Core Strengthening: Difference between revisions
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== What is the Core? == | == What is the Core? == | ||
Although this seems like a straightforward question, "What is the Core?", there exists discrepancies not only in consumer media, but also among researchers and practicing healthcare providers. Therefore discrepancies also exist in how to effectively strengthen the core. | |||
The core muscles are involved in maintaining spinal and pelvic stability and can be divided into two groups, according to function.<ref name=":0">Chang WD, Lin HY, Lai PT. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4395677/pdf/jpts-27-619.pdf Core strength training for patients with chronic low back pain]. Journal of physical therapy science. 2015;27(3):619-22.</ref> The first group of muscles is the inner | The core muscles are involved in maintaining spinal and pelvic stability and can be divided into two groups, according to function.<ref name=":0">Chang WD, Lin HY, Lai PT. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4395677/pdf/jpts-27-619.pdf Core strength training for patients with chronic low back pain]. Journal of physical therapy science. 2015;27(3):619-22.</ref> The first group of muscles is the inner or deep core muscles. This group of muscles is also known as the local stabilising muscles.<ref name=":0" /> Hodges et al (1996)<ref>Hodges PW, Richardson CA. Inefficient muscular stabilization of the lumbar spine associated with low back pain: a motor control evaluation of transversus abdominis. Spine. 1996 Nov 15;21(22):2640-50.</ref> 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:<ref name=":1">Akuthota V, Ferreiro A, Moore T, Fredericson M. [https://www.researchgate.net/publication/5555200_Core_Stability_Exercise_Principles Core stability exercise principles]. Current sports medicine reports. 2008 Jan 1;7(1):39-44.</ref><ref>Saiklang P, Puntumetakul R, Swangnetr Neubert M, Boucaut R. The immediate effect of the abdominal drawing-in manoeuver technique on stature change in seated sedentary workers with chronic low back pain. Ergonomics. 2021 Jan 2;64(1):55-68.</ref> | The inner core muscles include:<ref name=":1">Akuthota V, Ferreiro A, Moore T, Fredericson M. [https://www.researchgate.net/publication/5555200_Core_Stability_Exercise_Principles Core stability exercise principles]. Current sports medicine reports. 2008 Jan 1;7(1):39-44.</ref><ref>Saiklang P, Puntumetakul R, Swangnetr Neubert M, Boucaut R. The immediate effect of the abdominal drawing-in manoeuver technique on stature change in seated sedentary workers with chronic low back pain. Ergonomics. 2021 Jan 2;64(1):55-68.</ref> | ||
* [[Pelvic Floor Anatomy|Pelvic floor]] | * [[Pelvic Floor Anatomy|Pelvic floor]] | ||
* [[Transversus Abdominis|Transversus abdominis]] | * [[Transversus Abdominis|Transversus abdominis]] | ||
* [[Internal Abdominal Oblique|Internal Obliques]] | * [[Internal Abdominal Oblique|Internal Obliques]] | ||
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The outer core muscles or the global muscles are also referred to as the “movers” and include:<ref name=":0" /><ref name=":1" /> | The outer core muscles or the global muscles are also referred to as the “movers” and include:<ref name=":0" /><ref name=":1" /> | ||
* [[Rectus Abdominis|Rectus abdominis]] | * [[Rectus Abdominis|Rectus abdominis]] | ||
* [[ | *[[External Abdominal Oblique|External]] obliques | ||
* [[Erector Spinae|Erector spinae]] | * [[Erector Spinae|Erector spinae]] | ||
* [[Quadratus Lumborum|Quadratus lumborum]] | * [[Quadratus Lumborum|Quadratus lumborum]] | ||
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=== Integrated Model of Function === | === Integrated Model of Function === | ||
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.<ref name=":0" /> In the case of dysfunction, such as a 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.<ref>Key J. [https://www.researchgate.net/publication/258058286_'The_core'_Understanding_it_and_retraining_its_dysfunction ‘The core’: understanding it, and retraining its dysfunction]. Journal of bodywork and movement therapies. 2013 Oct 1;17(4):541-59.</ref> | When the inner and outer (or local and global) 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.<ref name=":0" /> In the case of dysfunction, such as a 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.<ref>Key J. [https://www.researchgate.net/publication/258058286_'The_core'_Understanding_it_and_retraining_its_dysfunction ‘The core’: understanding it, and retraining its dysfunction]. Journal of bodywork and movement therapies. 2013 Oct 1;17(4):541-59.</ref> | ||
=== Abdominal Canister === | === Abdominal Canister === | ||
The inner core muscles | The inner core muscles can be thought of as an abdominal canister with muscles forming the top and sides of the canister. | ||
[[File:Abdominal canister - breathing.jpg|thumb|Diaphragm, transverse abdominis and pelvic floor activity during respiration. During active inhalation, the diaphragm descends as it contracts and the transversus abdominis and pelvic floor lengthen. During active exhalation, the pelvic floor and transversus abdominis contract, assisting diaphragm elevation.<ref name=":2">Siracusa C, Gray A. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7641036/ Pelvic Floor Considerations in COVID-19.] Journal of Women's Health Physical Therapy. 2020 Oct;44(4):144.</ref>]] | [[File:Abdominal canister - breathing.jpg|thumb|Diaphragm, transverse abdominis and pelvic floor activity during respiration. During active inhalation, the diaphragm descends as it contracts and the transversus abdominis and pelvic floor lengthen. During active exhalation, the pelvic floor and transversus abdominis contract, assisting diaphragm elevation.<ref name=":2">Siracusa C, Gray A. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7641036/ Pelvic Floor Considerations in COVID-19.] Journal of Women's Health Physical Therapy. 2020 Oct;44(4):144.</ref>]] | ||
The abdominal canister functions similar to the action of a piston. As the diaphragm expands during inspiration, it lowers and presses down on the contents of the abdomen.<ref name=":2" /> To allow for this pressure, the pelvic floor muscles relax and elongate. Below is a short summary of how the abdominal canister functions to facilitate breathing:<ref name=":2" /> | The abdominal canister functions similar to the action of a piston. As the diaphragm expands during inspiration, it lowers and presses down on the contents of the abdomen.<ref name=":2" /> To allow for this pressure, the pelvic floor muscles relax and elongate. Below is a short summary of how the abdominal canister functions to facilitate breathing:<ref name=":2" /> | ||
Inspiration | Inspiration | ||
* Diaphragm contracts and flattens | * Diaphragm contracts and the dome shape flattens | ||
* Chest wall expands | * Chest wall expands | ||
* Creates negative pressure in the thorax, drawing air into the lungs | * Creates negative pressure in the thorax, drawing air into the lungs | ||
* Descent of diaphragm also causes expansion of abdominal wall and pelvic floor, due to increase in abdominal pressure | * Descent of diaphragm also causes expansion of abdominal wall and pelvic floor, due to increase in abdominal pressure | ||
Exhalation (during quiet breathing): | |||
* Diaphragm recoils to resting position | * Diaphragm recoils to resting position | ||
* Passive expulsion of air from the lungs | * Passive expulsion of air from the lungs | ||
* The abdominal wall and pelvic floor gently contract to return to resting position | * The abdominal wall and pelvic floor gently contract to return to resting position | ||
Active exhalation (increased respiratory demand): | |||
* Increases air expulsion efficiency to accelerate gas exchange | * Increases air expulsion efficiency to accelerate gas exchange | ||
* Accessory respiratory muscles contract to speed up diaphragm elevation | * 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.<ref name=":2" /> | * 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.<ref name=":2" /> | ||
== Activating the Core == | == Activating the Core<ref>Riczo DB. Back & Pelvic Girdle Pain in Pregnancy & Postpartum: Find Relief Using the Pelvic Girdle Musculoskeletal Method. Orthopedic Physical Therapy Products; 2020.</ref> == | ||
=== Optimal | === Optimal posture and Conditions to Monitor while Activating the Core === | ||
* | * Posture of the rib cage over pelvis | ||
** | ** Maximum activation of the inner core occurs when the rib cage is in neutral over the pelvis, not positioned in extension or flexion (breastbone too elevated or depressed)<ref>Lee DG. The Pelvic Girdle E-Book: An integration of clinical expertise and research. Elsevier Health Sciences; 2011 Oct 28.</ref> | ||
* Abdominal wall | * Conditions to monitor | ||
** | ** Abdominal wall | ||
*** | *** Doming in the abdominal muscles | ||
**** Monitor: | |||
***** Breath-holding and creating a vacuum | |||
***** Less than optimal breathing pattern | |||
***** Exercise too difficult | |||
****** Rectus abdominis or other weakness resulting in a poor pattern | |||
** Pelvic floor symptoms | |||
*** pressure/bulging in the perineum area (symptoms of [[Pelvic Organ Prolapse|pelvic organ prolapse]]) | |||
*** any incontinence or pelvic pain<ref name=":4">Casey EK, Temme K. Pelvic floor muscle function and urinary incontinence in the female athlete. The Physician and sportsmedicine. 2017 Oct 2;45(4):399-407.</ref> | |||
**** Breath-holding and creating a vacuum | **** Breath-holding and creating a vacuum | ||
**** Exercise | **** Less than optimal breathing pattern | ||
**** | **** Exercise too difficult | ||
***** Rectus abdominis or other weakness resulting in a poor pattern<ref name=":4" /> | |||
* | === Activating the Core in a Static Position<ref>Riczo DB. Back & Pelvic Girdle Pain in Pregnancy & Postpartum: Find Relief Using the Pelvic Girdle Musculoskeletal Method. Orthopedic Physical Therapy Products; 2020.</ref><ref>Riczo DB. Sacroiliac Pain. Orthopedic Physical Therapy Products; 2018</ref> === | ||
** | * Supine position | ||
** Take note when prescribing exercises in the supine position: “Maintaining a supine position during exercise after 20 weeks of gestation may result in decreased venous return due to aortocaval compression from the gravid uterus, leading to hypotension, and this hemodynamic change should be considered when prescribing exercise modifications in pregnancy.”<ref>Syed H, Slayman T, Thoma KD. [https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2020/04/physical-activity-and-exercise-during-pregnancy-and-the-postpartum-period ACOG Committee Opinion No. 804: Physical Activity and Exercise During Pregnancy and the Postpartum Period.] Obstetrics & Gynecology. 2021 Feb 1;137(2):375-6.</ref> | |||
*** Position | |||
* | **** Knees can be straight or bent | ||
** Knees can be straight or bent | **** Pillow/wedge under the hips with very weak pelvic floor muscles | ||
** | ***** gravity is assisting and to take the weight off the pelvic floor<ref name=":3">Deborah Riczo. Core Strengthening. Physioplus, Course. 2021.</ref> | ||
** Activate diaphragm with diaphragmatic | *** Inhalation | ||
** | **** Activate the diaphragm with diaphragmatic breath | ||
** Pelvic floor activation with exhale | ***** Imagery suggestions | ||
*** Cues that can be used include: | ****** umbrella imagery to expand ribcage (like opening up an umbrella) | ||
**** Stopping flatulence or the flow of urine | *** Exhalation | ||
** [[Pelvic Girdle Dysfunction Interventions: Core Activation, Targeted Strengthening and Stretching|Transversus abdominis activation]] | **** Activate the pelvic floor through pursed lips or hissing sound | ||
** Cues such as: | ***** Imagery suggestions for exhale | ||
*** zip up tight jeans | ****** Quieting a child, shushing sound | ||
*** drawing in manoeuvre | ****** Blowing up a balloon | ||
*** blowing up a balloon | *** Pelvic floor activation with exhale | ||
** Static core activation can be performed in various positions, for example:<ref>Moghadam N, Ghaffari MS, Noormohammadpour P, Rostami M, Zarei M, Moosavi M, Kordi R. Comparison of the recruitment of transverse abdominis through drawing-in and bracing in different core stability training positions. Journal of exercise rehabilitation. 2019 Dec;15(6):819.</ref> | **** Cues that can be used include: | ||
*** Prone, 4-point kneeling, half-kneeling, standing<ref>Escamilla RF, Lewis C, Pecson A, Imamura R, Andrews JR. Muscle activation among supine, prone, and side position exercises with and without a Swiss ball. Sports health. 2016 Jul;8(4):372-9.</ref> | ***** Stopping flatulence or the flow of urine | ||
***[[Pelvic Girdle Dysfunction Interventions: Core Activation, Targeted Strengthening and Stretching|Transversus abdominis activation]] | |||
*** Cues such as: | |||
**** zip up tight jeans | |||
**** drawing in manoeuvre | |||
**** blowing up a balloon | |||
*** Static core activation can be performed in various positions, for example:<ref>Moghadam N, Ghaffari MS, Noormohammadpour P, Rostami M, Zarei M, Moosavi M, Kordi R. Comparison of the recruitment of transverse abdominis through drawing-in and bracing in different core stability training positions. Journal of exercise rehabilitation. 2019 Dec;15(6):819.</ref> | |||
**** Prone, 4-point kneeling, half-kneeling, standing<ref>Escamilla RF, Lewis C, Pecson A, Imamura R, Andrews JR. Muscle activation among supine, prone, and side position exercises with and without a Swiss ball. Sports health. 2016 Jul;8(4):372-9.</ref> | |||
<div class="row"> | <div class="row"> |
Revision as of 21:23, 26 May 2021
Original Editor - Deborah Riczo
Top Contributors - Wanda van Niekerk, Kim Jackson, Tarina van der Stockt, Vidya Acharya and Olajumoke Ogunleye
What is the Core?[edit | edit source]
Although this seems like a straightforward question, "What is the Core?", there exists discrepancies not only in consumer media, but also among researchers and practicing healthcare providers. Therefore discrepancies also exist in how to effectively strengthen the core.
The core muscles are involved in maintaining spinal and pelvic stability and can be divided into two groups, according to function.[1] The first group of muscles is the inner or deep core muscles. This group of muscles is also known as the local stabilising muscles.[1] Hodges et al (1996)[2] 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:[3][4]
- Pelvic floor
- 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:[1][3]
Integrated Model of Function[edit | edit source]
When the inner and outer (or local and global) 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.[1] In the case of dysfunction, such as a 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.[5]
Abdominal Canister[edit | edit source]
The inner core muscles can be thought of as an abdominal canister with muscles forming the top and sides of the canister.
The abdominal canister functions similar to the action of a piston. As the diaphragm expands during inspiration, it lowers and presses down on the contents of the abdomen.[6] To allow for this pressure, the pelvic floor muscles relax and elongate. Below is a short summary of how the abdominal canister functions to facilitate breathing:[6]
Inspiration
- Diaphragm contracts and the dome shape flattens
- Chest wall expands
- Creates negative pressure in the thorax, drawing air into the lungs
- Descent of diaphragm also causes expansion of abdominal wall and pelvic floor, due to increase in abdominal pressure
Exhalation (during quiet breathing):
- Diaphragm recoils to resting position
- Passive expulsion of air from the lungs
- The abdominal wall and pelvic floor gently contract to return to resting position
Active exhalation (increased respiratory demand):
- 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.[6]
Activating the Core[7][edit | edit source]
Optimal posture and Conditions to Monitor while Activating the Core[edit | edit source]
- Posture of the rib cage over pelvis
- Maximum activation of the inner core occurs when the rib cage is in neutral over the pelvis, not positioned in extension or flexion (breastbone too elevated or depressed)[8]
- Conditions to monitor
- Abdominal wall
- Doming in the abdominal muscles
- Monitor:
- Breath-holding and creating a vacuum
- Less than optimal breathing pattern
- Exercise too difficult
- Rectus abdominis or other weakness resulting in a poor pattern
- Monitor:
- Doming in the abdominal muscles
- Pelvic floor symptoms
- pressure/bulging in the perineum area (symptoms of pelvic organ prolapse)
- any incontinence or pelvic pain[9]
- Breath-holding and creating a vacuum
- Less than optimal breathing pattern
- Exercise too difficult
- Rectus abdominis or other weakness resulting in a poor pattern[9]
- Abdominal wall
Activating the Core in a Static Position[10][11][edit | edit source]
- Supine position
- Take note when prescribing exercises in the supine position: “Maintaining a supine position during exercise after 20 weeks of gestation may result in decreased venous return due to aortocaval compression from the gravid uterus, leading to hypotension, and this hemodynamic change should be considered when prescribing exercise modifications in pregnancy.”[12]
- Position
- Knees can be straight or bent
- Pillow/wedge under the hips with very weak pelvic floor muscles
- gravity is assisting and to take the weight off the pelvic floor[13]
- Inhalation
- Activate the diaphragm with diaphragmatic breath
- Imagery suggestions
- umbrella imagery to expand ribcage (like opening up an umbrella)
- Imagery suggestions
- Activate the diaphragm with diaphragmatic breath
- Exhalation
- Activate the pelvic floor through pursed lips or hissing sound
- Imagery suggestions for exhale
- Quieting a child, shushing sound
- Blowing up a balloon
- Imagery suggestions for exhale
- Activate the pelvic floor through pursed lips or hissing sound
- Pelvic floor activation with exhale
- Cues that can be used include:
- Stopping flatulence or the flow of urine
- Cues that can be used include:
- Transversus abdominis activation
- Cues such as:
- zip up tight jeans
- drawing in manoeuvre
- blowing up a balloon
- Static core activation can be performed in various positions, for example:[14]
- Prone, 4-point kneeling, half-kneeling, standing[15]
- Position
- Take note when prescribing exercises in the supine position: “Maintaining a supine position during exercise after 20 weeks of gestation may result in decreased venous return due to aortocaval compression from the gravid uterus, leading to hypotension, and this hemodynamic change should be considered when prescribing exercise modifications in pregnancy.”[12]
A caveat to consider when prescribing static core activation exercises to a client is if the patient is showing symptoms of an overactive pelvic floor, such as pelvic pain, pain with bowel movements, pain increasing with contraction, etc. In such cases, the patient should refrain from adding the pelvic floor contraction and rather focus on relaxing the pelvic floor.[16]
Activating the core in a Dynamic Position[edit | edit source]
- Core strength can be challenged by adding movement[17]
- This can be done in various positions and with various movements
- Some examples are:
- Supine
- Adding alternate arm reaches
- Adding alternate knee lifts – important to monitor if the patient’s core is able to control the weight of the leg with this movement. (A way to do this is to ask the patient to place hands on ASIS while performing an exercise. If ASIS’s are unable to remain stable with alternate knee lifts, rather prescribe an exercise such as heel slides or knee fall-outs (bent knee abduction and adduction) to start with.[13])
- Combine opposite arm and leg
- Adding knee extension as a progression from alternate knees in supine
- Straight leg raise
- Supine
- Prone
- Glut sets with core activation
- Adding hip extension – if open chain exercise is too difficult start with closed chain – keep toe on the ground and lift the knee
- Alternate arms/legs
- 4-point kneeling
- 4 -point kneeling
- Adding alternate arms
- Alternate arms and legs
- Prone
- ½ kneeling
- This is a good position for core strengthening as it also incorporates balance training as well
- Alternate arms reach – aim for good excursion in lattisimus dorsi
- Trunk rotation
- Can add light weights
- Standing
- Higher-level Exercises
- Plank on elbows
- Start off on knees, progress to on toes
- Plank on elbows
- ½ kneeling
- Side-plank
- Single leg bridge
- 4-point alternate arm/leg balance
- Progress to whole-body movements, agility and balance
- Lunges
- Stepping
- Stepping to the side
- Side squats
- High stepping, hand to opposite heel while moving
Conclusion[edit | edit source]
Core strengthening is effective from the inside (inner core first) to the outside. Modifications of the level of difficulty of exercises and breathing strategies can help avoid symptoms of doming, bulging, leaking and pain. It also motivates the patient when improvements are evident and challenges the patient in small incremental steps.
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 Chang WD, Lin HY, Lai PT. Core strength training for patients with chronic low back pain. Journal of physical therapy science. 2015;27(3):619-22.
- ↑ Hodges PW, Richardson CA. Inefficient muscular stabilization of the lumbar spine associated with low back pain: a motor control evaluation of transversus abdominis. Spine. 1996 Nov 15;21(22):2640-50.
- ↑ 3.0 3.1 Akuthota V, Ferreiro A, Moore T, Fredericson M. Core stability exercise principles. Current sports medicine reports. 2008 Jan 1;7(1):39-44.
- ↑ Saiklang P, Puntumetakul R, Swangnetr Neubert M, Boucaut R. The immediate effect of the abdominal drawing-in manoeuver technique on stature change in seated sedentary workers with chronic low back pain. Ergonomics. 2021 Jan 2;64(1):55-68.
- ↑ Key J. ‘The core’: understanding it, and retraining its dysfunction. Journal of bodywork and movement therapies. 2013 Oct 1;17(4):541-59.
- ↑ 6.0 6.1 6.2 6.3 Siracusa C, Gray A. Pelvic Floor Considerations in COVID-19. Journal of Women's Health Physical Therapy. 2020 Oct;44(4):144.
- ↑ Riczo DB. Back & Pelvic Girdle Pain in Pregnancy & Postpartum: Find Relief Using the Pelvic Girdle Musculoskeletal Method. Orthopedic Physical Therapy Products; 2020.
- ↑ Lee DG. The Pelvic Girdle E-Book: An integration of clinical expertise and research. Elsevier Health Sciences; 2011 Oct 28.
- ↑ 9.0 9.1 Casey EK, Temme K. Pelvic floor muscle function and urinary incontinence in the female athlete. The Physician and sportsmedicine. 2017 Oct 2;45(4):399-407.
- ↑ Riczo DB. Back & Pelvic Girdle Pain in Pregnancy & Postpartum: Find Relief Using the Pelvic Girdle Musculoskeletal Method. Orthopedic Physical Therapy Products; 2020.
- ↑ Riczo DB. Sacroiliac Pain. Orthopedic Physical Therapy Products; 2018
- ↑ Syed H, Slayman T, Thoma KD. ACOG Committee Opinion No. 804: Physical Activity and Exercise During Pregnancy and the Postpartum Period. Obstetrics & Gynecology. 2021 Feb 1;137(2):375-6.
- ↑ 13.0 13.1 13.2 Deborah Riczo. Core Strengthening. Physioplus, Course. 2021.
- ↑ Moghadam N, Ghaffari MS, Noormohammadpour P, Rostami M, Zarei M, Moosavi M, Kordi R. Comparison of the recruitment of transverse abdominis through drawing-in and bracing in different core stability training positions. Journal of exercise rehabilitation. 2019 Dec;15(6):819.
- ↑ Escamilla RF, Lewis C, Pecson A, Imamura R, Andrews JR. Muscle activation among supine, prone, and side position exercises with and without a Swiss ball. Sports health. 2016 Jul;8(4):372-9.
- ↑ Stein A, Hughes M. A classical physical therapy approach to the overactive pelvic floor. The overactive pelvic floor. 2016:265-74.
- ↑ Escriche-Escuder A, Calatayud J, Aiguadé R, Andersen LL, Ezzatvar Y, Casaña J. Core Muscle Activity Assessed by Electromyography During Exercises for Chronic Low Back Pain: A Systematic Review. Strength & Conditioning Journal. 2019 Aug 1;41(4):55-69.
- ↑ Cakmak B, Ribeiro AP, Inanir A. Postural balance and the risk of falling during pregnancy. The Journal of Maternal-Fetal & Neonatal Medicine. 2016 May 18;29(10):1623-5.
- ↑ Rehab my patient. Core control 7. Available from https://www.youtube.com/watch?v=MAzd-kxnH18 (last accessed 8 April 2021)
- ↑ Rehab my patient. How to improve lower abdominal strength 2. Available from https://www.youtube.com/watch?v=I665l7U4oOA&t=34s. (last accessed 8 April 2021)
- ↑ Rehab my patient. BOSU balance catching a ball. Available from https://www.youtube.com/watch?v=T69RBvA5Jek&t=14s. (last accessed 8 April 2021)