CORE STABILIZATION TRAINING IN REHABILITATION

KINETIC CHAIN REHABILITATION

DEFINITIONSFunctional 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

DEFINITIONSFunctional 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

DEFINITIONSNeuromuscular 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-pelvic-hip

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 MUSCLESANTERIOR MUSCLESHIP MUSCLES

FUNCTIONAL ANATOMY

POSTERIOR MUSCLESERECTOR SPINAE

Dynamic intersegmental stabilizationEccentrically decelerates forward flexion &

rotationQUADRATUS 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 ABDOMINUS1. Abdominals operate as an integrated

functional unit2. 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 OBLIQUESConcentric opposite side rotationConcentric 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 MUSCULATUREPSOASGLUTEUS MEDIUSGLUTEUS MAXIMUSHAMSTRINGS

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 MAXIMUSMajor SI joint stabilizer

FUNCTIONAL ANATOMY

HAMSTRINGSWork 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 L4-

L5,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 TrAIf 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 functionalBegin in most challenging environment

the athlete can controlPerform in a proprioceptively enriched

environment

PROGRAM VARIATION

Plane of motionRange of motionLoading parameterBody positionSpeed of movementAmount of controlDurationFrequency

EXERCISE SELECTION

SafeChallengingStress multiple planesProprioceptively enrichedActivity-specific

EXERCISE PROGRESSION

Slow to fastSimple to complexStable to unstableLow force to high forceGeneral to specificCorrect execution to increased intensity