Core is King!
Let’s talk about core strength! Needless to say I am very passionate about this topic. Those who work with me will tell you I’m quite picky about proper instruction and programming when it comes to core stability. There are two reasons for this. One, it is the foundation for our movement patterns and is relevant to every individual under my care. Two, while fact one has become rather accepted in the mainstream wellness world, core training is often miscued or inappropriately progressed under both fitness and rehabilitation umbrellas. So climb on my soapbox with me and let’s talk about it!
When I say core, I am not talking about the aesthetic six-pack abs and obliques. Those are wonderful, but they come with diet and exercise regimens that promote fat loss to expose the muscle definition we all have somewhere under there. I am not saying these muscles can’t be developed and toned like any other muscle. I am also not denying their function in producing movement and power thru the torso. All that being said, the core I am focused on is the layer of muscle below the washboard; the layer that provides functional STABILITY. And I can tell you from personal and clinical experience that having one does not correlate with having the other. I have worked with countless high-level athletes who are ripped up, but cannot stabilize worth a darn. I myself was humbled during my time recovering from spinal fractures as a level 9 gymnast. When they told me I needed to improve my core strength, I scoffed, ha! Then, not two minutes later I was dumbfounded when I couldn’t succeed at the world’s most simple exercise. From that day forward, I had a new respect for core training and have continued to incorporate these exercises into my workouts…maybe not daily like they suggested, but hey even physical therapists aren’t perfect!
But before we can talk about proper core activation we need to elaborate on some foundational concepts…
We have movers and stabilizers when it comes to muscles in our body. The main role of the stabilizers is not to produce movement, but rather to protect our joints while movers produce gross motor patterns by pulling at origin and insertion to create changes in joint position. Again, the core muscles I’m talking about are stabilizers NOT movers. The rectus abdominis and obliques are the six-pack, the movers producing trunk flexion and rotation, primarily. The transverse abdominis (TrA) wraps around the torso deep to these muscles and serves as a functional corset to protect the spine and stabilize the lumbopelvic region, when activated properly. The TrA is not alone in its task, but works with the diaphragm, pelvic floor, and multifidi. If any one of these components isn’t working in coordination with the others, then we get non-optimal stability; this can lead to pain, dysfunction, or decreased performance.
Now, we can get down to the nitty gritty about core activation. Videos can also be found in the instagram post @truenorthkp.
How NOT to use core properly:
1.anterior tilt creating tunnel under lower back from complete lack of stability
2.flat back, but stomach distended from being cued to “brace core” or "valsalva"
3. concavity in stomach due to rectus and oblique substitution from being told to suck stomach in
I can’t tell you how many times I see core mis-advertised, poorly cued, improperly advanced, and neglected even in the rehab world. I cringe seeing some of the social media posts related to this topic, especially from individuals with no real training. I was so fortunate to have some amazing clinical instruction during my rotations from a physical therapist specializing in women’s health AND orthopedics. Her insight into the intricacies of the deep core system has been invaluable during my early career and the key to success with several patients who didn’t reach their goals with previous therapists.
So what is the proper progression for evaluation and exercise prescription when it comes to core? Below are the steps I follow.
Then, prescribe HEP appropriately based on deficits found in various core groups.
It may seem like a lot, but with practice and a trained eye you can streamline the process. That being said, there is not one formula for how to teach core activation; what works for one person may not resonate with another. Sometimes tedious experimentation with cuing, positioning, biofeedback, etc. is required to have that lightbulb moment with a patient! Never rush the basics; a strong foundation is a must prior to progressing to more advanced exercises. Once you master the basics though, deep core activation will become second nature during daily activities and more advanced abdominal exercises.
Let's end by briefly touch on some common misconceptions about core
Remember, be functional not trendy and have a solid source of information for any core training in your program!
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Kelly Phillips PT, DPT, MPH
Doctor of Physical Therapy