Core stability

2 muscle types

• movement

  • consist of big muscles, fast twitch fibres → dynamic → move joints

• stability

  • consist of smaller, deeper muscles + slow twitch fibres in other muecles

  • low grade contraction that lasts, provides support + control

need both muscle types for successful function

Whats responsible for stability at various joints

Upper quadrant

• GHJ → scapula muscles tg = stabilisers for shoulder mvnt

  • middle + lower traps position scapula on chest wall

Lower quadrant

• spine + trunk = multifidus + transversus abdominus (TrA) → support for trunk and lower quad mvnt

• glut medius = NB at hip to support pelvis in WB acts

• vastus medialis at knee

Why does back pain happen + 3 subsystems

Back pain occurs when deficit in one subsystem can no longer be compensated for by another

3 subsystems are matched

• if have passive failure → will lead to muscle dysfx → changes in control → pain

Spinal stability (PASSIVE) (ligaments + art surfaces)

• interspinous + supraspinous ligaments + facet joints + joint capsules + intv discs = stabilising structures for trunk flexion

• ant long. lig + ant aspect of anular fibrosis + facet joints = stabilise end range trunk ext

• intervertebral discs + facet joints = rotational mvnts

Spinal stability (ACTIVE)

• consists of spinal muscles + tendons

• Lumbar spine = unstable at low loads when muscles removed

• Shows muscles are essential for spinal stability

• Muscle activity = critical even for light tasks

Spinal stability (NEURAL)

• Neural control = receives input from passive + active subsystems

• Determines what's needed to keep spine stable

• If neural control dysfunction + not restored after injury → other spinal structures at risk of injury

• LBP patients = often have persistent neuromuscular control deficits

• Recovery of proper neural control = NOT automatic after initial injury

Evidence base for core

TrA + multifidus = role in stabilising lumbar spine

TrA activates before + during unilateral arm + leg movements

Multifidus

• deepest layer of back muscles

• global muscles (erector spinae) run over it to extension movement

effects of LBP

• transversus abd affected by LBP

  • loss of motor control (timing of activation, delayed activation, activation → phasic instread of tonic)

• multifidis adversely affected on ipsilateral side as symptoms in LBP

  • fatigueability, activation, muscle composition, muscle size

Same core stability theories applied to chronic neck pain & headaches → focused on deep neck flexors + upper quadrant postural muscles as foundation for functional rehab.

Principle remains: stabilisers must work first before optimising others

Pilates + core stability

• Pilates focuses on central core (pelvic floor, diaphragm, TrA, multifidus) → "centering" refers to this core.

• Pilates = one method to activate & train spinal stabilisers if taught properly.

Where are we now with ideas on stability ?

• Core stability ideas have been challenged recently as pain science evolved.

• Biopsychosocial model says physical deficits aren't the only cause of pain — rehab must consider everything.

• Focus on encouraging movement (not just rigidity), and core should work with other muscles, not be seen as more important.

• Stability and movement systems are not separate — they function as a continuum, with muscles and joints sometimes doing both at once.

• Core stability alone improves LBP in the short term but not long term, where general integrated exercises are just as effective.

• There's some evidence that improved core strength enhances athletic performance. The focus should be on overall motor control and control during functional tasks.

NB things to note

• Exercise and movement = key to recovery; avoid sedentary.

• Match stability with dynamic mobility. Build rehab around patient's goals & needs.

• No muscle group is more important than others — all work together for function.

• The spine is not fragile — don't discourage movement or encourage too much stiffness, and avoid catastrophising about the back pain.

Assessing trA

2 methods:

Pressure biofeedback unit (objective measure of fx)

Method:

1. Before beginning explain anatomy and function of muscle

2. Prone lying, arms at side, neck straight if able or forehead resting on hands

3. Biofeedback cushion under abdomen with top edge in line with ASIS

4. Inflate cushion to 70mmHg

5. Without breathing activate TrA (pelvic floor, zip, hammock)

6. Pressure on cushion should decrease by 8-15mmHg

7. Hold for 10seconds while breathing diaphragmatically

8. Repeat 10x

Hands on monitoring (needs good palpation skills, useful if taught properly)

Manual method:

1. Before beginning explain anatomy and function of muscle

2. Crook lying

3. Physio and patient, palpate TrA 1cm in and 1cm down from ASIS

4. Breathe or sigh to relax abdominals

5. Without breathing activate TrA muscle (Pelvic floor, Zip, Hammock)

6. Palpate for contraction

7. Hold contraction x10 diaphragmatic breathes

8. Repeat 10x

Tricks:

• breath holding, recuiting rectus, recruiting obliques (watch bulge) + shallow breathing

Multifidus retraining

• standing/lying → pt to palpate MF

• bulge muscle under fingers w/o active lumbar extension

• hold contraction with diaphragmatic breathing

Assessing multifidus

• palpation

• prone lying w head in neutral

• palpate muscle at each segment adjacent to spinous process on L + R side

• breath in/hour, sigh to relax

• command = gently swell out your muscles under my fingers without moving your spine or pelvis

• hold 10x diagphragmatic breaths

• repeat at next level then compare

TrA retraining

Stage 1

• and drawing in to activate TrA + hold for 10 secs

• use preferential activation w expiration

• exercise e.g. = hundreds

Stage 2

• challenge core contraction with diff positions

• apply to sport/function

• modify starting positions

Stage 3

• introduce fx limb mvnts to challenge core contraction

• use pressure biofeedback for ex in crook lying, sitting, standing while maintaining pressure on cushion

• start w closed chain ex

• choose ex based on pathology/fx/requirements of job or sport

Stage 4

• incorporate core stability into fx + dynamic ex

• reate ex to job/sport + apply sport training situations

make sure you can do this

Could you explain purpose

Demonstrate ex in steps

Set up posture and starting position

Facilitate mvt and gradually withdraw your input Introduce breathing

Use visualisations

Slow progressions – keep reviewing the basics!