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What is core?:

What is core? Core refers to the body minus arms and legs. Core can be described as a muscular box with the abdominals in the front, paraspinals and gluteals in the back, the diaphragm as the roof and the pelvic floor and hip girdle musculature as the bottom. Within this box 29 pairs of muscles are there which helps to stabilize the spine, pelvis and kinetic chain during functional movements.

29 pairs of muscles:

29 muscles attach to core Lumbar Spine Muscles Transversospinalis group Rotatores Interspinales Intertransversarii Semispinalis Multifidus Erector spinae Iliocostalis Longissimus Spinalis Quadratus lumborum Latissimus Dorsi 29 pairs of muscles

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Transversospinalis group -Poor mechanical advantage relative to movement production Optimal for providing proprioceptive information to CNS -Inter/intra-segmental stabilization Erector spinae -Provide intersegmental stabilization -Eccentrically decelerate trunk flexion & rotation Quadratus Lumborum -Frontal plane stabilizer -Works in conjunction with gluteus medius & tensor fascia latae Latissimus Dorsi -Bridge between upper extremity & core

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Abdominal Muscles -Rectus abdominus -External obliques -Internal obliques -Transverse abdominus -Work to optimize spinal mechanics -Provide sagittal , frontal & transverse plane stabilization

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Psoas -Works with erector spinae , multifidus & deep abdominal wall (Works to balance anterior shear forces of lumbar spine) -Can reciprocally inhibit gluteus maximus , multifidus , deep erector spinae , internal oblique & transverse abdominus when tight (Extensor mechanism dysfunction) -Synergistic dominance during hip extension Hamstrings & superficial erector spinae May alter gluteus maximus function, altering hip rotation, gait cycle

Hip musculature:

Hip musculature

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Gluteus medius -Frontal plane stabilizer Weakness increases frontal & transverse plane stresses ( patellofemoral stress) -Controls femoral adduction & internal rotation -Weakness results in synergistic dominance of TFL & quadratus lumborum Gluteus maximus -Hip extension & external rotation during OKC, concentrically -Eccentrically hip flexion & internal rotation -Decelerates tibial internal rotation with TFL -Stabilizes SI joint -Faulty firing results in decreased pelvic stability & neuromuscular control

Hamstrings :

-Concentrically flex the knee, extend the hip & rotate the tibia -Eccentrically decelerate knee extension, hip flexion & tibial rotation -Work synergistically with the ACL to stabilize tibial translation All muscles produce & control forces in multiple planes Hamstrings

Anatomy of core muscle:

Anatomy of core muscle The core acts through the thoracolumbar fascia, ‘‘nature’s back belt.’’ The transversus abdominis has large attachments to the middle and posterior layers of the thoracolumbar fascia . Two types of muscle fibres comprise the core muscles i.e slow-twitch and fast twitch. Slow twitch fibres -make up primarily the local muscle system (the deep muscle layer). These muscles are shorter in length and are suited for controlling intersegmental motion and responding to changes in posture and extrinsic loads.

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Fast twitch fibers- comprise the global muscle system i.e the superficial muscle layer. These muscle are long and possess large lever arm, allowing them to produce large amounts of torque and gross movements. MUSCLES There are two types of muscle used when stabilizing the lumbar spine and pelvis:

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a) Local postural muscles: these are the deeper muscles in the area. They are traditionally known as the core muscles. They attach directly to the lumbar vertebrae and surrounding thoracolumbar fascia tensing and relaxing to provide stability to the area. The main postural muscles are: i . Multifidus ii. Transversus Abdominus iii. Diaphragm iv. Pelvic Floor

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b) Global dynamic muscles: these are the large torque producing muscles which ling the pelvis to the thoracic cage and provide a more general stabilization to the area along with trunk movement. Overuse of these muscles can decrease the function of the local postural muscles. Some of these muscles include: i . Rectus Abdominus ii. Internal Oblique iii. External Oblique iv. Erector Spinae ( Longissimus and iliocostalis )

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The Transversus Abdominis The TA is the body’s natural corset. It’s the muscle you use to pull in your tummy when you walk along the beach. The T.A. connects at the left of the spine, wraps around the abdomen attaching to the ribs and hips, until it reaches the right side, encasing the internal organs. The more superficial abdominal muscles that give you a six pack are layered on top of these support muscles.

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The Pelvic Floor You will have located and used your PF when you have been in need of a toilet and canʼt find one. You will also be aware of them when you cough or sneeze as they tend to tense spontaneously under this pressure. Unfortunately people generally do not pay enough attention to these important muscles. The PF is the structure, not unlike a basket that hold in and support your abdominal organs, stablise the hips in association with the core and helps with balance as well as reducing the risk of stress incontinence.

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The Diaphragm The Diaphragm is a sheet of muscle that works with the muscles of the ribs to expand and contract the ribcage during respiration (breathing). We do not often take control of the Diaphragm. The way we control our diaphragm is usually through breathing; rate, rhythm and depth, you donʼt focus on the diaphragm but the inhale and exhale. The stronger we make the diaphragm, however, the deeper, slower and more paced our breathing will be.

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The Multifidus The Multifidus runs the length of the spine, it has a unique design which provides support as well as keeping us upright by providing scaffolding for the vertebral column. Unlike most muscles when the multifidus is on stretch, (when we bend forward) it gets stronger. Generally if a muscles is lengthened it has a tendency to lose strength. Obviously the Multifidus is operating under different rules.

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The abdominals serve as a particularly vital component of the core. The transversus abdominis has received attention for its stabilizing effects. It has fibres that run horizontally (except for the most inferior fibers, which run parallel to the internal oblique muscle), creating a belt around the abdomen. The internal oblique and the transversus abdominis work together to increase the intra-abdominal pressure from the hoop created via the thoracolumber fascia. Increased intraabdominal pressure impart stiffness of spine. The external oblique, the largest and most superficial abdominal muscle, acts as a check of anterior pelvic tilt.

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The abdominal and multifidi need to engage only to 5% - 10% of their maximal volitional ontraction to stiffen spine segments. The hip musculature is vital to all ambulatory activities, and plays a key role in stabilizing the trunk and pelvis in gait.

A system of spinal stability and this system can be compared with viking ship:

A system of spinal stability and this system can be compared with viking ship

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These natural curves of the spine are caused by muscles, ligaments and tendons that are connected to the vertebrae of the spine. These structures support the spine which would collapse without them. These ligaments, muscles and tendons are often compared to the guide ropes that support the mast of a ship.

Benefits of spinal stability:

Benefits of spinal stability Improve posture and prevent deformities. More stable Centre of gravity and control during dynamic movements. Optimal movement patterns. Breathing efficiency. Distribution of forces and absorption of forces. Reduce stress on joint surfaces and pain. Injury prevention and rehabilitation.

Pelvis neutral:

Pelvis neutral The pelvis in a neutral alignment will help to balance the spine. Neutral spine alignment is when the pelvis is balanced between the two exaggerated anterior and posterior positions. When the pelvis is in neutral the bones at the top of the pelvis back and front, the Anterior Superior Iliac Spine (ASIS) and the Posterior Superior Iliac Spine (PSIS) are level.

Components of spinal stability :

Components of spinal stability

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Passive subsystem - Vertebrae Discs Joint capsules Ligaments Active system - Muscles Tendons surrounding the spinal column. Neural and Feedback subsystem- constituted the various force and motion transducers, located in ligaments, tendons, and muscles, and in the neural control. Core stability could be considered as the interplay between these three components centres.

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Assessment -

Wisbey-Roth Core Stability Grading System ( T Wisbey-Roth, 1996):

Wisbey -Roth Core Stability Grading System ( T Wisbey -Roth, 1996) Tests were stopped when muscles were insufficiently activated. Multifidus activity should be bilateral. Glut Max activity at least ratio 2:1 with hamstrings Grade 1-2, ratio 1: 2 Grade 3-4 Glut Med activity at least ratio 2:1 with TFL Grade1-2, ratio 1: 2 Grade 3- 4.

Grade 1:

Grade 1 Grade 1 Able to maintain an isometric contraction (min 10 sec) without compensatory movement of the core, in a position aimed to facilitate the stabilising role of key muscles. Grade 1 a 4 point kneeling Grade 1b: Sitting

Grade 2:

Grade 2 Able to maintain an isometric contraction (for min 10-20 seconds) without compensatory movement of the core, with superimposed slow movement of the limbs Grade 2: Sitting with foot slide

Grade 3:

Grade 3 Able to maintain control of the core without compensatory or inappropriate movement, while performing slow movements of the trunk itself. Weight shift side to side

Grade 4:

Grade 4 Able to maintain control of the core, while performing joint angle and contraction specific movements of the limbs. 4pt kneel with resisted hip ext via theraband

Grade 5:

Grade 5 Able to maintain an isometric contraction of core stabilisers while performing:- a) fast movements of the trunk. b) fast movements of the limbs. c) against increased resistance, all involving sport/activity specific postures . Theraband resisted kicks

Other method:

Other method Lateral musculature test Test performed on both sides of the body Lying in full side bridge, legs extended, top foot in front subject supported on one elbow and feet while lifting hips off the floor to create a straight line over their body length Uninvolved arm placed across the chest with hand on opposite shoulder Failure occurs when person loses the straight-back posture and hip returns to ground

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Assessment (cont):

Flexor endurance test Begins with person in a sit-up posture with the back resting against a jig angled at 60 degrees Knees and hips flexed at 90 degrees Arms folded across chest Hands on opposite shoulders Toes are secured by examiner or toe straps Test begins by pulling support back ten centimeters Failure occurs when subject falls back and touches jig 41 Assessment (cont)

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Lunge Assessment:

Instruction-ask the client to perform a forward lunge. Results-observe how the client performs the lunge. Core weakness may be present if the client bends the trunk to the side,adducts and internally rotates the hip, or shows valgus of the knee( the knee crosses the midline). Lunge Assessment

Single-leg Squat test:

The single-leg squat test is a functional test that is useful for identifying dysfunctional hip strength and core control in clients and athletes ( zelfer et al.2003;DiMattia et al 2005.) Instruction-Ask the client to squat on one leg,having the client flex the knee to approximately 60 0 ,then return to a full upright posture. If the client is unable to maintain his balance during the test, that test is considerd a failure and must be performed again. Single-leg Squat test

Assessment (cont):

Back extensors test Upper body cantilevered over the end of test bench - hands across chest Time to failure - drop from horizontal CPAFLA - similar test described in detail 45 Assessment (cont)

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Lower extremity functional profiles Isokinetic tests Balance tests Jump tests Power tests Sports specific functional tests

Stabilizations and Strengthing:

Stabilizations and Strengthing

Core Stabilization Training Program:

48 Level I: Stabilization Core Stabilization Training Program

Level II: Stabilization and Strength:

49 Level II: Stabilization and Strength

Level II: Stabilization and Strength:

50 Level II: Stabilization and Strength

Level III: Integrated Stabilization Strength:

51 Level III: Integrated Stabilization Strength

Level IV: Explosive Stabilization:

52 Level IV: Explosive Stabilization

Basics of Core Stability :

Essential to sport performance and injury prevention Core serves as the foundation for all movement Contraction of core muscles stabilize the spine, pelvis, and shoulders creating a solid base of support A solid base of support allows for forceful movements of the extremities Basics of Core Stability

Basics of Core Stability:

Training core muscles helps to correct postural imbalances preventing injury A strong core is extremely important in activities of daily living. Training the core involves using many muscles in a coordinated movement rather than isolation. Stability exercises recruit numerous muscles of the torso at once. Basics of Core Stability

Basics of Core Training:

Basics of Core Training

Basics of Core Training:

Abdominal bracing is the main technique used. This refers to contraction of the abdominals throughout the movement. In bracing one would attempt to draw the navel toward the spine while breathing normally. The transverse abdominus is primarily recruited Basics of Core Training

Basics of Core Training:

There are a number of exercises used to train the core Push-ups and crunches are the most basic type Use of stability balls, wobble boards, and medicine balls in these exercises is common Basics of Core Training

Basics of Core Training:

A study comparing 13 different abdominal exercises ranked them from best to worst based on muscle stimulation in the rectus abdominus, and the internal and external obliques. The ratings next to some exercises indicate where they fell in comparison. Only 13 were tested so not all shown will have a rating. The torso tack was 5 th making it the most highly rated commercial product. Ab Roller was 9 th . Basics of Core Training

Core Exercises :

Core Exercises Basic Crunch-11th Bicycle Maneuver-1st Lie on back, knees bent, feet on floor, lower back pressed to floor, fingers on side of the head Bring knees up to about a 45° angle and slowly go through a bicycle pedal motion Touch left elbow to right knee, then opposite

Core Exercises :

Core Exercises Captain’s Chair- 2nd Requires gym equipment or a stable platform appropriate for the exercise Start with legs dangling and slowly lift knees toward chest Motion should be controlled and deliberate as knees are raised and lowered

Core Exercises:

Crunch on stability ball – 3rd Sit on ball with feet flat on floor, fingertips at side of head Let ball roll back slowly and lie back until thighs and torso are parallel with floor Contract abdominals to no more than 45° angle with floor Core Exercises

Core Exercises:

Core Exercises Vertical Leg Crunch-4th Lie on back, knees bent, feet on floor, lower back pressed to floor, fingers on side of the head Extend legs into air with ankles crossed and a slight bend at knee Lift torso upward toward knees

Core Exercises:

Oblique Crunches Lie on back, knees bent, feet on floor, lower back pressed to floor, fingers on side of the head Drop knees to one side Curl up slowly so shoulders clear the floor Hold for a count of 2 seconds Core Exercises  

Core Exercises:

Core Exercises Reverse Crunch-7th Lie on back, knees bent, feet on floor, lower back pressed to floor, fingers on side of the head Cross feet at the ankles, lift feet off the ground to the point where there is a 90° angle at hips and knees Rotate hips to push legs upward

Core Exercises:

Core Exercises Plank Body in push-up position (back flat angling from toes to shoulders) but with elbows under shoulders and palms down Hold abdominals tight and keep spine neutral being careful to prevent buttocks from sticking up (tilting pelvis will do this) Hold for 30-60 s

Core Exercises:

Alternating Supermans Lie prone on mat with arms stretched obove head (like Superman when flying) Raise right arm and left leg 5-6 inches off floor Hold for at least 3 seconds Repeat with opposite Can be performed on a SB Start with stomach on ball balancing on hands and feet Core Exercises  

Core Exercises:

Back Extensions on Stability Ball Feet firmly on floor and stomach centered on SB Back rounded over ball Slowly lift shoulders until back is straight or slightly arched, do not hyperextend Core Exercises  

Core Exercises:

V-ups with SB Lie with arms extended over head holding SB between hands Bring extended arms and legs together (creating a V) and transfer ball from hands to legs Slowly return to starting position Core Exercises  

Core Exercises:

Push-ups with SB With arms in extended push-up position and stability ball under thighs slowly walk hands out until ball is below knees. Legs are extended during the ex. Attempt a few push-ups. Continue to walk hands out and attempt a few more. Advanced ex has toes pivoted on SB Core Exercises  

Core Exercises:

Seated Oblique Twists with Medicine Ball Sit on floor knees bent and feet flat on floor Hold medicine ball in hands directly in front, twist to side and place ball on ground behind back Turn to the other side and retrieve ball Needs to be repeated for other side May be done with a training partner Core Exercises  

Core Exercises:

An additional movement to the medicine ball twists is passing the ball under the legs. Feet remain off of the floor and ball is transferred from hand-to-hand under and over the legs This can be done in the middle of the set of twists as a variation Core Exercises  

Core Exercises:

Supine Hip Extension with SB Lie on back with knees and hips at 90° Fully extend hips in a slow controlled motion and slowly return to starting position Feet stay on ball throughout ROM and ball is not to move Core Exercises  

Core Exercises:

Elbow Bridge with SB Start with elbows supporting on sb and knees on surface Balance on knees while maintaining a stable position Brace and roll ball away from knees with elbows in position Advance by doing same motion from feet Core Exercises  

Core Exercises:

Reverse Hyperextension Start prone on sb with center of ball under navel Extend at hips in a slow steady motion to 180° Core Exercises  

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Thanks you By ushma saini.R

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