed for volitional training of TrA

• contraction quality
• symmetry
• global substitution

What 2 things should be avoided when performing a TrA draw in?

• posterior pelvic tilt
• other muscle activation

What is the dosage for a TrA draw in?

hold 10 sec for 10 reps with minimal effort

What is the progression for TrA draw ins?

• hooklying in supine
• prone with scapular retraction and T-spine extension
• quadruped
• half kneeling
• advancing to reflexive level

What is the major role of the pelvic floor muscles?

incontinence

How do the pelvic floor muscles contribute to control of the lumbar spine and pelvis?

stiffening the SI joint and increasing intra-abdominal pressure

Describe a good PFM contraction

can stop flow completely

Describe a weak PFM contraciton

can partially stop flow

Describe a very weak PFM contraction

flow isn't stopped

Describe poor pelvic floor contraction

contraction pushes more urine output

What is the lumbar multifidus responsible for?

inner core stability at multiple vertebral segments

What muscle is turned off if there is back pain?

multifidus

What type of training should be first when working the multifidus

reflexive training, then volitional training

How would a patient perform volitional training of the multifidus?

attempt to contract lumbar multifidi muscles into fingers

List 3 ways to perform reflexive training for the multifidus while in a split stance

• weight shift - co-contraction with TrA
• contralateral arm lift
• hip hinge

What multifidus exercise can be performed in isolation and progressed to an alternating pattern?

prone arm and leg raises

How would you differentiate between multifidus and erector activation?

• multifidus = contraction toward ceiling
• erectors = medial pull

List 2 progressions from the prone arm and leg raise

• quadruped contralateral arm lift
• bird dogs

How would treatment be progressed once local core volitional motor control has been established?

integrate core function into a functional pattern per neurodevelopmental progression

What is the pelvic tilt core progression?

• hooklying -> marching -> 90/90 -> deadbugs
• lumbar flexion -> back flat

What type of rolling pattern is desired?

segmental, not rolling

What obliues are activated during a rolling pattern?

ipsilateral internal oblique and contralateral external oblique

What obliques are turned off during a rolling pattern?

contralateral internal oblique and ipsilateral external oblique

What is rolling a progression from?

TrA draw in

List 6 ways to correct rolling

• cervical rotation
• dissociation
• traction or distraction of stance limb
• band to pre-engage core
• hard rolling
• going down wedge

What does functional rolling look like?

multifidus activation precedes prime mover activation

What does dysyfunctional rolling look like?

multifidus muscle onset, latency is reduced relative to the activation of the anterior deltoid

What can cause someone to not be able to segmental roll?

faulty sequencing of lumbar multifidus firing

What is hard rolling?

opposite elbow contacts knee or same side elbow to knee

What is the quadruped power position a progression from?

posterior pelvic tilt

How should someone lift past a neutral spine when in the quadruped power position?

10%

List 7 progressions from the quadruped power position

• knee lift
• shoulder tap
• downward dog
• leg slide
• assisted bird dog
• kneeling chop and lift
• standing SL desdlift