A New Approach to Core Stability © 2019

A New Approach to Core Stability © 2019

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A New Approach to Core Stability

Written by Lisa Howell

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Disclaimer The contents of this manual, including text, graphics, images, and other material are for informational purposes only, and is provided as an accompaniment to the online video course. Nothing contained in this manual is or should be considered or used as a substitute for professional medical or health advice, diagnosis, or treatment. The information provided in this report is provided on an “as is” basis, without any warranty, express or implied.

Never disregard medical advice from any treating doctor or other qualified health care provider or delay seeking advice because of something you have read in this document. We urge that dancers seek the advice of a physician or other qualified health professional with any questions they may have regarding a medical or health condition. In case of emergency, please call your doctor immediately.

The Ballet Blog holds no liability or responsibility for any injury or complication that may arise from following this information. Any use of this manual is voluntary and at your own risk. If you require further information about any injury, please feel free to contact us to organise an individual consultation either in person or via Skype/Phone.

Published 2019 by The Ballet Blog © © Copyright The Ballet Blog 2019

ALL RIGHTS RESERVED

Except for the purpose of fair reviewing, no part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or any information storage and retrieval system, without prior written permission from the publisher.

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Contents

Introduction 5 Part One - What Is Core Stability? 7

The Development of Stability 8 The Motor System 10 The Inner Unit 11 The Deep Back Muscles 12 The Outer Unit & Dynamic Slings 17 Fascia and its Influence on Stability 18

Part Two - Natural Core Development 21 Lack of Crawling or Natural Play 22 The Influence of Pain on Stability 24

Part Three - Core Stability Grading & Exercises 26 Grade One 28 Grade Two 39 Grade Three 47 Grade Four 56 Grade Five 65

Injuries Due to Instability 73 Disc Injury 73 Facet Joint Injury 75 Spondylolisthesis 76 Rehabilitating Back Injuries in Dancers 78

Related Resources 81

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Introduction By far one of the major problem areas that we see as therapists working with dancers, athletes, office workers and weekend warriors alike is in the the area of “Core Stability.” The issues we see are two-fold. On one hand, very few people have good natural core control and dynamic stability of the spine. Lack of true stability of the spine leads to over compensation by other structures which leads to many of the injuries that we see in the clinic. This is especially true for young dancers who are training specific movements over and over again.

On the other hand, many dancers, athletes and other individuals who have been involved in Personal Training, Physio or Pilates classes are performing “core” exercises that may focus too much on control or restricting movement by bracing. Often we discover that the very exercises that individuals are using to try and better themselves are actually part of the problem. Over recruitment of muscles can cause just as many, if not more issues, than weakness in muscles, and this often happens when individuals have been formally taught how to move.

What is needed is a radical rethink of what ‘core stability’ actually is, and a new approach to training stability in dancers which is built up over the years. When addressing it when there is an issue with stability in older dancers, we need to make a careful assessment of each individuals movement strategies, isolate their specific weaknesses and a develop a carefully considered retraining program to retrain stability.

When we ask most dancers what they do for their ‘core training’ we get the common reply of “Planks, Sit-ups and Crunches”. These exercises are not necessarily “bad” exercises, however the problem is in the way they are performed if the individual lacks the control to do them properly. Also, if they are not movements that are a part of our normal movement in daily life, then excessive training of them can lead to altered movement patterns when it matters most! Training your stability should be done in accordance with what you actually have to do in life, whether that is sitting in an office, lifting a three year old, or performing a Grand pas de deux in a Classical Ballet.

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This program aims to give you a completely new approach to the development of core stability in your own body, whether you are young a dance student, a professional dancer, an office worker or a keen athlete. I aim to give you an insight into the nature of true core stability and how it can be developed naturally over the years, rather than with the onset of problems and pain.

Stability of our spine is one of the most important factors in staying vibrant, vital, happy, healthy, and physically capable as we age. If we are intrinsically more mobile, or spent many hours training in our youth; learning how to correctly stabilise our own spine can give us greater insight into how to train our students. As the demands on dancers placed upon dancers increases through challenging choreography, acrobatics being included in dance, and ever increasing ranges of motion becoming ‘normal’, effective and specific training is becoming more and more essential into the long term health of our dancers.

Thank you for taking the next step in your own professional and personal development, and I look forward to sharing the jewels that I have discovered in this area of training with you.

Kindest regards,

Lisa Howell

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Part One - What Is Core Stability? Before we can start training it, we need to know what ‘Core Stability’ actually is. There are so many myths in the fitness, health and exercise world around ‘Core Training’ and it can get quite confusing when trying to work out what approach is best. Some of these are variations on a vaguely correct theme, however many are outdated and trained poorly. To understand why these exercises are not so great, as we l l as how to do them properly, we need to look at the anatomy of the abdomen, and of the whole human body. We also need to look at all of the latest research to understand the best approach in training stability of the spine.

True Core Stability is not: • A ‘Six Pack’ • Being able to do several hundred sit ups • Doing a ‘plank’ for 5 minutes • Being able to ‘brace’ yourself in any position

True Core Stability is: • The ability to control the spine dynamically - that is - with movement. • Fine co-ordination of all of the muscles that control your trunk, not just the

abdominals. • The ability to adjust the level of control needed, depending on the situation. • Creating a stable base off which to work the limbs. • Keeping the spine and pelvis stable in motion to allow smooth and effective transfer of force

through the body.

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The Development of Stability

Stability should naturally be improved as we progressively go through each of the developmental stages that we experience, as babies, infants, toddlers, children, adolescents and adults. It is determined by our physicality, our life experiences and our emotions, and sometimes it all works brilliantly. However, sometimes it doesn’t. For a variety of reasons certain individuals may miss important physical milestones, or fail to make certain connections in the chain. Some possible factors that may interfere with the natural development of stability are outlined below.

Being born prematurely As well as having less time in the womb to fully develop, time spent in an incubator in the first few weeks of life, with movement limited by wires and tubes may have an effect on the development of a new babies natural movement patterns.

Being swaddled as a baby Thomas Myers wrote a very interesting article about the development of fascial lines in utero, and how swaddling a new baby may shut down some of the already developing pathways in the body. Crawling Crawling is an essential developmental stage and if it is missed out, or limited, this may have an effect on the stability of the child. This may happen for any number of reasons, from the season that the baby is born in, the weight of the child (bigger babies sometimes find it harder to sit up and to move) and even cultural differences may play a part. I have found that some nationalities discourage crawling in young babies, preferring to carry the child or have it in a pram.

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Personality Personality is involved in so much to do with the development of our physical body: From the “Me Too!” attitude that brings a child into standing early (thus limiting the amount of time spent crawling), through to the postural habits of introverted adolescents and their extroverted, confident peers, how we feel about ourselves truly shapes us.

Physicality The sports and hobbies that we are exposed to will have an impact on how our physical body develops, either positively or negatively. An active young boy who is encouraged into martial arts may do better long term than one who is made to sit and study chess. A young sprinter will develop differently than a swimmer, and a Jazz dancer differently to a girl learning Flamenco. The way we move and hold our body has repercussions on the amount of muscle control we have in certain areas, as well as our patterns of flexibility or restrictions.

Pain We will discuss this is more detail later, however it is important to realise that pain can interfere with the development of stability enormously. Whether due to an acute injury such as a broken bone, period pain, or abdominal bloating due to food intolerance, pain in a limb or in the abdomen for any period of time may affect a persons movement patterns and their development of stability.

Organised vs Natural Activity Many parents, eager for their children to be physically capable will put them into dance class and swimming very early. The child may also be learning an instrument or another language, all of which are wonderful things. However, we must also look at how much active ‘play’ time children have. Time in unstructured play, such as climbing trees, monkey bars or playing on a playground helps develop strength and stability in many different directions, rather than in the very specific movement patterns in classical ballet.

If a child didn’t do any of these things, all is not lost, as in this program we are going to go through a sequenced process of developing stability in each direction, so that we can develop any of the missing connections needed for optimal stability. Good things can take time, but progressively rebuilding true core stability with these things in mind, will ultimately help your students enormously with their stability!

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The Motor System

When most people think of core stability, they think about muscles. While muscle activation does play a part in stability of the spine, its not always in the way most people think.

There is a very sophisticated network of muscles that help us to both control and move the trunk. Each set of muscles has its own role, is specially shaped and positioned for this this. It is therefore very important that when training the muscles, they are trained in a similar way to how they are designed to work. This is especially true if you are training stability in athletes or dancers who use extreme ranges of motion. Knowing the anatomy and correct functioning of this area not only allows you to train more safely, but also allows you to achieve faster and more efficient improvements in range and control to accelerate the development of technique safely.

Some muscles are very deep and small, and designed to stabilise the spine. These muscles have a higher proportion of ‘slow twitch’ or tonic muscle fibres, which means that they are designed to activate at a low intensity for a long period of time. I call these muscles Postural Muscles or The Inner Unit . These muscles tend to be quite thin, and sit very deep inside the body, close to the bones and joints.

Then there are muscles which are much larger and lie over top of the small muscles. They are sometimes called the Superficial Muscles because they are close to the surface. These muscles are physiologically designed to contract strongly to create movement, and then relax, therefore they may be called “movement or phasic muscles”. These muscles have a high proportion of ‘fast twitch’ muscle fibres that are very powerful but fatigue quickly. If the small inner muscles are not working for whatever reason, the movement muscles may assume the stabilising role, however because they are not physiologically designed for stability problems including muscular pain or a lack of flexibility may develop. This kind of dysfunction will then interfere with the Outer Unit’s role in dynamic stability.

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The Inner Unit

The Inner Unit is a very special group of muscles that are the true basis for effective core stability. The Inner Unit can be inhibited by pain so must be specifically retrained after any back injury. This includes back pain, pelvic pain (period pain) or pain from surgery (such as having your appendix taken out). The Inner Unit is made up of the following muscles;

Transversus Abdominis (TrA) TrA is the true, deep abdominal muscle. This muscle wraps around the mid section like a corset. The fibres lie horizontally. When this muscle activates it does not move the spine in any way but narrows the waist slightly. It gently tightens the ‘fascia’ or fibrous sheaths that attach into the spine, stabilising it. If there is pain in a specific area of the spine, one isolated band of this muscle may switch off, creating instability at one or two joints. This can happen following abdominal surgery (ie Appendectomy) or pregnancy and childbirth.

The Pelvic Floor These muscles not only help to control when we go to the bathroom but also control our core stability! They are linked to the deep abdominals and deep back muscles and help to keep tension in the fascia through the pelvis, lower abdomen and back. Again, the process of delivering a baby can have a huge effect on your pelvic floor, but women are not the only ones who have weaknesses in this area. Many younger women and girls, as well as men can be quite weak in their pelvic floor.

The Diaphragm Many people do not understand the importance of the diaphragm in core stability, however it is essential. The breath is the driver for all core stability with the “stretch to shorten” reaction of the core allowing for ongoing connection. If you hold your breath while doing any abdominal exercises you will increase the pressure in your internal cavity as it is a closed system. This can put a lot of pressure on your low back so it is best to focus on breathing out if pressure is increasing in other areas of the inner system during an exercise. Many types of stability training advocate specific breathing techniques for certain exercises (ie 100’s breathing in Pilates) however I tend to advocate breathing normally as much as possible. All of this training is trying to get the inner and outer units functioning as they should naturally, so we want the movement to be as non-constructed as possible.

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The Deep Back Muscles

Multifidus, Rotatores and Intertransversarii There are several small deep back muscles which are very important in stabilising the spine, especially in hyper-mobile people who have more flexible ligaments. The one we talk about the most is Multifidus, which act to extend just one or two joints in the spine, but the others are also very important in controlling segmental stability of the spine in all directions. If higher level exercises are attempted without appropriate activation of the deep stabilising muscles of the spine, this will simply result in excessive contraction of the more superficial muscles resulting in stiffness and pain.

In young children who live an active life, and have their stability challenged in all different kinds of situations, they should activate naturally, however, in older individuals, or after an injury, they may need to be specifically retrained.

These deep small back muscles are under a lot of strain in hyper-mobile people, and especially when sitting or standing in a flexed position. Unfortunately, these little muscles can get inhibited by pain, so if you have some pain in your back, or any abdominal pain, you may have to reduce the pain before you can effectively strengthen them.

If the back has been sore for some time, a therapist will be able to feel specific levels where the Multifidus is not active and teach you how to regain control of these individual levels. The exercises here will help with the general tone of these muscles, but you may need specific retraining if the pain does not settle. It is important that you do not simply grip on with the big back muscles for this exercise but feel a deep control from within.

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Preparing the Spine - Somatic Tucks and Tilts

If there is any pain in the spine then this will inhibit exactly the muscles that we are trying to activate. If the deep muscles are inhibited due to pain, then any attempts to strengthen will simply result in tension in the outer global muscles. It is far better to spend some time clearing out any pain or restriction in the spine before commencing any strengthening.

We use this simple process of self mobilisation to correct any small restrictions or pain in the low back. It works very well for most instances of back pain, however if you have persistent pain that does not clear with this technique then we highly advise that you get this seem to by an appropriate health professional before progressing any further with this program. This technique works by taking the back into a non painful positions and performing very small, pain free movements of the lumbar spine. This exercise is excellent for improving the control of your lower back. A restriction in just one or two joints in the lower back can cause a loss of range and can result in pain in the lower back. It is also a great way to assess your range in each direction.

Finding Neutral Lie on your back, with the knees bent and the feet in line with your hips. Make sure that your spine is in neutral, with your shoulders and neck relaxed. Neutral spine is a position where the triangle formed by the two hip bones and the pubic bone lies horizontal to the floor. This position is different for everyone, and should be found by the position of the front of the pelvis, not the shape of the back, however try to keep the ribcage relaxed.

Tuck (Lumbar Flexion) Using as little muscle tension as possible, slowly roll your pelvis back so that your lower back flattens into the floor. Make sure that your deep abdominals are hollowing as you move, rather than bracing or bulging. Try to get the feeling that the bones are moving themselves, rather than contracting muscles to make the movement happen. Note any points of tension in your lower back.

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Tilt (Lumbar Extension) Now reverse the movement, by tilting the tip of the sacrum to the floor. Try to just move the lowest part of the back (only 2 – 3 vertebrae) and keep the ribcage still. Your body should not move up and down on the mat. Note any points of tension and whether you are tighter on one side than the other. Usually when performing this exercise, one direction will feel freer than the other. To improve this, notice the restricted/painful movement, move into the opposite direction, and then use an alternative movement to restore movement to the joints.

For instance, if arching (extending) the low back is restricted or painful, take the back into flexion (flattened) and then use a small hip hitch movement from side to side (see below) to open and close the joints in the low back. Keep the correcting movement very small, slow and deliberate. There should be no pain with the correcting movement. After performing ten of the correcting movements, return to neutral and then reassess the flexion/ extension movement. Side to Side (Lumbar Side Flexion) Next, keeping the front of the pelvis horizontal with the floor, slowly pull your right hip up towards your right lower ribs. Focus on contracting your side muscles and lengthening out your left side. Repeat to the left, noticing any restriction, pain or difficulties in co-ordinating the movement. If there is pain or restriction in lifting one side (ie Right hip hitch), use the opposite direction (left hip hitch) and the opposite movement (flexion and extension) to fix it.

Rotation Then, try rotating the pelvis from side to side - taking one hip bone up to the ceiling, while the other moves towards the floor. Both knees should stay pointing at the ceiling. Often this movement is simply uncoordinated, rather than painful so simply practice the movement slowly ten times.

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Figure 8 (Combined Movement) Once you can perform all directions (flexion, extension, left and right side flexion, and rotation) you can combine them all by moving the pelvis in a figure 8 or infinity sign movement. This movement takes some people a while to master, but it is an excellent way to get all of the small muscles in the low back and pelvis working together, and gently mobilising and stabilising the spine, without having to do each one individually!

1. Start by rolling up the sacrum, to flatten the lower back into the floor…

2. Then roll over the top of the left buttock, down the side of the left buttock…

3. …underneath the left buttock to take the back into extension.

4. Then roll up the centre again and repeat on the right.

5. Repeat several times in that direction then reverse the movement, rolling down the centre of the sacrum and under each buttock.

6. Try different magnitudes of movement, from very large to very small to improve your control of this area.

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Activating the Inner Unit - 6 Dimensional Breathing

This is a wonderful way to start getting the core facilitated naturally. The first part focuses on getting all parts of the lungs correctly involved in breathing, and then using a breath out to facilitate a gentle “collecting” of the inner unit. It is less about “switching on” or “contracting the core” and more about allowing the body to go back to its natural way of working. Try to keep all breathing exercises slow, low and quiet, and make sure that the outer abdominals stay relaxed.

Front and Back Place one hand on your diaphragm, just under your ribs at the front, and the other under the back of your ribcage. Close your eyes and observe your natural breath, then, gently try to even it out to expand equally front and back. This may take practice as many people do not use the back of their lungs!

Side to Side Place your hands around the sides of your ribcage. Feel for whether the bases of the ribs expand evenly, or whether one happens before the other. Try to gently even it out so that this happens evenly. Up and Down Place two fingers in the hollow where your two collarbones meet, and the other hand low on the front of the pelvis, just above the pubic bone. When you breathe in the diaphragm contracts downwards, and pushes the abdominal contents and organs down. When you breath in, imagine expanding from top to bottom, and then deflate when the air leaves.

Collecting the Core Place your fingers in a triangle on your low abdomen. Take a breath in and expand in all 6 directions, then breathe out with a long “Shhhh” sound. Feel the low abdomen, pelvic floor and deep back gently “collect” as you exhale. Repeat this 4 times.

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The Outer Unit & Dynamic Slings

The Outer Unit of the core stability muscles is of great importance; however some muscles of the outer unit are often over-trained and relied on too heavily by dancers and other athletes. A strong outer unit is effective when it is supported by a strong inner unit, and when the muscles are used in conjunction with other muscles in dynamic slings, rather than when trained and used alone. For example: The Rectus Abdominis is an important muscle for a dancer, but is often trained in crunches - from neutral moving into flexion. However, in reality it is needed in controlling and recovering from a back bend, and so should be trained in extension, once the spine is stable, along with the other muscles that feed into the Superficial Front Line (Myers).

The Obliques (both Internal and External) are also extremely important for dancers as they are involved in so many movements. They should be trained in carefully as their effectiveness is dependant on a strong and stable spine. The External Oblique works in conjunction with the opposite Adductor group and is often termed the Anterior Oblique Sling. When this sling is working well it helps to stabilise the dancer in a développé devant.

The Latissimus Dorsi and Gluteus Maximus form part of the Outer Unit via a fascial sling called the Posterior Oblique Sling. This helps stabilise the back body in many positions, such as in an arabesque. There is also a Lateral Sling which uses the simultaneous contraction of Quadratus Lumborum, Adductors and Gluteus Medius to stop sinking into the supporting hip. Training these slings may be done in many ways, and the exercises that we do in this course will give you lots of ideas for working with your students.

If part of the inner unit is not working for any reason, and there is compensatory gripping of the outer layers, they will not be available to work in this Outer Unit system of Dynamic Slings. If harder ‘core’ exercises are attempted by an individual who does not have true deep core control, excessive tension will build up in these outer muscles, which usually leads to the development of chronic stiffness and pain.

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Fascia and its Influence on Stability

In Level one, and in the Front Splits Fast program we looked at Fascia and its role in flexibility. However one of the main roles of fascia is stability. If this is trained dynamically, it results in freedom of movement, superior strength and control, all essential elements in a highly functioning body. However, if the system is not trained, or moved well, then sections of the fascial system thicken up - leading to restriction of certain movements, and over stretching of other areas.

Thinking of your habitual posture that we discussed in Level 1, what dynamic slings or fascial trains do you think may be:

Tight?

Weak?

Active?

Overactive?

Overstretched?

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Part Two - Natural Core Development When babies are still developing they learn to push off the walls of the womb to turn themselves around. When they come into the world they reach out with their hands and feet, searching for something to press against. Most often we swaddle young babies to contain their limbs, but some schools of thought fear that this may break down the already developing fascial lines in the body. If a babies heel can be guided towards the floor they will often learn to roll much faster by utilising the spiral line. Practising this movement can help restore a natural flow to your movement, and kick start some of the deeper, intrinsic stabilising habits that you may have lost.

Start on your back with the feet wider than the mat. Place your hands on your hip bones initially to become aware of the natural movement sequence. Press one foot very gently into the floor and feel what happens to the hips. The hip of the same leg should rise slightly up from the floor as the heel is pressed, starting a spiral movement of the spine. Release the pressure and try with the other side.

Gradually increase the magnitude of the movement and feel the hips start to move more freely. Notice as the spiral starts to move up the spine and just how little pressure it actually takes to move the body. Keep your hands on your hips initially and keep the back of the head and shoulders resting on the floor. These movements should not be painful. If there is any pain with this movement it is quite possibly due to an unstable segment that needs to be looked at more carefully.

Finally, add on a reach with the arm and feel how this affects the movement. Try to use as little conscious contraction of specific muscles for this exercise. Instead, let the bodies natural, intelligent patterns begin to remember an easy way of moving.

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Lack of Crawling or Natural Play

For many reasons, some children fail to crawl for very long as an infant and miss out on the natural strengthening of fascial slings, especially the Anterior Oblique Sling. This often results in the rounded tummy, anteriorly tilted posture that can be very hard to correct. Lack of this sling development may also occur due to the sedentary lifestyle that many people have, and the lack of outdoor space to play in that most children have.

If this sling is not well defined, the child will often tend to sit back into their knees, and slump through the upper body. They will often lack the strength and endurance needed to be able to hold a good position for any period of time, and will need constant prompting to “stand up straight!”

Some young people lack the varied physical exercise needed to develop these patterns naturally or only perform certain movement patterns in their structured dance classes. However, there are lots of ways to bring fun and engaging exercises into the studio, that will have many benefits on both cognitive and physical development.

While playing with my three year old nephew, who is obsessed with animals, I started exploring different ways of moving on all fours. Exploring the difference between the quality of a cat, a rhino and a gazelle brings forward all kinds of movement patterns! However, I am certainly not the only one to play with this, and there is a nice series of exercises which can be found online in the “Animal Flow” series by Mike Fitch. Animals to try include: Frog, Ape, Beast, Crab, Crocodile and Scorpion.

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Crawling

While crawling should be one of the most natural movements, for many people it is surprisingly difficult. However, with a little focused practice, restoring the natural crawling motion can have a huge influence on your overall stability, especially on the Anterior Oblique Sling.

Crawling A Start on all fours, then lift the right hand and the left knee off the floor. Place hand and knee forward slightly and accept weight onto them before lifting and replacing in the starting position. Repeat on the other side. Do this several times, using the opposite arm and leg each time, with a small stability ball paced at the top of the Sacrum to check for stability, before starting to do the second crawling exercise.

Crawling B Once you can perform the transfer of weight while keeping the ball stable, try sequencing it together to perform normal crawling. Keep it slow and deliberate initially, making sure not to sink into the supporting shoulder or drop the pelvis over the supporting leg too much. If you have any issues with your knees it may be wise to wear some knee pads when doing these exercises. Perform ten crawls forward, and then reverse back to your starting point. You might like to try balancing a yoga block or small stability ball on your pelvis to maintain stability.

Crawling C Once you can crawl easily on your hands and knees, try increasing the load by starting in a 4 point hover position. Crawl forward with opposite arm and leg as for the first variation.

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The Influence of Pain on Stability

Due to how pain interferes with the natural firing of the deepest stabilising system, it is essential to deal with the real cause of pain rather than trying to battle through. Many people try to “strengthen their back muscles” to fix the pain, however, most of these exercises simply develop more tension in the already overused global muscles. Techniques to relieve pain include heat, gentle stretches, soft tissue massage, supported sitting, gentle traction and postural modification.

It is essential that if there has been pain or dysfunction in the low back, the process of developing stability of the spin and pelvis is taken slowly and carefully. Overloading in different directions is fine for uninjured, active children, but is not the best once an issue has already developed. This may require hands on manual treatment, heat, acupuncture, taping or other modalities, and is it is best to do this under the guidance of a qualified allied health practitioner.

Our Core Stability Grading and Exercise chart is in constant revision, and is purely a framework for you to develop out your own sequences. A good exercise is to consider the most appropriate placement of your favourite “core exercises” and see how balanced your program is. Many people may be very stable in one position yet be unable to maintain a level one stability in another.

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Part Three - Core Stability Grading & Exercises Once correct firing of the inner unit has been established, we need to work through a grading system that assesses and develops stability in all directions. The following table will help you guide any student as to where they are strong, and where they need to improve. Note that crunches and plank are on here as exercises, but only after they have learnt the appropriate awareness and control of the deeper inner unit. Using this form as a screening and training tool has dramatically increased the core control of our clients and gives them concrete goals of what they need to achieve next.

The exercises are split into different positions, and progress through five grades of difficulty. Often, and especially if an athlete has already been doing some “Core Stability” exercises, they will be much more stable in one direction that the others, due to their current training program. Please note that this chart can be modified to include many other exercises, and is by no means an exclusive list of the core stability exercises that we give to students. It is simply designed to get you thinking about the different directions of stability, and multiplayer movements that are necessary for a comprehensive stability program.

The grades that we work on are progressed with added complexity and require fine co-ordination rather than adding load to develop strength. You can also tweak the tempo as another variable.

Grade 1 - Able to maintain isometric contraction (>10 breaths, or up to 30 seconds) of the deep inner unit muscles without compensatory movement of the spine, or global stabilisation, whilst maintaining normal breathing.

Grade 2 – Able to maintain contraction 10 breaths / 30 seconds with superimposed slow movement of the limbs.

Grade 3 - Maintain appropriate control and perform slow controlled movements of the trunk, and/or more loaded movements of the limbs.

Grade 4 – Able to maintain appropriate control and with dynamic movement of the spine .

Grade 5 – Able to maintain appropriate spinal and pelvic control while performing, faster movements of trunk, limbs or resistance. May be done on an unstable base and/or be sport specific.

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Perfect Form Physio Core Stability Assessment & Training

Position Grade 1 Grade 2 Grade 3 Grade 4 Grade 5

Supine / On Back

Crook Lying, Inner Unit

Activation & Hold for 30

seconds

Cushion Squeezes

Knee Openings

Leg Slide

Arm Float

Knee Fold I

Knee Folds II

Bug Legs

Toe Taps

Basic Crunch

Pelvic Roll vs Bridge

Full Range Crunches

Oblique Crunch with Cushion

Squeeze

Pelvic rolls on ball

Ball Crunches

“Charlies Angels”

Chair Exercise with Twist

Side Lying Side Lying, Inner Unit


seconds

Balance on Side

Side Lifts with Variations

Side Lifts with Flutter Kick

Dynamic Side Plank

Modified side plank with thread and

Open

Sides on Ball

4 Point or Prone (On Stomach)

4 Point Position Inner Unit


seconds

Paw Lifts

Leg Slides

4 Point sit backs and forward lean

Crawling

4 Point Flitter

4 Point Hover

Prep for plank

Thoracic Sliding

Stingray

Ball Flitter

4 Point to Down Dog

Ball Walkouts, Pike, leg lift

Crawling beast on toes

Push ups with wobble board

under feet

Sitting Sitting in neutral,

unsupported, Inner Unit


seconds

Foot Circles

Knee lift

Arm Lift

Seated Lean

Sit to stand

Sitting on a ball - Pelvic tucks

and tilts

Controlled Side Flexion and

rotation

Seated Forward bend

Extension in sitting

Seated lean back on small stability

ball

Boat Pose

Seated on Ball with knee lift and rotation

Standing Standing in neutral, Inner

Unit Activation & Hold for 30

seconds

Stork test

Arm floats against wall

Wall Squats with neutral spine

Waiters Bow

Lunges, and Dynamic Lunges

Triangle Pose

Dynamic Lunge with Twist

Theraband Pull Backs - Various

Kneeling on Ball, With Rotation

Sports Specific Wobble board

Variations

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Grade One

Grade One focuses on being able to maintain isometric contraction (>10 breaths, or up to 30 seconds) of the deep inner unit muscles without compensatory movement of the spine, or global stabilisation, whilst maintaining normal breathing. This is done in a position aimed to facilitate stabilising role of key muscles, and we use a lot of palpation of the external global muscles to make sure that they are not taking over. Mastering the art of maintaining a good spinal position, held with subtle activation of the deepest possible muscles can be literally life changing!

Finding the right cues for you to correctly activate those deep stabilising muscles does take some practice, however the 6 dimensional breathing technique works well for many people. Every practitioner and teacher has their favourite way of cueing the core, however the interesting thing is that the same words may produce a completely different pattern of muscle activation in some individuals.

This is where visual ultrasound comes in handy as you can check exactly what happens with each cue. You can try activating pelvic floor and Transversus Abdominis in several different positions, and in each one, aim to keep the outer abdominals relaxed and breathe normally.

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Visual (Real Time) Ultrasound

The best way to check the correct firing of the deep inner unit is by using a Visual (Real Time) Ultrasound machine. These are becoming more frequently used by therapists to image the firing patterns of the deep inner unit of muscles that are too deep to see. I recommend that EVERYONE get this done at least once, so that you can check how good your control of these muscles really is. I once went to a workshop with 25 Physiotherapists, where only two of us could actually correctly isolate Transversus Abdominis, and this was due to the fact that we had had a machine already!

The Ultrasound can be used to look at Transversus Abdominis, Pelvic Floor and Multifidus. You can also use it to check the firing of the deep turnout muscles! It helps each individual work out the exact cuing that they need to use to get the correct pattern of muscle activation of all of the deep muscles.

Function of these muscles can be checked with activities such as coughing and laughing, as well as more formal exercises. Weakness can be isolated to just one level, or it may be over a large area. Using the ultrasound helps increase the effectiveness of the rehab and can result in very quick improvements in specific control of previously unseen weaknesses. The machine is not used at every session, but may be used to assess the function of the inner unit, teach the exercises, and then to retest function after a period of training. I highly recommend finding a studio that has one of these machines if you are delivering any kind of “core training” in your studio or clinic.

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Supine/On Your Back

Most people find it easiest to find the subtle activation of the deepest core stabilisers lying on their back as it is a very supported position. This allows us to totally relax the outer global muscles and focus on getting the inner unit firing. However, if you have already done a lot of abdominal work in the past lying on your back, it may be hard to switch off your old engrained pattern. In this scenario, we recommend starting in an alternative position to find the subtle contraction, and to then try it lying on your back.

1. Lie on your back with your knees bent. Find a neutral spine position by tucking and tilting the pelvis then come to rest in the mid position with the triangle of the front of the pelvis is horizontal to the floor.

2. Place one hand under your low back to check for movement and to check for contraction/relaxation of your big back muscles. Place the other hand on your hip bone, front of the thigh, or your low abdomen. Focus on internally lengthening your spine from the top of your head to the tip of your tail bone.

3. Try each of the following cues and see which is easier to feel • Practice the collecting feeling from the 6 Dimensional Breathing exercise • Gently pull up internally, like you are trying not to go to the bathroom • Hollow out the lowest part of your abdomen, maintaining neutral spine • Imagine a piece of elastic connecting your pubic bone with the base of your low

back, and pull these two points together • Imagine a point five centimetres deep in your abdomen pulling up internally to sit

under your navel (or if you are female, your Ovaries lifting) • If you are a male, imagine drawing up internally just in front of the scrotum.

4. Aim for a very slight hollowing of the lowest part of the abdomen, with no flattening of the spine. The abdomen should not push outwards or down at all and the rib cage should stay relaxed. The control should be dynamic rather than static.

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Side Lying

Many people forget to include stability exercises lying on their side into their program, but this is an essential element to consider. When we start moving around in three dimensions, the stability down the lateral line is a very important part. If it has not been trained at a low level, it will not be functional at a high level.

1. Lie on your side with your knees bent. Find a neutral spine position by tucking and tilting the pelvis then come to rest in the mid position with a very small arch in the low back, while remaining relaxed through the upper back.

2. Place a small folded towel or pillow under your side to avoid slumping down even when relaxing all of your muscles.

3. Place your upper hand spread out on your low tummy, with your thumb near your navel, and your pinkie finger stretching towards your pubic bone.

4. Completely relax your abdominals so that your belly falls out into your hand. 5. Focus on slowly gathering or collecting in the area of the low abdomen, pelvic floor

and low back as you did in the 3 Dimensional Breathing exercise, without any gripping of the upper abdominals.

6. Hold for three breaths, gently relaxing as you breathe in, and collecting again as you breathe out.

7. Relax everything again, and then repeat at least 10 times. Try it again, lying on the other side to see if one side is easier than the other.

8. Make sure to remain relaxed in your jaw and upper shoulder.

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4 Point

This is a nice position to get the feel of turning on your deep abdominals while keeping the outer ones relaxed, and to become aware of the ability to relax the upper abdominals and diaphragm while maintaining control a little lower. As postural muscles should be trained at a low intensity, just use 10% of your maximum effort when performing these exercises.

1. Start on your hands and knees, making sure not to hyperextend the elbows. 2. Make sure that there is a small curve in the low back, but do not sink the chest. 3. Lengthen the spine from the tailbone to the crown of the head. 4. If your elbows tend to hyperextend, then focus on keeping them soft. 5. Take a breath in and fill the diaphragm and belly, then slowly breathe out, feeling the

collection deep in the abdomen. 6. The skin of your low abdomen should start to draw in and up, but keep the upper

abdomen relaxed. 7. Hold the contraction and breathe normally for 5 counts. Relax and repeat 10 times. 8. Make sure the buttock muscles stay relaxed and the neck is kept long.

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Sitting

One of the most profound discoveries that students and teachers often make in our Core Stability workshops is how the way that they sit can affect the flexibility of their back, and more specifically how much pain they get. Many dancers slump in sitting, unaware of how this affects their spine.

If asked to sit upright, most dancers will try, but often fatigue after only a few minutes and end up slumping again. This is due to the fact that most people attempt to use their ‘Movement Muscles’ to sit up straight. The large Erector Spinae muscles are physiologically not designed to be held contracted for a long period of time. If they are held in a static position, they will get tense, sore and stiff.

Learning to sit on an unsupported chair but stabilising with the deep segmental stabilisers of the spine can offload these big back muscles leading to less back pain and ultimately, more flexibility in the back. This takes practice, but it is an essential step into developing true spinal stability, and freeing up the bigger muscles for their true roles.

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Finding your correct sitting posture

1. Start seated on the edge of a chair with your feet on the floor. Feel for the two knobbly bones just outside the top corners of your tail bone (PSIS)

2. Slump forward with the upper back and let the tail bone tuck under. 3. Sit up from the lowest part of the spine, keeping your upper back relaxed, and feel

the pelvis move as you roll over your sitting bones. Make sure that this first movement is isolated to the low back, keeping the upper back slumped forward.

4. Once you can isolate the movement of the low back, maintain a slight forward tilt of the pelvis and then allow the upper back to unravel into a relaxed neutral spine position. The aim is to hold neutral with very little activation of the outer back muscles, or the front of the hips.

5. Use your fingers to check for excessive contraction in these muscles as you gently activate your pelvic floor and deep abdominals, and then lengthen the spine from tailbone to the crown of the head. Once you have found a good position, then hold for 10 slow gentle breaths, before relaxing back into a slump and starting again.

6. Until you build the strength to sustain your posture in sitting without gripping, you may lean back in the chair, and use a pillow to help maintain neutral.

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Standing

Since we spend so much of our lives in standing, it is important to make sure that we have good stability of the spine in an upright position when moving around in our day to day activities as well as when dancing. Most of these standing exercises are best performed side on to or facing a mirror initially so that you can check the position of your spine throughout. However the best thing is really to be able to carry yourself feel throughout the day, no matter what you are doing!

To find a good standing posture may also take a lot of practice. Try the tips below to work out where in space your spine should be. Usually begin with weight bearing through the feet; there should be approximately 60% of the weight through the ball of the foot and 40% on the heel.

Many people tend to rock their weight too far back onto the heel and sway the knees backwards. They may then also push the hips forward, round the upper-back forward and push the neck forward. This is a very not conducive posture for living a pain free life!

An ideal alignment should result in the lobe of the ear, the shoulder, the hip, through the centre of the knee and a point just in front of the ankle bones falling in line. This is called your ‘plumb line’.

1. “Stand in parallel, with your feet slightly apart.” 2. “Make sure that your weight is spread evenly

through both feet” think tripod foot position. 3. “Have a very small arch in the lowest part of your

lower back” pelvis in neutral. 4. “Open your chest but keep your shoulders relaxed

and apart” 5. “Have your head aligned above your shoulders”

keep breastbone over the pubic bone. 6. “Feel lengthened through your entire spine”

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The Influence of Emotion on Posture

One of the biggest driving factors to how we hold ourselves during the day is our emotional state. In the last few years I have been using this concept frequently in rehab to help my clients maintain a good standing or sitting posture for longer periods of time. Ideally, our posture should be held as subtly as possible, with the most minimal amount of tension in just the right muscles.

Often when people have been taught to “correct their posture” they do so by generating a lot of tension in their big outer movement muscles. This results in a very temporary improvement in alignment, but os not sustainable as these muscles are not designed to stay contracted for long periods of time. What I have discovered is that certain emotions bring us either out of alignment, or towards a better alignment, however these are different for each individual. For instance, “Excited” for one person might bring them into a lovely light, lifted standing posture, however for me, this brings on too much muscles activation and makes me want to bounce around!

Identifying a positive emotion as a cue word for your postural control also has the added benefit of making you consciously aware of experiencing that emotion more often during the day. Since identifying “Compassion” as my cue word, I find that I am much more compassionate to many more people during the day! When you find yourself in a less-than-perfect posture, recreating the positive feeling in your body will help you regain a good postural position that you can then maintain with movement, rather than being rooted to one spot!

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Some people find this exercise very easy to do, while others find it hard. If you find it difficult at first, spend some time sitting on a park bench or a seat in a mall, and watch the posture of each person that walks past. See if you can identify how they are feeling (about life and about themselves) by the way they are holding their body. Write down each of the emotions that you see in others, and see if you can recreate them in your own body. Remember to look at happy, bouncy children, through to tired mothers and wise old men to get a full spectrum!

HOMEWORK TASK

An interesting exercise is to brainstorm as many different emotions as you can, and then create them in your body to determine which ones bring you into a good position and which ones take you out of it. You are aiming to find a nicely aligned standing posture with as little muscle effort as possible required to stay there. Try to get at least 40 different emotions, and then test them out. If you have difficulty actually feeling the emotion, this is ok, try imagining that you are an actor, and you have to portray the emotion on stage…

1 16 31

2 17 32

3 18 33

4 19 34

5 20 35

6 21 36

7 22 37

8 23 38

9 24 39

10 25 40

11 26 41

12 27 42

13 28 43

14 29 44

15 30 45

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Notes on Grade One _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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Grade Two

In Grade Two we start to challenge the endurance of the inner unit by adding in slow movement of the limbs. This can be done in any number of different ways but the focus remains the same - to maintain stability without any excessive gripping of the outer unit. Use your fingertips to check that you are not gripping with the big back muscles, arching or flattening the back, or letting the pelvis tilt to one side. Take these progressions slowly and carefully to make sure you are doing them correctly, as it is very easy to “fake” stability at this level by bracing. Some gentle activation of the outer muscles will happen during some exercises, however it should be a slow activation, just as much as is needed, rather than a sudden grabbing feeling. If the movement muscles are being excessively used at this level, they will not be available when we need them later on.

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Supine

Cushion Squeezes Once you can activate the inner unit, try adding an inner thigh squeeze against a small ball or cushion. This allows you to check how well you can maintain inner unit control with more load on the outer unit. Visualise the thigh bones coming together in parallel, making sure not to let the big back muscles or the muscles at the front of the hips contract. Hold for three natural breaths. Release the inner thighs, but maintain Pelvic Floor. Repeat ten times.

Knee Openings This is good for isolating rotation of the hip from the stable pelvis. Lie on your back, with the spine in neutral and fingertips on your hip bones to feel for excessive movement. Slowly lower one knee out to the side, using a gentle inner contraction to ensure that the hips stay stable, and do not rock to the side. Slowly return the leg to the starting position. Repeat to the other side. Make sure to use the Inner Unit only for stability, don’t grip with the obliques or the big back muscles.

Notes: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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Leg Slides Leg slides help isolate leg movement from that of the pelvis. Start as for Knee Openings but slide one foot away from you, rather than dropping the knee to the side. Be careful when changing legs that there is not a dramatic shift in the position of the pelvis. If you extend the leg too far or too fast before you are strong enough to control it the pelvis will invariably tilt forward. Variation: As you slide the first leg back in, begin sliding the other leg away.

Arm Floats While this looks like a very simple exercise, many people struggle with it due to tension in their upper back. Start in neutral with your arms by your sides. Slowly raise the hands to take your arms above your head while maintaining neutral. You can do this one arm at a time so that the other hand is available to check the tension in the back. If you find it hard to maintain neutral when taking your hands overhead, try some fascial mobilisers for the thoracic spine before doing this exercise.

Knee Folds I Make sure to maintain neutral spine without gripping with the big back muscles throughout this exercise. The pelvis will tend to roll back when you lift the leg if the Multifidus muscles are not active. Slowly lift one knee until the thigh is vertical, and shin is parallel to the floor. Ensure that the hips stay stable and the back does not flatten or arch. Slowly return the leg to the starting position. Make sure spine does not arch as you lower the leg. Repeat to the other side. Try to keep the upper chest and neck relaxed, using your diaphragm to breathe.

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Side Lying

Once you move from lying on your back in such a supported position it is harder to avoid using the global muscles for stability and they will need to come on a little. However, try to have any activation of the big muscles come on gradually and as you need them, rather than a sudden gripping. As the levels progress it is essential that you are using just the right amount of muscle at the right time to maintain flexibility and functionality of all of your muscles. While it seems like a simple thing for many people, some really struggle when lying on their side, and many find one side much more stable that then other.

Balance on Side Simply lie on your side, with one arm stretched out as pillow for your head. Have the legs fully extended so that you are lying in one straight line. Place your fingers very lightly on the floor and test your stability taking them off the floor. If there is pain in your hip lying on your side, fold in the ends of a towel to make a hollow for your hip bone.

Side Lifts This exercise focuses on the Lateral System as well as the Anterior Oblique System. Start by lying on your side with one arm up by your ear, supporting your head. Rest the fingertips of the other hand gently on the floor. Make sure your feet are a little bit further forward than your hips. Activate your inner unit, then slowly lift both legs just off the floor and hold for five seconds. Repeat for ten repetitions each side. If one side is a lot harder that the other, doouble up on the weak side. Variations: 1. Palm facing the ceiling or the floor 2. Top hand on your hip 3. Close your eyes 4. Place a small ball between your ankles

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4 Point

Paw Lifts Find neutral spine in the 4 point position. Have the knees directly under the hips and the hands under the shoulders. Keep the ribcage gently floating up away from the floor and the neck long. Slowly transfer your weight onto one hand and lift the other hand just off the floor. Make sure not to sink into the supporting shoulder or elbow. Replace the first hand and repeat to the other side. The more stable you are, the less you will have to shift your chest from side to side.

Leg Slides Start in the same position but keep both hands on the floor. Slowly transfer the weight onto one knee and slide the tip of one toe out behind you. Keep the hips and shoulders stable as you slide the leg out and back in. Transfer to repeat on the other side with as little shifting through the pelvis as possible. This exercise can be done with a soft small stability ball balanced where the sacrum meets the low back.

4 Point Sit Backs Start on hands and knees in neutral spine. Sit the sitting bones back to the wall behind you, maintaining neutral. Common mistakes include allowing the tail to tuck under, or sinking the upper back into extension. Initially this exercise may be done with a pole along the back to get an awareness of maintaining neutral. Once you can shift the weight backwards, try shifting it forward over the hands .

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Sitting

Once you are able to maintain a good position in unsupported sitting for at least 30 seconds (without gripping with the big back muscles) it is good to practice challenging the stability of the spine by adding movements of the arms and legs. The bigger muscles will have to come on a little at some point, but it should be a slow stiffening, rather than a spasm or gripping sensation. It is good to do these exercises side on to a mirror so that you can use visual feedback to confirm that you are maintaining neutral spine throughout.

Foot Circles Sitting on the front of a chair, spine in neutral and big back muscles relaxed. Transfer your weight onto one foot to release the other. Draw slow clockwise circles with the free foot, monitoring the tension in your low back and the position of the pelvis with your fingertips. Do ten slow circles in each direction, with each foot. Keep the foot on the floor, and ideally use socks on a wooden or tiled floor so that your foot slides easily.

Knee Lifts Start by sitting in neutral, and again use fingertips to check the position of the pelvis and the tension in the low back. Slowly transfer your weight to one side and lift the heel of the opposite foot off the floor. Slowly peel the entire foot off the floor, keeping the pelvis still and the spine in neutral. Replace the foot carefully to the floor, and then repeat on the other side. Repeat at least ten times, alternating between legs.

Arm Lifts Sit on the edge of a chair, with both feet flat on the floor. Place one hand on your low back with the thumb in the big muscles on one side of the spine, and the fingertips on the other. Adjust the position of the pelvis, and use the collecting feeling in your low abdomen until there is very little tension in the big back muscles. Slowly lift the free arm up the front, through 90 degrees, and then up over your head. Note any points where the big back muscles want to grab on. Slowly lower the arm, and repeat at least 10 times on each arm.

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Standing

Obviously we all spend quite a bit of time in standing so it is essential to gradually build our stability in standing as part of our core program. Many people complain of getting a sore back when they are standing at a function or spending a long time shopping. This is usually because the big back muscles are getting overloaded for a job that they are not designed to do. We must learn to use the deeper stabilisers for endurance, and just use the bigger movement muscles to contract and relax for movement, over a stable base.

Single Leg Balance / Stork Test Stand in parallel with the thumbs on the knobbly bones at the back of your pelvis (Your PSIS). Transfer your weight to one foot and slowly float the opposite knee up to 90 degrees. Make sure to soften in the front of the lifted hip, imagining the top of the thigh bone sinking back deep into the hip socket. Make sure that the back of the pelvis stays level, by creating a tiny lift in the deepest low back muscles. Replace the foot to the floor and repeat ten times on each leg, alternating.

Arm Floats Against Wall Stand in a mini squat, with the spine in neutral at the wall. Monitor the tension of the big back muscles with one hand. Float the opposite arm up above your head whilst maintaining relaxation of the big back muscles. Repeat this ten times for each arm. If you are able to do this at the wall, try doing it in unsupported standing. As the arm moves your centre of gravity is shifted slightly, so note the changes that you need to make to the balance point of your feet to keep the back in neutral and the big back muscles as calm as possible.

Wall Squats with Neutral Spine Start in neutral spine at the wall, feet in parallel and the knees slightly bent. Slowly bend the knees deeper to slide the pelvis down the wall, maintaining neutral and controlling the movement with the legs. Return to standing using your gluteals to power the movement. Make sure that the low back does not flatten or arch when moving up and down. There should be no pain in your knees with this exercise.

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Notes on Grade Two _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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Grade Three

In Grade Three we start to add on more load and introduce movement of the trunk in relation to the limbs. Make sure to keep the focus on using the inner unit muscles as possible to maintain stability, as you will soon need to use the outer muscles for movement.

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Supine

Heel Press Lie on your back in neutral with one foot holding a large stability ball up on the wall with the knee at 90 degrees. Place one hand under the low back to check for movement, and the other at the front of the hip to make sure they stay relaxed, or on the gluteals to make sure they activate. Press the heel into the ball quite firmly, focusing on driving the leg from the gluteals rather than the knee/quads. Hold for five seconds, then relax and repeat ten times on each leg.

Knee Folds 2 - Prep Many people do a variation of this exercise however they miss out on most of the benefits as they are not doing it correctly. Take time to work through the modifications until you are able to do it properly. You should not feel any strain in the back with this exercise.

Only take both legs up if you are sure that the back is not moving and the tummy is controlled. Lie on your back in a neutral spine position. Gently collect in your low abdominals, but keep breathing naturally. Slowly lift one knee up to 90˚. Hold the knee with your fingertips, or use the ball of the foot on the wall for stability. Lift the second leg to 90˚, making sure that the tummy stays hollow and the back does not change position. Lower the first leg back to the floor, and then the second, keeping the deep collecting feeling in the low abdomen and the back in neutral.

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Toe taps Once you can have both feet off the floor without letting the low abdomen bulge out, you can progressively increase the load. Keep one hand under the low back to check for movement, or gripping, and the other on the low abdomen to check for bulging. Slowly lower the tip of one toe down to the floor, keeping the leg bent at 90 degrees. Return to the starting position and then repeat with the other leg. Alternate side to side for at least ten repetitions each.

Basic Crunch Maintaining Neutral Start lying on your back with the legs bent, or extended to ensure that you do not overuse your hip flexors. Place one hand behind you head to support the neck in a lengthened position, and the other on your low tummy to check for bulging. Slowly peel the spine off the floor, bringing your ribs towards your hips, keeping flat through the low tummy, hold, then lower slowly. Imagine you have a very ripe mango placed between your chin and your chest to maintain a long neck.

Bridge It is good to be able to isolate movement of the hips from the spine, and a simple bridge is a great way to do this. The aim is to keep the spine in neutral and extend the hips using your gluteals. Many fitness instructors ask clients to not use their gluteals for this movement, but I cannot understand why this would be desirable. If you do not use your gluteals then you will overuse the hamstrings and back, two areas where people are often very tight anyway!

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Side Lying

Side Lifts with Flutter Kick Start as for the normal side lifts, with your top hand on your hip. Once in the lifted position start kicking the legs back and forth, as though you are swimming. Start off very small, and gradually increase as you master the isolation and control needed to keep your hips still with leg movement. If you feel any discomfort in your supporting hip, simply fold up a towel to create a hollow for the Greater Trochanter.

Leg Swings Keep the underneath leg slightly bent on the floor, and the lifted leg horizontal. Keep your top hand on the hip to check for movement of the pelvis. Slowly take the foot of the lifted leg forward without losing neutral spine. Then take the heel back, to take the leg behind you, without letting the pelvis tilt forward. Repeat, alternating the leg from front to back in a range and speed that you can control. Aim for 20 swings with each leg.

Side Plank Start by sitting on the side of your hip with the legs extended and feet stacked on top of each other. Place the forearm of your underneath hand on the floor, palm down. In a slow, smooth movement, press up into a stable side plank position. Maintain regular breathing and hold the position for 10 seconds. Repeat ten times on each side. Feel a gentle collection in the low abdomen with each breath out.

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4 Point 4 Point Flitter Start in the 4 point position as for each of the other exercises. Place a small stability ball on the area between your Sacrum and your low back to check for movement. Slowly extend one arm forward, and the opposite leg back behind you. Hold momentarily, then return to the starting position, and repeat to the other side, with as little shifting through the pelvis as possible. Keep the ribs gently pressed up away from the floor, and the neck long.

4 Point Hover Start in the 4 point position, then tuck your toes under, and lift the knees just off the floor, maintaining neutral spine. Hold, maintaining regular breathing for five breaths, then lower the knees and sink the hips back into Childs Pose to rest. Repeat ten times, or as tolerated by the wrists. You can place a folded towel or mat under the heels of the hands to take the pressure off the wrists.

Prep for Plank The plank exercise is often included in core stability classes however it is usually done very poorly. Focus on maintaining the spine in neutral and relaxing the neck rather than on how long you can stay up in the position. Start in 4 point. Keeping the pelvis in neutral, straighten one leg behind you and place the ball of the foot on the floor. Accept your weight onto this leg, and then take the other leg to meet it in the plank position. Make sure that the spine is still in neutral and the neck is long. Bring the knee of the first leg back to the floor and then follow with the second. Repeat ten times, alternating legs.

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Crawling A While crawling should be one of the most natural movements, for many people it is surprisingly difficult. However, with a little focused practice, restoring the natural crawling motion can have a huge influence on your overall stability, especially on the Anterior Oblique Sling. Start on all fours, then lift the right hand and the left knee off the floor. Place hand and knee forward slightly and accept weight onto them before lifting and replacing in the starting position. Repeat on the other side. Do this several times, using the opposite arm and leg each time, with a small stability ball paced at the top of the Sacrum to check for stability, before starting to do the second crawling exercise.

Crawling B Once you can perform the transfer of weight while keeping the ball stable, try sequencing it together to perform normal crawling. Keep it slow and deliberate initially, making sure not to sink into the supporting shoulder or drop the pelvis over the supporting leg too much. If you have any issues with your knees it may be wise to wear some knee pads when doing these exercises. Perform ten crawls forward, and then reverse back to your starting point. You might like to try balancing a yoga block or small stability ball on your pelvis to maintain stability.

Crawling C Once you can crawl easily on your hands and knees, try increasing the load by starting in a 4 point hover position. Crawl forward with opposite arm and leg as for the first variation.

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Sitting Seated Lean This time we start moving the trunk in relation to the pelvis. Many people do this movement poorly hundreds of times a day and never realise how much instability it is creating in their low back. Mastering this movement and integrating it into your daily life will make a profound difference to your core stability. Sit side on to a mirror in neutral. Practice folding in the hips and leaning the trunk forward, maintaining neutral spine. Imagine the top of the thigh bone sinking deeply back in the socket and stay relaxed through the front of the hips.

Sit to Stand Start sitting upright on a stable chair or stool. Lean forward from the hips, keeping the spine neutral, and transfer the body forward and up into standing. Feel like someone is lifting you up from a string attached to your chest. Keep the heels on the floor, long arches of the feet lifted and knees over the 2nd toe. Return to sitting keeping the spine neutral and bending deeply into the hips. Repeat 10-20 times. Variation: Place a ball or rolled towel between the knees.

Sitting on Ball - Tucks and Tilts Moving the pelvis in isolation from the upper body takes practice for most people however if you have spent some time with the Somatic Tucks and Tilts it will be a lot easier. Ensure you have the correct sized ball. Your hips should be slightly higher than your knees in sitting. Keeping your shoulders and ribcage still, tuck and tilt the pelvis forward and back; hitch the hips side to side; rotate the pelvis keeping it level; then perform the figure 8. Focus on smooth flowing movement of the low back and pelvis in isolation from the upper body.

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Standing Waiters Bow Stand in parallel with neutral spine, with the knees soft and the spine in neutral. Watching your spinal profile in the mirror, hinge forward from the hips, letting the heads of the thigh bones sink back in the sockets and fold at the front of the hips. Make sure to keep the spine in neutral but take care not to over grip with the low back. Return to standing, and repeat 10 times. Try with feet in first position. May be done with the feet turned in or out for an extra challenge. Static Lunges Set yourself up by starting in a high kneeling position with both knees at 90 degrees. Ensure that the legs are slightly apart for stability. Tuck the toes of the back foot under and come into a standing lunge position side on to the mirror. Make a triangle with your fingers and place on the front of your pelvis, or hold your hip bones to check for movement. Slowly lunge up and down, as though you are a carousel pony on a vertical pole, keeping the spine in neutral. Try toontrol the movement from the gluteals of the front leg, rather than from either thigh.

Toe Taps Stand in parallel with your hands on your hips, fingertips feeling for the position of your pelvis. Transfer your weight onto one leg and take the lifted leg into the stork test as in Grade 2. Then tip the pelvis forward and tap the toe of the free leg to the back, keeping your hips level. Bring the pelvis back into neutral as you lift the knee again, and repeat ten times, maintaining neutral spine throughout. Keep your breathing natural and flowing, with a gentle collecting feeling in your deep core.

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Notes on Grade Three _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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Grade Four

In Grade Four we start integrating controlled spinal movement into the exercises. At this level it is essential that you have done the exercises in the earlier stages correctly. If at any point you feel the low abdomen bulging out, or the tell-tale shuddering of the movement muscles not knowing whether to stabilise or to move, then drop back to the previous stage and master that before moving on. You want to develop perfect firing patterns, rather than just “pulling it off ”.

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Supine

Pelvic Roll A Pelvic Roll is quite a different exercise to the Pelvic Bridge. Start with a gentle pelvic tuck and then continue peeling the spine off the floor one bone at a time. The aim is to roll up one vertebrae at a time, remaining relaxed in the neck and the shoulders. Note any areas of the spine that want to move as a block, or that do a sideways shift as you move through that part. Pause at the top of the movement, keeping relaxed through the neck. When you roll down, make sure not to close in through the chest but articulate through each level of the spine.

Full Range Crunches This exercise can be done over a Foam Roller or off the edge of a firm bed/table. It is an excellent exercise for any athlete who needs strength in extension. Start on your back with the Foam Roller just below your shoulder blades, spine in neutral. Slowly lower your upper body into extension, focusing on lengthening the sternum to avoid flaring the ribs or hyperextending the neck. Slowly curl back into neutral, and then continue curling forward into thoracic flexion, while keeping the neck long. This is a difficult exercise, so just do a few repetitions first. As your control and endurance improves, build to be able to do 20 repetitions.

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Oblique Crunch with Cushion Squeeze Start by lying on your back with a small ball between the legs and the spine in neutral. Place both hands under the back of the neck and lengthen the spine. Exhale to squeeze the ball and peel the spine up into an oblique curl, keeping the spine in neutral. The deep back muscles need to support the spine to stop excessive pressure on the discs as you increase the pressure in your abdomen. Focus on bringing your right ribs towards the left hip, rather than lifting too much. Keep the spine in neutral and the lowest part of the abdomen flat. As a variation, try taking the right hand to the outside of the left knee when curling up, but make sure that your shoulders stay wide.

Roll Backs Start sitting in front of a closed door, with a resistance band attached securely to the door handle. Ideally have the door locked. or opening away from you just in case someone comes through while you are exercising! Loop the free ends of the band around your hands so that you do not need to actively hold them. Sit up from the lowest part of the spine to start in neutral. Tuck the pelvis under, and then slowly roll down through the spine to bring the shoulders and back of the head to the floor against the resistance of the band. Take a breath in as you exhale, roll back up through the spine, articulating every joint of the spine, and using the assistance of the band to make sure that the low abdomen stays flat.

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Side Lying

Once you get past doing exercises in side lying, several other joints come in to play. Your shoulders, elbows and wrists should not feel vulnerable or painful with any of these exercises. If they do, please check with your therapist for modifications or additional strengthening that you can do to improve your stability. Sometimes simply placing a folded up yoga mat under the heel of the hand can make this more comfortable in the wrist, especially if you are hyper-mobile.

Dynamic Side Plank Start by sitting on the side of your hip, with the arm straight and the knees slightly bent. In one movement, straighten the legs, lift the hips and take the hand up towards the ceiling. Hold for three natural breaths, then return to the starting position, again in a single movement. Repeat ten times on each side, keeping the movement smooth and flowing, and the breathing natural.

Side Plank with Thread and Open Push up into a stable side plank, with the feet stacked on top of each other. Press through the supporting hand to stabilise the shoulder, then curl the free hand down in an arc, under the body, to touch the opposite side of the mat. Rotate the upper body, but keep the feet stacked on top of each other. Repeat the upper body movement three t imes before lowering the hip to the floor. Repeat this five times.

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4 Point

Thoracic Sliding Lie on your stomach with arms extended in a wide ‘V’ over a foam roller. Collect through your centre to draw the skin of the low abdomen away from the floor. Slide your hands towards you, extending the upper back and keeping shoulders away from ears. Keep the collecting feeling in the low abdomen throughout. Try to stay reasonably relaxed in the gluteals throughout this exercise. Variations: Try taking one arm to 5th position, and adding in a rotation. Can also be done with the hands on a small stability ball.

Stingray Start on your stomach with your hands under forehead. Lift the chest slightly off the floor, gently collecting through the low abdomen to stabilise the spine as you lift. Focus on creating space between the ribs on one side to side bend the upper back. Try not to crunch over or shorten the side waist. Return to neutral, maintaining regular breathing and repeat on the other side before lowering. Repeat five to ten times each side, or until fatigue.

Ball Flitter Lie over a large stability ball, with the spine in neutral. Have the balls of the feet and the finger tips resting lightly on the mat. Slowly engage your core as you lift the opposite arm and leg off the floor. Make sure not to over-stabilise, just increase the tension in your body as needed to keep steady. Replace the hand and foot and repeat on the other side, noting if one side is significantly harder than the other.

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4 Point to Down Dog Many people perform the Downward Dog position in yoga, but many people are not aware of keeping their low back in neutral. This takes a lot of awareness, and strength, as well as flexibility in the hamstrings. It is better to maintain stability of the low back and have the knees bent, rather than straightening the legs and losing neutral.

Start in the 4 point position with your hands under your shoulders and your knees under your hips. Tuck the toes under and slowly lift the hips up and back towards a downward dog position, maintaining neutral spine. Feel like someone is drawing your thigh bones back to the wall behind you. Hold for three breaths, then return to kneeing in 4 point.

Push Ups Maintaining a good position of the spine during push ups takes lot of awareness. Some people tend to arch their low back, while others tuck the tail under. Try doing this exercise side on to a mirror to check that you can maintain a small downward curve in the low back, and a small upward curve in the upper back.

Have the little fingers parallel with the edges of the mat so that the hands are slightly turned in. Slowly bend the elbows, keeping them pointed towards your heels to protect your shoulders. Your shoulder blades should stay wide and the movement slow and controlled throughout. No pain should be felt, either in the shoulders or low back.

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Sitting Controlled Side Flexion Start sitting in neutral with the big back muscles relaxed. Get a sensation of lengthening the spine then slowly start side bending to one side. Try to focus on lengthening the long side, rather than slumping down on the short side. Any activation of the back muscles should happen slowly and in response to the load, rather than gripping. This will usually happen on the side of the spine that is lengthening. Slowly return to neutral and feel the back muscles melt as you return.

Controlled Rotation Starting from a neutral sitting position, imagine the ribcage floating away from the pelvis and then slowly rotate it to one side. Again, activation will occur in the bigger back muscles, but this should be slow and controlled, rather than sudden gripping. Make sure that the sitting bones and the legs do not move too much as you rotate. Rotate back to the starting position and feel the big back muscles relax again. Repeat to the opposite side. Repeat, alternating sides, 20 times or until fatigue.

Extension in Sitting The focus for this exercise is slightly different, maintaining awareness on not collapsing in the low back when you extend. Aim to keep a very slight tension in your back as you lift up and extend the upper back, bringing the breast bone to horizontal with the ceiling. Pause, then bring yourself back to neutral. Each time go slightly deeper into the back bend. Mastering this exercise will help you prevent compression in the low back when performing extensions.

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Standing

Dynamic Lunges Prepare by starting in a kneeling lunge, with both knees bent to 90 degrees. Tuck the toes of the back leg under, and lift the knee just off the floor to hover in a low lunge position. Drive the back leg forward and up to come into the stork position, maintaining neutral spine. Then take the leg back and lower into a deep lunge. Repeat at least 10 times, using the gluteals of the supporting leg to drive the movement.

Dynamic Lunge with twist Repeat as for the dynamic lunge, but add in a rotation of the upper body at both ends of the exercise. Keep the eyes facing forward, and drive your arms as though you are running. Make sure that the opposite arm and leg are raised in front when in standing, and when in the low lunge position. Keep your hips square and rotate the thoracic spine as much as possible towards each wall.

Theraband Pull Backs There are several different variations of this exercise. Start in a neutral standing position, then slowly add load by adding a resistance band. Good directions to try initially include: down to your thigh; drawing the elbow back; raising the hand up and to the side; or even above your head. Try to keep the weight centred on your feet, and maintain neutral spine.

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Grade Five

In Grade Five we do step it up a notch and include multiple components in each exercise. There are many variations of each of these exercises, and it is good to try these so that you do not get conditioned into one particular pattern. By now you should be pretty good at stabilising the spine in all different positions, and the exercises, while challenging, should start to feel quite nice to do rather than hard!

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Supine

Ball Crunches Start sitting on the ball, with one hand on your hip and low abdomen, checking for building of the low abdomen, while the other hand supports under the base of the head. Make sure that the ball is the right size for you. When sitting on the ball your hips should be slightly higher than your knees.

Tuck your tail under, and slowly walk the feet away, scooping out through the low abdomen and flattening the low back into the ball. Continue to roll down through the spine, one vertebrae at a time, until your body is horizontal with the floor. Make sure that the ball is in the middle of the upper back and the hips are in neutral.

Slowly lower the upper back back into extension, maintaining control of the position of the pelvis. Back sure not to arch the low back, and keep the pelvic triangle horizontal with the ceiling. Curl the upper body slowly back up into a crunch, then lower back into extension. Repeat five times, before rolling back up into sitting. Repeat at least 5 times, making sure to make each crunch smooth and slow.

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Charlies Angels This exercise is very popular, and not just for the name! It is a great challenge to maintain the position of the pelvis, with rotation of the upper back on the unstable surface of the ball. Start by rolling down as for the previous exercise, but roll a little further out to have the shoulders on the ball. Take the arms forward and shape the hands into a gun! Keep the hips lifted away from the ball, and imagine a laser beam shooting under your low back that you need to keep away from. Keeping the hips high and facing the ceiling, draw the right shoulder back underneath you to take the upper back into rotation. Keep your head in line with the midline of your chest - looking along the line of your ‘gun’.

Chair Exercise with Twist This is a great exercise for developing control and stability around a central axis, while moving into rotation. Take care getting into and out of the position for this exercise. Place two chairs at either end of a yoga mat and make sure that they cant slide apart. Place your shoulders on one and your calves and ankles on the other. First, try drawing one leg up into a parallel retiré, maintaining neutral, not arching your back.

Once you can do this repeatedly on each side, try adding in a controlled rotation of the hips and lifted leg, while keeping your shoulders square on the chair. Maintain normal breathing throughout. This exercise can also be done taking the leg into a développé.

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Side Lying

Sides on Ball

1. Start by placing your hip on a ball and the feet on demi-point at the wall. Have your top leg forward, and make sure that you are high enough on the ball so that you don’t slide off it! Initially, you may like to get a partner to help stabilise the ball until you find your balance.

2. Slowly lower yourself over the ball, one vertebrae at a time, laying your side waist and then you ribs down onto the ball. Make sure to maintain a collecting feeling in the low abdomen, and keep the spine in neutral. Fully lengthen out your top side over the ball and take a deep breath into the ribs.

3. As you breathe out start to peel your side back up off the ball, focusing on folding in one rib at a time, until you return to the starting position. Keep the neck long and relaxed, and your elbows wide during the exercise. Repeat up to 20 times, but notice for the fatigue point. Many people are extremely asymmetrical in the strength of their sides, which often results in adage being much better with one leg in the air!

4. As a challenge, you may like to try the exercise with the legs the other way around, with the top leg to the back. Some people find this easier, and some find it harder. Experiment with different positions, but try to keep both legs bent to help protect the knees and back.

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4 Point

4 Point on Ball

Start with both feet on the floor, and both knees and hands on the ball. Make sure to slightly extend the lowest part of the back to maintain neutral spine. Rock your weight forward onto your hands and knees, and then slowly take the feet of the floor. Balance for 30 seconds, or as long as possible, maintaining natural breathing.

Ball Walkouts + Variations

Start off the mat with the ball under your hips. Walk forward on your hands, maintaining the spine in neutral. Keep the legs together and take small, controlled ‘steps’ with the hands, rather than rolling out all at once. Accept your weight onto your hands and continue walking out until the ball is under your shin bones, or even your feet. Keep the ribcage pressed up away from the floor and check the position of your spine in the mirror. Avoid sinking between the shoulder blades or in the low back, yet also avoid tucking the tail under and flattening the lumbar spine.

Variations: Try transferring your weight to one leg and lifting the other just off the ball, or bending at the hips and knees to draw the ball in towards you. You may also like to try a pike position, maintaining neutral spine as much as possible.

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Sitting

Boat Pose Sit on the floor with your feet in parallel and the knees bent to 90 degrees. Place your hands behind your knees and ensure that the spine is in neutral. Make sure to relax the back of the ribcage back, while gently bringing the low back forward. Exhale to collect the deep inner unit to stabilise in this position. Gently rock back as you lift both feet off the floor, maintaining neutral spine.

Variations: If you can maintain this position, challenge yourself by taking the hands away from the backs of the knees and keeping the spine in neutral. The shins can be relaxed down, horizontal with the floor, or fully extend the knees to take the toes towards the ceiling. Make sure to maintain natural breathing with all variations.

Sitting on Ball with Knee Lift and Rotation Start sitting on a ball, with the knees and elbows flexed to 90 degrees, palms facing up. Make sure not to overextend the upper back and keep the feet firmly in contact with the floor. Check that the spine is in neutral and maintain normal breathing, collecting the low abdomen with each out breath. Slowly lift the left knee, and simultaneously rotate the upper body towards the left. Make sure to keep shoulders relaxed, and rotate the body about a central axis. Pause for a moment, and then slowly return to the starting position. Repeat to the other side, taking note if one side is significantly harder than the other. Repeat at least ten times to each side. Variations: Try extending the knee of the lifted leg, making sure to still maintain neutral. Try adding a basic port de bras with the arms, and include upper back movement. Once you are really confident with this exercise, try doing it with your eyes closed!

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Standing There are an unlimited number of variations of core stability exercises in standing, so use your imagination! We want to get as close as possible to real life scenarios, so think of all the movements that you are required to do during the day, and see if you can come up with an exercise to challenge your stability during this task. This may be as easy as standing on a wobble board, or adding a resistance band to some limb movements.

Kneeling on Ball with Thoracic Rotation

Make sure to have a friend help you with this one first! Move from 4 point on the ball through to kneeling. Play with the position of the pelvis a little and use your inner thighs to maintain control of the ball. Once you have your balance, test your ability to rotate the spine by turning the upper body to one side. Repeat slowly to the other side. Once stable, try to increase the speed of rotation.

Sports Specific Wobble Board Variations

Standing on a wobble board challenges your stability in all areas of the body, but especially the ankle. Wobble board variations are often given following foot and ankle injuries, but they are a very handy too for all core stability training. Stand on the wobble board and try any of the other standing exercise variations including the Waiter Bow, Stork Test, Toe Taps, or even a developpé.

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Injuries Due to Instability The most common back injuries that we see in clinic that result from a lack of segmental stability are injuries to the disc (from too much flexion and rotation) or the pas interarticularis (from too much extension). While teachers will never need to identify these injuries, it is good to know what each of them are in case your students do get diagnosed with one of them. This will also help you help the student return to dancing safely.

Disc Injury

There are several different disc injuries that dancers may suffer from, and again prevention is always better than cure. Often the disc has been weakened by years of overloading with uncontrolled extensions and rotation, which can be prevented by improving range, stability and control gradually over many years.

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Annular Tear The Annulus Fibrosis is the multi-layered fibrocartilage ring that forms the majority of the Intervertebral Disc. Excessive twisting, flexion and extension of the spine, especially if focused at only one or two levels can cause premature wear and tear of this cartilage and result in a tear. Only the outer few layers of the disc are innervated (supplied by sensory nerves) so this may be pain free in the early stages, but is a big risk factor for developing more serious disc injury later on. As the disc has a very limited blood supply it does not actually have the capacity to heal itself very well, meaning that damage is often permanent. Prevention is always better, and working on the segmental stability of the spine, and gradually moving with control into more extended positions is the best way to avoid this kind of damage.

Disc Bulge

A bulge may happen when there is weakening of the wall of the Annulus Fibrosis, followed by an increase of the intra-abdominal pressure, or a flexion and rotation movement. The actual injurious movement in an acute disc injure may be very small, such as bending down and twisting slightly to tie up shoe laces, doing a sit-up while holding the breath, or even something as simple as coughing. Dancers with a disc bulge will often have to avoid flexion, which includes all forward bends as well as tucking the pelvis. Chronic tucking of the pelvis is actually a risk factor for disc injury as it inhibits all of the deep stabilising muscles of the low back.

Disc Prolapse

Once the Nucleus Pulposis has migrated from its central position, the dancer will constantly have to manage their spine in order to keep pain free. While a minor Disc Bulge may be managed via exercises and Physiotherapy, a major bulge or Herniation may require surgery, especially if there is any nerve compression.

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Facet Joint Injury

The facet joints are the only point of direct communication from one vertebrae to the other. Because of the extreme ranges of motion required in high level dance, good mobility at all levels in the spine is essential to avoid injury. If a dancer is pushed into a certain movement occasionally a facet joint will ‘lock’ with all of the small muscles around the joint going into spasm. This will have significant, and often painful impact on all movements that involve that joint.

Careful assessment and manual therapy to restore the mobility to that particular joint is essential to avoid any further injury or compensation. If stiffness develops as a result of injury to the ligaments surrounding one particular joint, the load will often be spread to the joints above and below that level, creating points of instability that are then more vulnerable to injury.

Therapists must make sure to clear the mobility of the joints in all movements, and in several different loading situations, before the dancer returns to his or her full work load. I.e. Lumbar extension is very different when done in standing (with gravity) compared to when lifting the upper body off the floor in prone (against gravity). It is also different again when working into an arabesque as there is also a rotation component, and the fascial tension on the system with change depending on the dancer’s upper back mobility.

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Spondylolisthesis

A Spondylolisthesis is a slipping forward (or backward) of one vertebral body on another. This may happen for various different reasons, most commonly due to a congenital Pas Defect (where the bones fail to form properly at one level) or from stress fractures due to constant overloading in extension. It can also occur due to degeneration or the presence of a tumour.

Dancers will often feel pain in extension that does not settle with rest. There may be some accompanying numbness and pins and needles sensations if the spinal cord is compromised. This injury can be very hard to rehabilitate in dancers, as the lower back is being constantly taken into extension, however it can be done. The most important factor for people with a Spondylolisthesis is avoiding extension at the level where the injury is. For many dancers, the low back extends even when taking the leg into a Tendu derrière. This extension is obviously much more advanced when taking the leg into the arabesque position.

Causes: The majority of cases of Spondylolisthesis in young people is due to excessive, uncontrolled training into extension. Prevention is always better than treatment, so we strongly advise teachers against letting young dancers work into extreme back bends, back scorpions and back mounts. Young spines are very mobile, and students will often not report pain while doing these exercises, however the constant pressure can lead to weakening of the bone in very important places. This can then lead to injury later on. In adults, the condition is usually related to degeneration, secondary to instability. Maintaining a good strong core, and working on improving your posture in standing (especially when pregnant) is very important.

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Symptoms:

While we usually discover this condition when a client presents with low back pain in the clinic, in the early stages it is not uncommon for a person with a spondylolisthesis to have no symptoms at all. Young students may be dancing with an unstable vertebrae without even knowing it.

The most common symptom of a low grade slippage (<50%) is that of lower back pain. Pain is usually worse in extension, such as in a back bend or in an Arabesque. Many performers put up with these symptoms for a long time before they come into the clinic for an assessment as they think that it is normal. Early detection is very important in preventing the injury from progressing, so if you do have lower back pain, then please get it checked out as soon as possible. Other common symptoms include tightness of the hamstrings and decreased range of motion and stiffness of the lower back.

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Rehabilitating Back Injuries in Dancers

I find rehabilitation of back injuries in dancers to be in some ways far more challenging than in ‘normal people’ but also in some ways easier. Dancers do need to be taught how to completely change their postural habits, stretching routines and core control, which can take long time, however, they are also often very good at attention to detail. One of the biggest issues in rehabilitating dancers with disc injuries is getting them out of an habitual ‘tucked’ position which holds them in a state of flexion in the lumbar spine. This requires a retraining of almost all of their positions and movements, both in and out of class.

If you have learnt the McKenzie method to treating disc injuries, this may still be of some benefit, however, I find it less effective in students with large amounts of extension range. The mechanics of the lumbar spine in a dancer with a disc injury are very different to that of a normally sedentary person. The dancer has usually weakened the Annulus Fibrosis by excessive movement in all directions, whereas the sedentary person has usually achieved this mainly by sitting and lifting with the spine in flexion.

Once the dancer has learnt how to stabilise the area with the ultrasound guidance, it is essential to learn how to transfer this control to all of their movements in class. This is extremely important in their standing posture, especially if they have a tendency to tuck the sacrum under, as this flexion inhibits the multifidus.

As dancers practice each movement hundreds and hundreds of times, it takes even more repetitions to retrain the brain into the correct way of stabilising the back in every single base movement, as well as all of the high level ones. The dancer must also be able to maintain good activation with movement, especially when landing from jumps. Even more importantly, for male dancers, they must learn how to stabilise the spine when performing Pas De Deux work, as this can place a huge amount of compressive load on the lumbar spine.

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Acknowledgements

Thank you so much to every single client I have ever worked with. Your uniqueness, challenges and feedback have helped me hone our programs to be the most effective and efficient way of dealing with common issues, with enough customisation to ensure great results for everyone.

Huge thanks must also go to the hundreds of dance teachers worldwide who have attended my Teacher Training courses, and given such positive feedback on the application of these pro-

grams. I thrive off the feedback you give me and and your infectious enthusiasm inspires me to keep on giving.

Lisa xx

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Related Resources

The Perfect Pointe Book This unique book gives you the extra help you need to really get strong enough for pointe work. It includes lots of exercis-es, divided into four simple stages to work on the flexibility of your feet and ankles, the strength of your little foot muscles, your turnout and your core control. It also guides you through tests for each stage so that you can work out where your problem areas are! This book is essential for any student preparing for, or already en pointe, an any teacher wanting to learn more about safely preparing students for the most beautiful of dance forms!

Injury Management Guides This series of Injury Management Guides is designed to help you understand any injury and empower you in managing your rehabilitation. Every dancer is different, and even two people diagnosed with the same injury may have totally dif-ferent causes and rehab plans. The huge amount of informa-tion included on injury prevention make them a great re-source for Dance Teachers who want to help the dancers in their care achieve their dreams without compromising their short term or long term physical health. The guides may also help health professionals convey more information to their clients in a shorter period of time, as well as understanding the complexity of rehabilitation of a dancer to full perfor-mance standard.

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A New Approach to Core Stability © 2019

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