Core Strengthening

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Original Editor - Deborah Riczo

Top Contributors - Wanda van Niekerk, Kim Jackson, Tarina van der Stockt, Vidya Acharya and Olajumoke Ogunleye  

Introduction

Core stabilisation

What is core?

In the literature, consumer as well as academic, there are various definitions available of what the core is and what core strengthening is. Even between various health professionals there seems to be a wide definition of what core work is.

The core muscles are involved in maintaining spinal and pelvic stability (ref) and can be divided into two groups, according to function. The first group of muscles is the inner core or deep core muscles. This group of muscles is also known as the local stabilising muscles. Hodges et al showed that the inner core acts in an anticipatory way and that these muscles are activated and fire before the global muscles are activated.

The inner core muscles include:

Pelvic floor muscles

Transversus abdominis

Internal Obliques

Multifidus

Diaphragm

Some literature also includes the deep fibres of the psoas and the deep hip rotators as part of the inner core.

The outer core muscles or the global muscles are also referred to as the “movers” and include:

Rectus abdominis

Internal and external obliques

Erector spinae

Qudratus lumborum

Hip muscle groups

When the core muscles function normally, segmental spinal stability is maintained, the spine and pelvic area is protected and the stress or load that may influence the lumbar vertebrae and intervertebral discs are reduced. In the case of a dysfunction, such as a weak inner core, the outer core compensates and “splinting” occurs

In cases of weak inner core, the outer core compensates for this weakness. Although the outer core muscles’ main function is movement and not stability it is able to contribute to stability with unexpected tasks or overload. As a result of this, splinting occurs and this leads to neuromusculoskeletal issues such as muscle spasms, neural compression and pain.

Abdominal canister

The inner core muscles all form part of the abdominal canister

Use image in slides of abdominal canister in page – just check reference etc. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7641036/

The abdominal canister works as pistoning action. As the diaphragm expands during inspiration, it lowers and presses down on the contents of the abdomen. To allow for this pressure, the pelvic floor muscles relaxes and elongate. Below is a short summary of how the abdominal canister functions to facilitate breathing.

Inspiration

Diaphragm contracts and flattens

Chest wall expands

Creates negative pressure in thorax, drawing air into the lungs

Descent of diaphragm also causes expansion of abdominal wall and pelvic floor, due to increase in abdominal pressure

During quiet breathing – exhalation

Diaphragm recoils to resting position

Passive expulsion of air from the lungs

Abdominal wall and pelvic floor gently contract to return to resting position

Increased respiratory demand – active exhalation

Increases air expulsion efficiency to accelerate gas exchange

Accessory respiratory muscles contract to speed up diaphragm elevation

Pelvic floor and abdominal muscles are included within these accessory muscles – as they contract more forcefully – create a cranially directed increase in intra-abdominal pressure – this assists with diaphragm elevation. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7641036/

Activating the Core

Optimal postures

Rib cage

Ribs in location to pelvis

Rib cage should be neutral over pelvis – maximum activation of the inner core

Abdominal wall

Look out for doming in the abdominal muscles

This may indicate:

Breath holding and creating a vacuum

Exercise is too difficult – rectus abdominis weak and contracting using a poor pattern

Be careful – pressure in the perineum area or bulging  - may aggravate pelvic organ prolapse  link to course page

Another red flag – any type of incontinence symptoms or pelvic pain – may indicate that breathing strategy is wrong, exercise too difficult and you need to adapt or decrease the level of exercise and ensure proper breathing strategy

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