Core stability : Local as well as Global musculature

What is core ?

It is a muscular box with the abdominals in the front, paraspinals and gluteals in the rear, the diaphragm at the top,  and the pelvic floor and hip girdle musculature at the bottom. Within the “box” multiple muscles help to stabilize the
spine and pelvis as well as transmit forces through the kinetic chain.

Defination of core stability ?

The core through three subsystems, the passive subsystem, active subsystem, and the neural control subsystem. It was proposed that these subsystems were highly integrated and optimization of all three were necessary for normal biomechanics of the spine. If any one of these subsystems became impaired it could lead to instability of the spinal column predisposing an individual to injury, dysfunction, and pain.

Generally, core stability comprises the lumbopelvic-hip complex and is the capacity to maintain equilibrium of the vertebral column within its physiologic limits by reducing displacement from perturbations and maintaining structural integrity.

Objective of core strengthening:

Strength is defined as the maximum force that a muscle or muscle group can generate at a specific velocity. Power refers to the amount of force that can be generated in a given time period 10 repeatation maximum squat is a measure of absolute strength, where the force of a racket on a ball a  given velocity determines the amount of power that is Imparted to the ball.

The crucial question is how core strength relates to each of these situations.

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Muscles such as local stabilizers are at work at all times even while sitting Standing and walking under the circumstances . Global stabilizers are under high loads in strength and power situations such as lifting weights or performing moments under resistance. According to the evidence in order to develop an exercise program that focuses on number stability the following principles should be followed.

* Use of a phasic not tonic contraction of the muscles
* Focus should be on joint position
* Proprioceptive q’s to enhance training of this muscles
* Focus on no load exercise is gradually include more unstable positions to the exercise regime
* Include proximal to distal segment movement (close chain exercise)

Local stabiliser systems                                       Global stabilizer

1. Transversus abdominis                                  Rectus abdominus
2. Internal oblique (posterior)                          External oblique
3. Multifidus                                                         Internal oblique
4. Intertraversaii, interspinales                        Erector spine
5. Longissinus thoracis
6. Lliocostalis lumborum
7. Quadratus lumborum (medial fiber)

What evidence say?

Bergmark et all thought that they cateogories muscles into two groups . Local stabiliser and global mobilizer .This classification is widely accepted and remains the basis for many core stabilization exercise programs.

Gibbons and Comerford24 proposed a functional model that maintained the local stabilizers and separated the global muscles into stabilizers (internal and external obliques, spinalis) and mobilizers (rectus abdominus, iliocostalis). Stabilizers generate force eccentrically to control movement throughout range of motion, while mobilizers concentrically accelerate through range of motion and act as shock absorbers, especially in the sagittal plane.

The classification systems all have merit, but some contain more detail and differentiation in muscle function, whereas others are an oversimplification, which may lead clinicians to focus on specific muscles and muscle groups rather than function and demands of the task.

Initial Exercise :

A great exercise to activate the rectus abdominis without compressive loading is the partial curl up. It has been measured to compress the spine between 2000-2500 N (Axler & McGill, 1997; Kavcic, Grenier, & McGill, 2004). This maneuver is performed by instructing the athlete to perform an abdominal brace then to curl up slowly lifting only their shoulders and neck off of the ground while maintaining a neutral spine. It may be beneficial to instruct them to have their axis of rotation just above the breast line.

The primary lateral stabilizer of the spine is quadratus lumborum and has been shown to greatly contribute to spinal stability (McGill, 1998). This muscle is often neglected in the athlete so retraining to build strength and endurance is crucial. This exercise can be done in one of two ways; in an upright position with the weight of the body supported on the elbow against the wall or it can be done from the table with the body weight supported by the elbow and knees and the hips off the ground. This exercise  has also been shown to activate the lateral oblique musculature that also contributes to spinal stability.

The Quadraped Exercise :

The first three exercises have focused on the anterior and lateral core musculature, but it is important to remember the posterior or the “back” of the muscular box is important for spinal stability as well. A great exercise to activate the posterior musculature with a low to moderate compressive cost is the quadraped exercise or fourpoint kneeling. (Kavcic, Grenier, & McGill, 2004) It is important to emphasize the abdominal brace maneuver and the maintenance of a neutral spine for the duration of the exercise. In the initial stages performance of a single arm raise or a single leg raise during the exercise will challenge the athlete and increase muscle activity. If the athlete is unable
to maintain a neutral spine during the limb movements regress with the exercise as it may
likely be detrimental to train poor motor patterns.

To date, there is no clear evidence that supports the relationship between poor core stability and musculoskeletal injury. There are progression of core stability exercises, it depends on your evaluation measure. Here we just provide you basic outline of core stability and its importance. I hope you like this article.

Comprehensive assessment and training require a multifaceted approach to address core muscle strength, endurance, and recruitment requirements for functional demands associated with daily activities, exercise, and sport.

What do you think folks after read this……..

Referance :

1. Bergmark, A. (1989). Stability of the lumbar spine: A study in mechanical engineering. Acta
   Orthopaedica Scandinavica Supplementum, 230 (60)
2. McGill, S.M. (1998). Low back exercises: Evidence for improving exercise regimens. Physical
   Therapy, 78 (7) 754-765.
3. McGill, S.M., Childs, & A., Lieberman, C., (1999) Endurance times for low back stabilization
   exercises: Clinical targets for testing and training from a normal database. Archives of Physical
   Medcicine and Rehabilitation, 80, 941-944
4. Kavcic, N., Grenier, S.,& McGill, S.M. (2004) Quantifying tissue loads and spine stability while
   performing commonly prescribed low back stabilization exercises, Spine, 29(20), 2319-2329.
5. Gibbons SGT, Comerford MJ. Strength versus stability: part 1. Concepts and terms. Orthop Division Rev. 2001;2:21-27
6. D’Hooge R, Hodges P, Tsao H, Hall L, Macdonald D, Danneels L. Altered trunk muscle coordination during rapid trunk flexion in people in remission of recurrent low back pain. J Electromyogr Kinesiol. 2013;23(1):173-181
7. Akuthota V, Ferreiro A, Moore T, Fredericson M. Core stability exercise principles. Curr Sports Med Rep. 2008;7(1):39-44
8. Barr, K., Griggs, M., & Cadby, T. (2005) Lumbar Stabilization: A review of core concepts and current literature part 1. American Journal of Physical Medicine & Rehabilitation, 84 (6), 473- 480.
9. Standaert, C.J., Weinstein, S.M.,& Rumpeltes, J. (2008). Evidence-informed management of chronic low back pain with lumbar stabilization exercises. The Spine Journal, 114-120
10. Van Dieen, J.H., Cholewicki, J., & Radebold, A. (2003). Trunk muscle recruitment patterns in patients with low back pain enhance the stability of the lumbar spine. Spine, 28(8), 834-841.
11. Vera-Garcia, J.F., Elvira, J.J., Brown, S,& McGill, S.M. (2007). Effects of abdominal stabilization maneuvers on the control of spine motion and stability against sudden trunk perrturbations. Journal of Electromyography and Kinesiology, 17, 556-567.
12. www.pptclinic.com,  https:lifestylephysio.com.au/core-strengthening/

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