Integration of Core Stability in Promoting Functional Gains

The core is the most integral component for building full body functional movement patterns. The terms ‘core’ and ‘stability’ are tossed around in our health and fitness world and the meanings are sometimes misconstrued. For starters, you can imagine the true deep ‘core’ as four muscles forming a canister around the thorax. The core is bordered superiorly (on top) by the diaphragm, anteriorly (front) by the transverse abdominis, inferiorly (on the bottom) by the pelvic floor, and lastly posteriorly (back side) by the multifidus. Although it might sound like I completely made up a few of these muscles, that is because they are some of the deepest muscles lying in this region and sometimes go unmentioned. Regardless we must all appreciate the functions each of these muscles have and how recruiting them appropriately will improve your quality of movement while reducing the likelihood of injury. According to the Panjabi Model there are 3 contributing factors to spinal stability as shown below.

Although I will be discussing more of the active subsystem or musculature involved in this interaction, it should be noted that our passive spinal column and neuromuscular components should ultimately be addressed to optimally ensure this desired spinal stability.

Lumbar Multifidus

This muscle was originally thought to have had some function in producing lumbar extension but more recent studies have suggested a strong stabilizing role. Being composed primarily of type I or tonic muscle fibers we hypothesize that there is more of a postural role being played (Sirca & Kostevc, 1985). Aside from helping control the spine in its neutral zone, the lumbar multifidus tensions the thoracolumbar fascia further stabilizing the core and spine.

Transverse Abdominis (TrA)

The TrA is the deepest abdominal muscle with fibers that run horizontally. This muscle is unique because it has a feed-forward loop in which it naturally fires to stabilize the spine prior to any body movement. For example every time you are bringing an arm overhead to stroke while paddling on a surfboard the TrA is firing to stabilize the spine. Over time if we practice compensatory movement patterns such as allowing our global muscles (rectus abdominis and obliques) to “over fire” we can lose the ability to recruit TrA and in turn lose some of our stability. As neuroscience research has indicated those movement patterns that we do not use, we lose (Kleim, 2008). Therefore it is crucial to re-train our TrA to function optimally to promote a healthy spine.

Pelvic Floor

Although it is an easily undermined area of focus, the pelvic floor muscles play an integral role in promoting core stability. These muscles resist increases in intra-abdominal pressure, which helps our core manage more complex movement patterns where many muscles are firing at once. Whether we recognize it or not, these muscles of the pelvic floor are contracting countless times throughout our day and when facilitated in conjugation with the TA, multifidus, and diaphragm can help keep the spine in its most stable position (neutral zone).

Diaphragm

Aside from its vital role of managing our breathing, the diaphragm is the largest contributor to our spinal stability through intra-abdominal pressure. According to Hodges et al. 1997, this muscle is needed to prevent displacement of abdominal viscera so that the TrA can increase its tension. This is important for our understanding moving forward as we should practice appropriate breathing techniques while exercising to further strengthen this muscle.

These muscular components discussed above can help improve spinal stability by incorporating simple exercises to your workouts. In most cases minor adjustments can be made to exercise technique to promote further recruitment of these local stabilizing muscles.

  • Prior to participating in sport activities, ask yourself if your body is as prepared as it should be and…
  • If you have already experienced some back discomfort consider how you can modify your training to focus on complete core stability to better prepare you to prevent injury.

Dr. Bryce Parrish

Physical Therapist

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What is pelvic floor physical therapy?? By: Dr. Rebecca Gasca, PT, DPT

In order to fully answer this question that I get on a regular basis, one must understand what the pelvic floor is. The pelvic floor is a group of muscles at the bottom of your pelvis that are essentially responsible for urination, defecation, and sexual activity.

5 “S” Functions of the Pelvic Floor

  • Support of abdominal and pelvic organs
  • Sphincter control of bowel and bladder
  • Sexual function such as achieving and maintaining arousal and orgasm
  • Stability across the pelvis and hips, including transferring force appropriately through spine to lower extremities
  • Sump pump, which is a muscular action that facilitates transfer of lymph (or swelling) from lower extremities and pelvis up through the trunk to be cleaned and recycled by the circulatory system

Now that we understand what a pelvic floor is, let us get to answering the mysterious question of pelvic floor PT.

Did you know:

  • 1 out of 4 women have one or more pelvic floor disorders?
  • 17% of women with a pelvic floor disorder will have urinary incontinence?
  • Nearly 90% of men that undergo prostate surgery will have a pelvic floor disorder?

That’s a lot of people! To put it another way, consider a few of these real life scenarios to help you relate.

Imagine you are a male cyclist with a new onset of groin and buttock pain. You have been to an orthopedic PT, which has helped most of your symptoms, but pain still remains. Pelvic floor PT can help with that! After the resolution of orthopedic impairments, there is a portion of patients that continue to present with symptoms referring from the pelvic floor muscles.

Imagine you are a female who celebrated the birth of her second child 2 months ago. You are experiencing leaking with strong urges to urinate and when you cough, sneeze, and laugh. Everyone tells you this is normal, but your gut tells you something just isn’t right. Your OB-GYN just cleared you to be able to have sex with your partner, but to your dismay you have to stop because it is painful. This concerns you because you’ve never had pain before. There is good news though, pelvic floor PT can address all of these problems! And chances are, they are all related.

OK, great!

What does a pelvic floor examination and treatment plan look like?

Depending on your medical history and subjective examination, your pelvic floor PT may recommend an internal examination along with a screen of external structures. Your pelvic floor PT has additional specialty education and training on how to properly assess and treat these issues. During the examination, your pelvic floor PT will be able to fully understand your mobility and strength limitations and devise an individualized program to help you reach your goals.

Stay tuned into our blog for new information coming out about specific pelvic floor conditions that can be treated with pelvic floor PT.


Rebecca

Dr. Rebecca Gasca

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