CORE STABILIZATION TRAINING IN REHABILITATION. KINETIC CHAIN REHABILITATION DEFINITIONS Functional...
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Transcript of CORE STABILIZATION TRAINING IN REHABILITATION. KINETIC CHAIN REHABILITATION DEFINITIONS Functional...
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