Establishing Core Stability in Rehabilitation Chapter 5.

Establishing Core Stability in Establishing Core Stability in RehabilitationRehabilitation

Chapter 5

ObjectivesObjectives

DefinitionsOriginsBenefitsTheory/Posture and anatomyResearchPractical

WHAT IS CORE STABILITY?WHAT IS CORE STABILITY?

“The system the body uses to give spinal support and maintain muscular balance while at the same time providing a firm base of support from which other muscles can work to enable the body to undertake its daily tasks. It is through this system of joint integrity and support that the body is able to maintain its posture – the position from which all movement begins and ends”

Chek P. 2000

What is the CORE?What is the CORE? Lumbo-pelvic-hip complex Location of center of gravity (CoG)

Efficient core allows for Maintenance of normal length-tension relationships Maintenance of normal force couples Maintenance of optimal arthrokinematics Optimal efficiency in entire kinetic chain during movement

Acceleration, deceleration, dynamic stabilization

Proximal stability for movement of extremities

CORE STABILITYCORE STABILITY

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

Orthopaedic viewOrthopaedic view“That state of muscular and skeletal balance which protects the supporting structures of the body against injury or progressive deformity, irrespective of the attitude in which these structures are working or resting”

Academy of Orthopaedic Surgeons 1947.

NOT A NEW CONCEPTNOT A NEW CONCEPT

STATIC• Alexander TechniquePilates

DYNAMICTai-chi/KarateSwiss ball training

ALEXANDER TECHNIQUE ALEXANDER TECHNIQUE 1869-19551869-1955

PRINCIPLES– RE-EDUCATION OF KINAESTHETIC SENSE– QUIETING THE MIND TO FOCUS ON THE

MIND/BODY CONNECTION– ESTABLISHING A GOOD HEAD AND NECK

POSITION

JOSEPH PILATES JOSEPH PILATES 1880-19671880-1967

PRINCIPLES

– CONCENTRATION– ALIGNMENT– BREATHING– CO-ORDINATION– STAMINA

FITNESS PARAMETERSFITNESS PARAMETERS CARDIOVASCULAR STRENGTH / POWER/SPEED ENDURANCE FLEXIBILITY CORE STABILITY PROPRIOCEPTION / NEUROMUSCULAR

CONTROL

Paradigm Shift: No longer looking to Paradigm Shift: No longer looking to improve strength in one muscle but improve strength in one muscle but

improvement in multidirectional improvement in multidirectional multidimensional neuromuscular multidimensional neuromuscular

efficiency (firing patterns in entire efficiency (firing patterns in entire kinetic chain within complex motor kinetic chain within complex motor

patterns).patterns).

The TheoriesThe Theories

Spinal StabilityThe passively supported spine (bone and

ligament will collapse under 20lb (9kg) of load.

Muscular components that contribute to lumbo-pelvic stability which take up the slack

Control subsystem

(Neural)

Passive subsystem

(spinal column)

Spinal stability

Active subsystem(spinal muscles)

Adapted from Panjabi (1992)

Neutral Zone ConceptNeutral Zone Concept

Every joint has a neutral zone or position

Overall internal stresses and muscular efforts are minimal

A region of intervertebral motion around the neutral position where little resistance is offered by the passive spinal column (Panjabi 1992)

•Movement outside this region is limited by the ligamentous structures providing restraint

Control of the Neutral ZoneControl of the Neutral Zone

Ligaments - support end of range only

- Can be unstable/over-stretched

Muscle - Can compensate for instability

- Increase the stiffness of the spine

- Decrease the neutral zone

- Form basis for therapeutic intervention

in treatment of spinal stability

Clinical instabilityClinical instability

• A significant decrease in the capacity of the stabilising system of the spine to maintain the internal neutral zones within physiological limits which results in pain and disability (Panjabi)

Patho-Kinesiological modelPatho-Kinesiological model

Muscular system Articular system Neural system All three must work as an integrated unit The movement system requires optimum function

of the core stabilisers resulting in precise arthokinematics and osteokinematics (Sarhmann 2000)

Spinal StabilitySpinal Stability

Demonstrated that submaximal levels of muscle activation adequate to provide effective spinal stabilisation

Continuous submaximal muscle activation crucial in maintaining lumbopelvic stability for most daily tasks.

Benefits of Spinal StabilityBenefits of Spinal Stability

Improve Posture and prevent deformities More stable Centre of Gravity and control during

dynamic movements contribute to optimal movement patterns breathing efficiency Distribution of forces and absorption of forces Reduce stress on joint surfaces and pain Injury prevention and rehabilitation

Improved PostureImproved Posture

Re-education of stabilisersRe-education of stabilisers

Reduced stress on jointsReduced stress on joints

Reduced injuryReduced injury

Increase function and sports performance.Increase function and sports performance.

For Sporting PerformanceFor Sporting Performance

•Forces transmitted - trunk to the limbs

•Core muscles support the spine to transmit power from the trunk.

•Power is transferred for kicking and throwing activities

•If the peripheral limbs are too heavy this will cause stress on the chassis

Functional AnatomyFunctional Anatomy 29 muscles attach to core

Lumbar Spine Muscles Transversospinalis

group Rotatores Interspinales Intertransversarii Semispinalis Multifidus

Erector spinae Iliocostalis Longissimus Spinalis

Quadratus lumborum Latissimus Dorsi

Transversospinalis group Poor mechanical advantage relative to movement production Primarily Type I muscle fibers with high degree of muscle spindles

Optimal for providing proprioceptive information to CNS Inter/intra-segmental stabilization

Erector spinae Provide intersegmental stabilization Eccentrically decelerate trunk flexion & rotation

Quadratus Lumborum Frontal plane stabilizer Works in conjunction with gluteus medius & tensor fascia latae

Latissimus Dorsi Bridge between upper extremity & core

Abdominal Muscles Rectus abdominus External obliques Internal obliques Transverse

abdominus

Work to optimize spinal mechanics

Provide sagittal, frontal & transverse plane stabilization

STABILISING CORE MUSCLESSTABILISING CORE MUSCLES

THE INNER CORETransversus abdominusMultifidusPelvic Floor MusclesDiaphragm

The Outer Core SystemsThe Outer Core Systems Anterior Oblique – ext and int obliques and

contralateral hip adductors connected by anterior abdominal fascia

Posterior Oblique – Lat Dorsi and contralateral Glut Max connected by T/L fascia

Deep Longitudinal – Erector spinae and c/l sacrotubrous ligament and biceps femoris (connected by T/L fascia)

Lateral – Glut med and min and c/l adductors

TRANSVERSUS ABDOMINUSTRANSVERSUS ABDOMINUS

Transversus AbdominusTransversus Abdominus