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.

1. Is diaphragmatic breathing pattern predominate, or are they using accessory  muscles instead?
2. Can they perform appropriate Kegel (yes, men and women)?
3. Can they isolate multifidi or can I feel palpable activation with the prone knee flexion test?  Multifidi is the most often neglected group in rehab programs as it is hard to cue.
4. Can they find neutral pelvis and isolate TrA without changing position of pelvis or causing visible concavity of upper abdomen? If not, then first step may be teaching them to turn everything OFF before learning how to turn muscles ON. You can’t use your deep core properly if your superficial abdominals are overactive. This is often the case athletes, especially gymnasts.
5. Can they hold TrA isometric for 10 seconds without holding their breath?
6. How far can they get in TrA core progression?

• TrA with low march
• TrA with march to 90 degrees
• TrA with alternating leg extension
• TrA reverse march unilateral
• TrA reverse march bilateral
• TrA leg extension from tabletop position, unilateral
• TrA leg extension from tabletop position, bilateral
• TrA with bilateral leg raise

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

• Lifting with a belt will ruin my core activation and make me weak-->FALSE.
  • Even I wear a belt for heavier sets, because it gives support and provides a proprioceptive cue to remind my body to engage core.  That being said, wearing a belt is NOT a substitute for engaging your core actively.  Rather, it is a supplement. If you valsalva and bear down under your belt that is also counterproductive and can contribute to hernias, pelvic floor dysfunction and even prolapse, especially in women.
• Wearing high-waisted leggings all the time inhibits my core and makes it weak-->FALSE
  • I saw a post recently claiming high-waisted leggings are causing an epidemic of core weakness. Come on people! Same concept as lifting belts, but to a lesser degree
• Learning how to use my core will make me skinny instantly-->FALSE
  • This won’t make you skinny, but it can help control bloating ladies and maybe make you feel more confident without those tummy tucker tights! But I see way too many IG model videos claiming extreme before and after pictures just from activating core…incorrectly I may add.
• Learning to engage your core is easy-->FALSE
  • Appropriate core activation is often counterintuitive, but once your body memorizes the pattern it carries over into both daily and exercise activities. However, if we are in pain or injured sometimes our core turns “off” and we have to go back to the basics and remind our bodies that it’s helpful not harmful to engage these muscles.

 
Remember, be functional not trendy and have a solid source of information for any core training in your program!