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Core exercise

Breathing

-breathing has on core stability and chronic neck and shoulder pain

-current literature suggests that the diaphragm, transversus abdominis, multifidius and pelvic floor work in unison to create the ideal intra-abodminal pressure for spinal stabilization

-these “inner core” muscles fire in an anticipatory manner milliseconds before the prime movers in an effort to stabilize the spine at the segmental level

High – low breathing

-Ideally, the hand on the belly should rise before the hand on the chest.

-The hand on the chest should move slightly forward (not toward the chin)

-If it moves significantly more than the hand on the abdomen, there is a suggestion of dysfunctional breathing

Breathing exercise

Diaphragm test(lateral expansion)

Both the fingers and thumbs should be moving apart form each other, ideally 1.5-2 inches apart

Bracing maneuver

-This is the practice of activating muscles surrounding the trunk in order to protect the spine, safely transfer power between upper and lower body, and stand ground against contact.

-Breathe in and out. Gently and slowly push out your waist without drawing your abdomen inward or moving your back or pelvis.

As multifidii contract, it pushes into the thoracolumbar fascia and along with contraction of the transversus abdominis, provides intersegmental stability.

a) The relaxed multifidi muscle in transverse section; b) Co-contraction of the transversus abdominis and multifidi creates a stiffening tension on the thoracolumbar fascia thereby providing intersegmental stability.

Bracing exersise

This is the practice of activating muscles surrounding the trunk in order to protect the spine, safely transfer power between upper and lower body, and stand ground against contact.

bracing + moment arm (UE>LE) >> theraband >> change of posture

supine bracing

1. Supine Core Bracing

2. Supine Core Bracing with Arms Extended Toward Floor

3. Supine Core Bracing with One Leg Up (hold 10-15 seconds each side)

4. Supine Core Bracing with One Leg Up and Arms Extended Toward Floor

5. Band Resisted Supine Core Bracing

6. Partner Resisted Supine Core Bracing

DEAD BUG (+ bracing)

1. Dead Bug

2. Dead Bug with Arms Extended Toward Floor

3. Dead Bug with One Leg Toward Floor

4. Dead Bug with Opposite Arm and Leg Toward Floor

5. Band Resisted Dead Bug

6. Partner Resisted Dead Bug

SIDE PLANK

PALLOF PRESS

SUPER HERO and HALF-AIRPLANE (from hands and knees or stability ball)

Caution during breathing

Co-activation of the multifidus

Common substitution patterns or faults

asymmetry of contraction

breath-holding

bracing and increasing intra-abdominal pressure with overactivation of the abdominal muscles

results in movement of the trunk or pelvis out of a neutral position, and into spinal flexion or posterior tilt.

Reference

co-activation of muscle in spinal column craig 2004

kibler et al. sports med 2003

Mcgill. Exerc Sport Sci Rev 2001

Paul Hodge. Intervertebral Stiffness of the Spine Is Increased byEvoked Contraction of Transversus Abdominis and theDiaphragm:In VivoPorcine Studies

Musculoskeletal Evidence based Treatment

Paul W. Hodges. 1.5 Low Back Pain and the Pelvic Floor

Jessica Reale, PT Yoga Anatomy: 6 Reasons Why the Diaphragm May Be the Coolest Muscle in the Body

faries&greenwood. streng & condit j 2007

C. Frank, A. Kobesová, P. Kolář Published 2013 Medicine International journal of sports physical therapy Dynamic neuromuscular stabilization & sports rehabilitation.

Sapsford RR, Hodges PW, Richardson CA, Cooper DH, Markwell SJ, Jull GA. Co-activation of the abdominal and pelvic floor muscles during voluntary exercises. Neurourol Urodyn. 2001;20(1):31-42. doi: 10.1002/1520-6777(2001)20:1<31::aid-nau5>3.0.co;2-p. PMID: 11135380.

Arnold Fomo on Aug 23, 2018 Trigger Point Therapy - Understanding and Treating Multifidus

McGill, PhD J Can Chiropr Assoc 1999 (Jun); 43 (2): 75–88 ~ FULL TEXT Stability: from biomechanical concept to chiropractic practice

Leon Turetsky (NASM-CPT, NASM-CES), Last Updated: March 5, 2020 Abdominal Bracing VS Drawing In – For Core Exercises

Kristen Gostomski, B.S. Sports & Health Science, HSSCS, INHC Best and Worst Core Exercises for Athletes

https://youthsportstrainer.com/

https://www.muscleandmotion.com/abdominal-bracing/

https://youthsportstrainer.com/best-and-worst-core-exercises-for-athletes/

Core

Abdominals in the front, paraspinals and gluteals in the back, the diaphragm as the roof, and the pelvic floor and hip girdle musculature as the bottom

The core is particularly important in sports because it provides "proximal stability for distal mobility".

* Provide mechanical stability of spine

* Increase functional mobility (N-M control)

* Decrease pain

Spinal stability

spinal stability is a prerequisite element that enables movement of the limbs by maintaining the spine upright in postural changes

Innor core – TRA, Diaphragm, Pelvic floor musculature, MF

TRA

The transversus abdominis has large attachments to the middle and posterior layers of the thoracolumbar fascia

Thoraco-lumbar fascia, provides a connection between the lower limb and the upper limb

Thoraco-lumbar fascia also functions as a proprioceptor, providing feedback about trunk positioning

Creating a belt around the abdomen. “hollowing in” of the abdomen creates isolated activation of the transversus abdominis

The transversus abdominis and multifidius habe been shown to contract 30ms before movement of the U/E and 110ms before movement of the L/E in healthy people

Theoretically to stabilize the lumbar spine

Delayed activation of transversus abdominis in patients with low back pain may be more related to the lack of trunk rotation used in the arm raise by these subjects

Re-establishes a normal asymmetrical transversus abdominis action during rotation tasks within a complex muscle synergy rather than correcting a single dysfunctional muscle.

Paul Hodge 실험

Electrical stimulation of the diaphragm increased IAP without abdominal or paraspincal activity

IAP produces an extensor moment.

IAP may influence intervertebral stiffness directly by tensioning the spine or indirectly by increasing the hoop tension in the abdominal muscles and their fascias.

Diaphragm

Contraction of the diaphragm increases intra-abdominal pressure, thus adding to spinal stability.

Abnormal position and recruitment of the diaphragm resulted in subsequent reduced intra-abdominal pressure conducive to low back pain

Pelvic floor musculature

Pelvic floor musculature is co-activated with transversus avdominis contraction

people with sacroiliac pain have impaired recruitment of the diaphragm and pelvic floor.

Abdominal muscle activity is a normal response th PF exercise in subjects with no symptoms of PF muscle dysfunction and provide preliminary evidence that specific abdominal exercises activate the PF muscles

in healthy subjects, voluntary activity in the abdominal muscles results in increased pelvic floor muscle activity

The increase in pelvic floor pressure before the increase in the abdomen pressure indicates that this response is preprogrammed

The diaphragm, pelvic floor and transversus abdominis regulate IAP and provide anterior lumbo-pelvic postural stability.

Multifidus

Multifidus attachment to the spinous process, the multifidus has a longer lever arm for producing extension than do the erector spinea muscles that attach to the transverse process

The most important action of the multifidus is controlling the flexion and anterior shear of the spine during forward bending via its eccentric contraction

Reference

Musculoskeletal Evidence based Treatment

co-activation of muscle in spinal column craig 2004

kibler et al. sports med 2003

Mcgill. Exerc Sport Sci Rev 2001

Paul Hodge. Intervertebral Stiffness of the Spine Is Increased byEvoked Contraction of Transversus Abdominis and theDiaphragm:In VivoPorcine Studies

Paul W. Hodges. 1.5 Low Back Pain and the Pelvic Floor

Jessica Reale, PT Yoga Anatomy: 6 Reasons Why the Diaphragm May Be the Coolest Muscle in the Body

faries&greenwood. streng & condit j 2007

C. Frank, A. Kobesová, P. Kolář Published 2013 Medicine International journal of sports physical therapy Dynamic neuromuscular stabilization & sports rehabilitation.

Sapsford RR, Hodges PW, Richardson CA, Cooper DH, Markwell SJ, Jull GA. Co-activation of the abdominal and pelvic floor muscles during voluntary exercises. Neurourol Urodyn. 2001;20(1):31-42. doi: 10.1002/1520-6777(2001)20:1<31::aid-nau5>3.0.co;2-p. PMID: 11135380.

Arnold Fomo on Aug 23, 2018 Trigger Point Therapy - Understanding and Treating Multifidus

Musculoskeletal Evidence based Treatment

McGill, PhD J Can Chiropr Assoc 1999 (Jun); 43 (2): 75–88 ~ FULL TEXT Stability: from biomechanical concept to chiropractic practice