Transcript Lecture 12 core stablization 2016

CORE STABILIZATION
TRAINING IN
REHABILITATION
KINETIC CHAIN
REHABILITATION
 DEFINITIONS
 Functional kinetic chain rehabilitation:
“a comprehensive approach that strives
to improve all components necessary to
allow a patient to return to a high level of
function.”
While caring for the affected area remains
the foremost, clinicians have developed
interventions to treat the whole as well as
the part.
KINETIC CHAIN
REHABILITATION
 DEFINITIONS
Functional strength:
“Is the ability of the neuromuscular
system to reduce force, produce
force, and dynamically stabilize the
kinetic chain during functional
movements, upon demand, in a
smooth, coordinated fashion.”
KINETIC CHAIN
REHABILITATION
 DEFINITIONS
Neuromuscular efficiency:
“ is the ability of the CNS to allow
agonists, antagonists, synergists,
stabilizers and neutralizers to work
efficiently and interdependently
during dynamic kinetic chain
activities”
KINETIC CHAIN
REHABILITATION
 SO:
 BY TRAINING THE “CORE”:
 Improve dynamic postural control
 Ensure appropriate muscular balance
 Ensure appropriate joint arthrokinematics
at the hip/pelvis/lumbar spine
 Allow for dynamic functional strength
 Improve neuromuscular efficiency
throughout kinetic chain.
WHAT IS THE “CORE”?
 CORE:
 The lumbo-pelvichip complex
 CoG is located
 Beginning point
for all movement
 29 muscles that
attach to the
lumbo-pelvic-hip
complex
CORE STABILIZATION
TRAINING CONCEPTS
 “core” of body
similar to
foundation of a
house.
 Connects kinetic
chain (lower to
upper body)
 therefore, strong,
efficient
movements
CORE STABILIZATION
TRAINING CONCEPTS
 benefits of strong core musculature
 Protective of spine
 Gain strength, power, endurance and
neuromuscular control
 If extremities are strong and core is weak
, there will not be enough force created
to produce efficient movements
 A weak core is a fundamental cause of
inefficient movements that may lead to
injury
FUNCTIONAL ANATOMY
 POSTERIOR MUSCLES
 ANTERIOR MUSCLES
 HIP MUSCLES
FUNCTIONAL ANATOMY
 POSTERIOR MUSCLES
 ERECTOR SPINAE
 Dynamic intersegmental stabilization
 Eccentrically decelerates forward flexion & rotation
 QUADRATUS LUMBORUM
 stabilizer
FUNCTIONAL ANATOMY
 POSTERIOR MUSCLES
 LATISSIMUS DORSI
 Is bridge between upper and lumbo-pelvic-hip complex
FUNCTIONAL ANATOMY

ANTERIOR MUSCLES/ ABDOMINALS

RECTUS ABDOMINUS

EXTERNAL OBLIQUES

INTERNAL OBLIQUES

TRANSVERSE ABDOMINUS
1.
Abdominals operate as an integrated functional unit
2.
When functioning efficiently , they offer sagittal, frontal
and transverse plane stabilization
FUNCTIONAL ANATOMY
 RECTUS
ABDOMINUS
 “6 pack”
 Eccentrically
decelerates
trunk extension
and lateral
flexion
 Dynamically
stabilizes trunk in
functional
movements
FUNCTIONAL ANATOMY
 EXTERNAL OBLIQUES
 Concentric opposite side rotation
 Concentric lateral flexion ( same side)
FUNCTIONAL ANATOMY
INTERNAL OBLIQUES
Concentric rotation ( same side)
Concentric lateral flexion (same
side)
FUNCTIONAL ANATOMY
TRANSVERSE ABDOMINUS
(probably most important muscle )
Increase intra-abdominal pressure
Dynamic stabilization
Active during all trunk movements
FUNCTIONAL ANATOMY
 HIP MUSCULATURE
 PSOAS
 GLUTEUS MEDIUS
 GLUTEUS MAXIMUS
 HAMSTRINGS
FUNCTIONAL ANATOMY
 PSOAS
 If tight, increase shear on L4/L5
FUNCTIONAL ANATOMY
 GLUTEUS MEDIUS
 If weak,
 Can increase shear @ lumbo-pelvic, tibio-femoral and
patello-femoral joints
 Can lead to tightness of the ITB and the lumbar spine
FUNCTIONAL ANATOMY
 GLUTEUS MAXIMUS
 Major SI joint stabilizer
FUNCTIONAL ANATOMY
 HAMSTRINGS
 Work synergistically with ACL
POSTURAL
CONSIDERATIONS
serial distortion patterns?
Predictable patterns of dysfunction
that occur when one segment of the
kinetic chain is out of alignment.
Therefore, there is a “break” in the
kinetic chain.
MUSCULAR IMBALANCES
 “the interplay of many muscles about a
joint is responsible for the coordinated
control of movement.”
 Therefore, changes in strength, length,
etc of muscles has an effect on other
muscles about the same joint (and other
joints). This can cause problems with
normal movement patterns which could
lead to increased susceptibility of injury.
MUSCULAR IMBALANCES
 i.e. tight psoas causes reciprocal inhibition of glut max,
TrA, multifidus and internal obliques.
 May decrease normal lumbo-pelvic hip stability
NEUROMUSCULAR
CONSIDERATIONS
 Injury to one ligament/structure alters function of other
muscles crossing same joint.
 i.e., swelling in knee…affects rectus femoris at both knee
and hip
 Therefore, can alter hip mechanics
ASSESSMENT OF “THE
CORE”
 tests that can be used:
 1. erector spinae:
 Prone lumbar extension. Lying on a table Hold at 30 degrees
for as long as possible.
Core Testing
 2. upper abdominals:
straight leg lowering test, bp cuff under L4L5,cuff raised to 40 mmHg, legs are
extended while hip flexed to 90 degrees .
Athlete draws in (TrA) and then flattens
back into table . The athlete then lowers
their legs to the table while maintaining a
flat back . Test is over when pressure in the
cuff decreases below 40 mmHg. Measure
hip angle
ASSESSMENT OF “THE
CORE”
 3. Lower abdominals:
bent knee lowering test, same as above
but now knees flexed to 90 degrees.
 4. core power:
Overhead medicine ball throw, hold
medicine ball between legs and squat
down , then jump as high as possible while
throwing the medicine ball backwards
over their head. measure distance ball
travels
Med ball throw
Transversus Abdominis
The main muscles of lumbo-pelvic
stability are the Transversus
Abdominus, the Pelvic Floor
muscles, and the Multifidus. Many
other muscles play a role too.
These muscles are too deep to be
obvious, so you need special
training to learn how to activate
them. The following exercise
teaches how to activate the
transversus abdominus:-
TrA
 Lie in the relaxation position and find pelvic neutral
(back not too arched ) . Put your hands on the
area of your abdomen that would be covered
by the front part of a bikini / Speedo. For the time
being, we shall call this the “bikini patch”. Have
your thumbs touching at the navel, and your
fingers touching at the midline, about 6 cm
below the navel.
 Now imagine that you have to zip up
a very tight pair of jeans:  Hollow the area under you thumbs
and fingers toward your spine. There
may only be a very small movement.
(maintain Pelvic and Chest Neutral)
 Now imagine (if it hasn’t already
happened), that the area under your
fingers is being zipped together like
that tight pair of jeans! (keep the rest
of your body relaxed, maintain Pelvic
and Chest Neutral!)
 Up until now you had no awareness of the
Transversus abdominis. It is a deep, slow moving,
postural muscle. The Transversus abdominis can
and indeed should be working at 2 to 20% of
maximum contractile force during all your
waking hours. Note: Your breathing will
undoubtedly feel restricted, by Transversus
abdominis contraction
SCIENTIFIC RATIONALE FOR
CORE STAB. TRAINING
 Need to train properly. need to stabilize pelvis,
increase EMG activity when drawing in
manoeuvre was performed prior to core training
 Therefore, don’t inhibit TrA
 If not trained properly, can increase interdisc
pressures and compressive forces in the lumbar
spine. (traditional curl ups increase intra-dicscal
pressure)
CORE STABILIZATION

Primary slow twitch muscles

Respond best to time under tension

Contraction lasts from 6 – 20 seconds
GUIDELINES
 Systematic, progressive, and functional
 Begin in most challenging environment the
athlete can control
 Perform in a proprioceptively enriched
environment
PROGRAM VARIATION
 Plane of motion
 Range of motion
 Loading parameter
 Body position
 Speed of movement
 Amount of control
 Duration
 Frequency
EXERCISE SELECTION
 Safe
 Challenging
 Stress multiple planes
 Proprioceptively enriched
 Activity-specific
EXERCISE PROGRESSION
 Slow to fast
 Simple to complex
 Stable to unstable
 Low force to high force
 General to specific
 Correct execution to increased intensity