Original Editor - Sem Bras Show Top Contributors - Sheik Abdul Khadir, Katherine Knight, Lucinda hampton, Khloud Shreif, George Prudden, Sem Bras, Vanessa Rhule, WikiSysop, Yagdutt Yagdutt, Admin, Kim Jackson, Wanda van Niekerk and Venus Pagare The core is the centre of our body and it functions to stabilize the trunk while the arms and legs move during functional movements. When we view it this way, we see that the core actually includes:
Image 1 and 2: Examples of core exercises: plank; abdominal drawing in maneuver (Figure 2). The importance of the core relate to its function ie sparing the spine from excessive load and transfer force from the lower body to the upper body and vice versa.
Clinically relevant anatomy[edit | edit source]The core is a box structure made up of the abdominal muscles in the front and the sides, the paraspinal and gluteal muscles at the back, the diaphragm at the roof, and the pelvic floor and the hip girdle muscles as the floor. The abdominal muscles create a rigid cylinder around the spine during movement and provide stability. Image 3: Abdominal canister The inner core muscles include:
The outer core muscles or the global muscles are also referred to as the “movers” and include: Change in Motor Patterns due to Pain The neural subsystem anticipates the loading of the spine and activates contraction of the transverse abdominis and multifidus muscle ahead of the loading.[3] When there is a delay in the contraction of the multifidus, the larger and global superficial muscles eg erector spinae contract to compensate for the delay in increasing the stiffness of the lumbar spine.[3]
Physiotherapy Assessment[edit | edit source]1. Local / deep muscles: Assessment of the function of the local/deep muscles is analogous with providing treatment. An understanding of the normal response is required for the abdominal drawing-in maneuver (transversus abdominis), isometric activation of multifidus, normal breathing (diaphragm), and pelvic floor activation[6]. [7] 2.Global/superficial muscles: There is a wide range of outcome measures for the dysfunction of the global muscles regarding core stability/motor control. Examples include: [8] Clinical prediction rules identifying people (with low back problems) likely to respond to specific motor control/specific muscle activation of the local muscles [9]:
Physiotherapy Treatment[edit | edit source]Treatment focuses on retraining Motor Control.
Examples of exercises to improve the motor control /core stability of the lumbar spine. See Core Strengthening for a more in depth read. Crunches- Lie supine on the floor with your knees bent, arms crossed over your chest and the feet flat on the floor. Then lift your shoulders from the ground and curl your stomach. Avoid a full sit up and ensure the low back remains in contact with the floor. Obliques crunches - As per a normal crunch but leading with one shoulder towards the opposite knee (alternate sides each repetition). [11] Plank - see link [12] Bridges - Lie supine with your knees bent and the feet flat on the floor. Lift your pelvis off the ground while supporting on your feet and shoulders. The bridge can be progressed by lifting one foot off the ground end extending the knee. Hamstring raises/ Bird Dog leg only- Balance on your hands and knees with your back flat and your arms/thighs perpendicular to the floor. Raise one leg behind you until it is horizontal. Alternate. [13] Superman – As per a hamstring raise but progress by lifting the opposite arm to a horizontal position at the same time. Alternate. [14] Leg raises - Lie on your back with your legs straight and your arms by your sides. Then lift one leg 4 inches of the ground. Your back has to stay flat on the floor. Don’t allow it to arch. Alternate. The exercise can be progressed by lifting both legs at the same time. [15] Hundreds - Lie on your back with your legs straight and your arms by your sides. Then lift both legs so that they form a right angle in the hip and knees. Lift your arm straight a few inches off the ground. Focus on keeping your hips and legs completely still and your back flat. [16] There are also multiple exercises that can be performed with a physioball. The exercises were proven to have a greater gain of torso balance and neural activity than regular floor exercises.[17] Summary[edit | edit source]There is no single muscle or single exercise for low back problems and motor control/core stability as a treatment. At a minimum practitioners/sports personnel should be aware of key concepts in motor control and exercise and follow an evidence-based approach to exercise prescription. Currently, there is strong evidence for specific motor control/specific muscle activation in isolation, progressing to more global and functional exercises. References[edit | edit source]
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