Tag Archives: Core

Why is your core so important?

By Courtney White, Registered Physiotherapist

Have you ever wondered what makes up your core, why is it important, or how to safely train your core without getting back pain? Keep on reading to find out these answers and more!

Your core is more than just the muscles that you can see. There is a group of muscles below the big six pack muscles that wrap around you like a corset. Their job is to support you during every movement. This inner unit is like a TRANSFER STATION. To get power generated from your legs all the way to your shoulders, it must pass through the inner core. So, if you do not have proper control over your core, that power will not move between your upper and lower body as smoothly as you want it to.

What Makes Up the Inner Core Unit?

The inner core consists of the following: the diaphragm, the pelvic floor, transversus abdominus (TA), and multifidus. Collectively, these 4 structures create a CORE CANISTER.IMG_5235-01Pic for Core

Diaphragm: The diaphragm is our primary breathing muscle and it forms the top of the core canister. The diaphragm is the component that has the primary control over the intraabdominal pressure within the canister. It moves up and down as you breathe which changes the space in the abdomen and as a result, influences the pressure within the core canister.

Pelvic Floor: The pelvic floor is a group of muscles that form the bottom of the canister. It supports the weight of all the internal organs within our abdomen, assists with bowel and bladder control, and helps to control the intrabdominal pressure along with the diaphragm. The pelvic floor is partners with the diaphragm. When the diaphragm moves up and down, so should the pelvic floor.

Transversus Abdominis (TA): This muscle connects the top and bottom of the canister as well as creates the front and sides of the core canister. It runs deeper than the external six pack muscles that you can see. Its role is to support your lower back during movement and transmit forces between your upper and lower body.

Multifidus: This muscle forms the back of the core canister and runs along the spine. Multifidus serves as a primary support for the spine, pelvis, and hips.

[1]Canister

What Are the Functions of the Core Canister? 

  1. To support the back, pelvis, hips, and trunk during movement
  2. To serve as a transfer station for power and energy between the upper and lower body
  3. To assist with bowel and bladder control
  4. To improve performance during physical activity

How Does the Core Canister Work?

To gain a stronger core overall, it is important to learn how to “pressurize” the core canister. Previously, inner core training has focused largely on tensing the walls of the core canister through focused contractions of TA. Learning how to activate the diaphragm and pelvic floor was often missed or brushed over. More recent evidence now suggests that breath is the driving force behind influencing the intrabdominal pressure. Therefore, the diaphragm is the leader behind pressurizing the core.

When you breathe in, your diaphragm contracts and pushes down into the abdominal cavity which increases the intraabdominal pressure. In response to this increased pressure, the pelvic floor relaxes and lengthens to accommodate the abdominal organs translating downward. During your inhale, the pressure in the front part of the core canister is increased as your belly expands. This is counteracted by multifidus in the back as well as TA which work together to try and keep the intraabdominal pressure evenly distributed. When you breathe out, the diaphragm relaxes and rises which decreases the pressure within the core cannister. As a result, the pelvic floor should normally contract and rise.

[2]GifCore blog

How Do We Train the Core Canister? 

Many people focus on crunches, planks, and other large abdominal exercises when training the core but negate breathing. Learning to connect your breath with movements is the key to developing a stronger core. It will allow you to control the intrabdominal pressure within the core canister. Exercises like planks and crunches are not necessarily bad exercises as they can be very effective later if you first learn to optimize the control of your core canister.

The first step is to learn how to engage your diaphragm through diaphragmatic umbrella breathing. Once you have achieved this, it is time to add in the pelvic floor so that you learn how to engage your diaphragm and pelvic floor together as a unit, referred to as piston breathing. You can also learn how to connect and activate TA and multifidus to further optimize your control over the core canister. However, it is important to highlight that the goal here is to learn how to change the size of your core canister by recruiting all these muscles together, rather than focusing solely on how to contract each specific muscle. Once you have learned how to control the pressure within the core canister, it is now time to perform bigger movements that require you to maintain control over the canister while doing a larger activity.

Check out our post on our Facebook and Instagram pages (dated May 21, 2020) for exercises you can try at home to increase your control of the core canister!

What Can Happen If You Do Not Have Control Over Your Core? 

It is not uncommon to have a weak inner core or lack control over your core canister. This can originate from prolonged sitting and slouching which distorts and changes the shape of the core canister (see part B in Figure 3 below). This positioning leads to breathing through the accessory muscles in your neck and chest, decreasing the engagement of your diaphragm. As you can see in the figure below, this puts a lot of strain on the lumbar spine which can lead to pain and injury. Ideally, your core canister should look something like part A in the figure below where the intraabdominal pressure is equally distributed. Without proper control over your inner core, it makes it very difficult for you to be able to hold your body in a good position during exercise and physical activity. This increases your risk for injury.

[3]DNS-Scissor

Now that you have learned more about what the core is and why it is important, if you have any questions or are interested in setting up an appointment with one of our Physiotherapists, contact us today! We will be happy to help you achieve your goals by developing an individualized treatment plan. 

BodyTech Physiotherapy

Text References

Diane Lee & Associates: core training vs. strengthening (internet). South Surrey: D G Lee Physical Therapist Corp; (cited 2020 May 22). Available from: https://dianeleephysio.com/education/core-training-vs-strengthening/

Key J. ‘The core’: understanding it, and retraining its dysfunction. Journal of bodywork and movement therapies. 2013 Oct 1;17(4):541-59.

Pronatal Fitness: the first move to teach your clients (internet). 2018 July 18. (cited 2020 May 22). Available from: https://pronatalfitness.com/2018/07/18/360-breathing/

Image References 

[1] The role of the diaphragm. Digital Image. Chiroup.com. Nov 2016. [Accessed on 2020 May 22]. Available from: https://chiroup.com/the-role-of-the-diaphragm/. 

[2] Breathing variations. Digital Image. S. McLaughlin. Aug 2019. [Accessed on 2020 May 22]. Available from: https://www.alignforhealth.com/self-care-for-pain/category/core%20stabilization 

[3] The “pop can” core. Digital Image. J Smeaton. Apr 2019. [Accessed 2020 May 22]. Available from: https://www.depthtraining.ca/the-pop-can-core/.

Exercises and Strategies for Stair Climb Events

Stair climbing is both a functional activity that most people complete daily and an activity that can be used for exercise. There are two different strategies that can be used to climb a flight of stairs: the knee first strategy (Figure 1) and the hip first strategy (Figure 2). In the knee first strategy, the movement is broken up into two distinct vectors with a horizontal vector (1) initiating the movement and the vertical component (2) following. This movement pattern relies on the quadriceps muscles as the primary mover and places increased stress on the knee which increases the likelihood of knee pain developing during stair climbing. The hip first strategy combines the vertical and horizontal components and results in a diagonal vector of movement. It relies primarily on the gluteal muscles to initiate the movement. This strategy decreases loading through the knee and reduces the risk of knee pain with repetitive stair climbing. Using a hip first strategy becomes especially important when using stair climbing as an exercise or when training for/completing an event like the CN Tower Climb.

Stair climb Fig 1 and 2

Excellent strength and endurance of the gluteals (buttocks), quadriceps (front thigh muscles), and core are required to successfully complete the CN Tower Climb without injury. A good preparation program will involve both strengthening exercises and stretches for the major muscle groups of the lower extremity and core.

Strengthening Exercises

As the CN Tower climb requires good muscle endurance, each exercise should be performed for a minimum of 20 repetitions.

Squats

Stair Climb - Squat

Stand with feet hip width apart, toes facing forward. Keeping the chest open and shins vertical, reach the hips back as if sitting on a chair, allowing the knees to bend. The knees should never go in front of the toes.

 

 

 

 

Single Leg Squats

Stair Climb- single leg squatStand on one leg, keeping the pelvis level. Keeping the knee in line with toes and maintaining a level pelvis, reach the hips back and allow the knee to bend as if sitting on a chair. The knee should never go in front of the toe.

 

 

 

 

Step Ups

Stair Climb- step upsPut one leg up onto a step. Keep the knee in line with the toe and drive through the glute to straighten the knee and hip. Weight should not shift forward prior to initiating the movement.

 

 

 

Monster Walks

Stair climb- monster walkStand on a band and cross it in front or tie the band around mid thigh as shown in the picture. Do a mini squat, ensuring that the hips are back and knees are behind toes. Keep the pelvis square and level and take a step to one side, slowly bring the other leg in. Perform to both sides.

 

 

 

 

Plank

Stair climb- plankWith forearms shoulder width apart, gently squeeze shoulder blades together and pull down from ears. Balance on knees (easier) or balls of feet (harder), keeping the spine long, hips in line with shoulders, and chin tucked. Hold 30-60 seconds.

 

Single Leg Jump

Stand on one leg, keeping the pelvis level. Do a mini squat, power through glutes and calf to jump off ground. When landing, ensure heel is on the ground, knee is bent, hip is back and knee is in line with toe.

Box Jump

Stand with feet hip width apart a comfortable distance from the box. Do a mini squat before powering through glutes and swinging arms up to jump onto the box. Land keeping knees behind toes and core engaged. Stand up straight. Jump off the box and land in a controlled squat.

Sprint

With good running form, sprint for 60 seconds. Walk or lightly jog to recover for 2-3 minutes. Repeat 5-8 cycles.

Stretches

All stretches should be held for 30-60 seconds and repeated twice. Stretches should be performed daily when trying to lengthen a muscle or after a work-out when the goal is to maintain muscle length.

Hip Flexors

Hip flexor and quad lungeIn a lunge stance with the back knee on the floor, tuck the pelvis under keeping the back straight.

 

 

Glutes

Piriformis supine #2 (1)Lying on your back, keeping shoulders and back on the floor, cross the leg to be stretched over the other in a figure 4 position and bring both hips to a 90 degree angle.

 

 

Hamstrings

Hamstring seatedSit with the leg to be stretched straight and the other foot tucked in. Keep the back straight and lean forward towards the straight leg by hinging at the hips.

 

 

Quadriceps

Quad standingStand and bring the heel of the leg to be stretched towards the buttock. Ensure that the bent knee does not drift forward in front of the other knee.

 

 

 

Calves (Soleus and Gastrocnemius)

image6Soleus

Stand in a lunge stance. Keeping the torso

upright, bend both knees and sit back over the back leg.

 

 

image7

Gastrocnemius

Stand in a lunge stance. Keep the back leg straight and bend the front leg keeping the back heel on the ground.

 

 

 

Child’s Pose

Stair climb- prayer stretchStart on hands and knees with hands and knees shoulder and hip width apart, keep hands on the ground and sit hips back towards the heels until a stretch is felt through the back.

The Truth behind Core Activation

Development of a strong core can be a common goal for numerous reasons, such as:  improving physical physique, preventing/relieving back pain, improving performance in recreational or competitive activities and building a stable base for our arms and legs to perform normal activities of daily living. This article will correct any myths about proper core activation. It will explain how development of a strong core will improve overall function for not only the lower back, but our bodies in general.

The first key to a strong core is developing a stable inner core. The inner core works as a unit to create dynamic stability around the spine and pelvis.

The inner core is made of up of four muscle groups:

  • transversus abdominis
  • pelvic floor muscles
  • multifidus
  • diaphragm

 

Transversus Abdominis (TA):

pic 1Transversus abdominis is a muscle that lies deep within the abdomen, attaching to fascia at the spine and wrapping forward towards the belly button, creating an internal corset. The function of the TA muscle is to stabilize your low back and pelvis prior to moving your arms or your legs. This muscle should be engaging subconsciously with any arm/leg/back movement throughout the day; however for many of us this is not the case. Reasons for inhibition of this muscle include: low back pain, surgery to the low back or abdomen, or pregnancy. To re-educate this muscle you must learn to tighten your lower abdomen without tilting your pelvis or puffing out your chest. Engagement is achieved by gently drawing your belly button inpic 2 towards your spine feeling tension develop on the sides of your pelvic bones. Make sure you remember to breathe naturally from your abdomen as you hold this contraction. Once the muscle is activated, movements of the arms and legs can be added to increase the difficulty and by integrating TA contractions into activities of
daily living.

 

Pelvic floor:

The second wall of the inner core is composed of the pelvic floor musculature. This creates the floor or base of the inner core unit. Contraction of these muscles can be achieved by envisioning that you are stopping your urine flow midstream. This exercise is very similar to the traditional Kegel exercise, and adds a second component of stability to our inner core. Please note that if you are experiencing any incontinence or retention issues you should visit a pelvic health physiotherapist before starting pelvic floor exercises.

 

Multifidus:

pic 3The third component of our inner core is the multifidus muscle. Multifidus is located on either side of the spine. This muscle is a segmental spinal stabilizer, and atrophy can be seen at one or multiple levels.  To retrain this muscle you will likely need the help of a physiotherapist. Your physiotherapist will palpate (touch) the sides of your spine and you will be asked to swell the muscle under their fingers. This is difficult for many of us to do without the help of additional muscles. Common ways we cheat to mimic this muscle function is by tipping the pelvis forward, flexing the hips or tightening the muscles of the buttock. A good way to feel multifidus activate would be to take a step forward while palpating the gutters beside the spine; you will feel a small bulge of muscle under your fingers as multifidus contracts.

 

Diaphragm:

The fourth component or roof of the inner core is the diaphragm muscle. To ensure correct stability/function through this muscle, make sure you breathe from your stomach (abdominal breathing) rather than from your chest during the inner core contraction. Breathing from the chest is less than ideal for proper core function and limits the use of the diaphragm muscle.

 

Why Core Engagement Helps Prevent Muscle Injury:

Dysfunction of the inner core results in increased pressure placed on passive structures (ligaments, bone/joints, discs, capsules) of the lumbar spine due to lack of support and stabilization when moving. If the passive structures are not supported with the core, repeatedly or over a prolonged period of time, injury or dysfunctions such as stiffness or poor movement patterns may occur, creating pain.

 

Lack of Proper Inner Core Strength Can Lead to Injury:

Often exercises that are meant to strengthen the core can lead to injury. A common mistake individuals make is performing exercises that challenge outer core muscles without proper endurance of the inner core. Performing exercises such as sit-ups and planks without a stable foundation can lead to injury of the lower back/pelvis due to the lack of dynamic stabilization around these joints. Without a strong core, maintaining the correct exercise position is also difficult and can lead to injury. Similarly, if an individual performs a lift without anticipatory engagement of the inner core, increased load is placed on the passive system of the back and pelvis, possibly leading to an injury.

 

Functional Retraining of Proper Core Engagement:

The core acts as a foundation or stable base on which all body movements are generated to maintain back and pelvic stability. Strength of core musculature enables effective load transfer throughout the body with functional movement and activity.

The exercise strategies listed above can be utilized to re-educate use of the inner core muscles. Once inner core activation is successfully achieved, activation should be performed in differing functional positions and levels of difficulty. Following successful re-training of the inner core, your physiotherapist will begin to introduce outer core exercises (to challenge your rectus abdominus, external obliques, internal obliques). Isometric outer core engagement will be integrated while performing arm and leg movements, ensuring that the spine remains stabilized in neutral throughout.

The outer core can be categorized into four sling systems, which exist in the body to help with stability around the trunk and pelvis. Your physiotherapist can create a graduated outer core retraining program using these slings once correct inner core engagement is achieved.

 

Outer Core Sling Systems:

Four sling systems (specific groupings of muscle) exist in the outer core. These sling systems are designed to help with Force Closure to the joints of the low back and pelvis (SI joint). Force closure describes use of the muscular and fascial system to assist with stability around joints.

 

Posterior Oblique Sling:

The posterior oblique system assists with force closure by use of the following muscles/fascia:

  • Gluteus maximus
  • Opposite latissimus dorsi (lats)
  • Thoracodorsal fascia (band connecting trunk to lower extremity)

pic 4An example of an exercise that incorporates use of the posterior oblique sling is bird dog.

Functionally the posterior oblique system is used during walking and rotational activities (ie. swinging a golf club).

 

Anterior Oblique Sling:

The anterior oblique system assists with force closure by use of the following muscles/fascia:

  • External obliques
  • Opposite internal obliques
  • Transversus abdominis

pic 5An example of an exercise that encourages use of the anterior oblique sling is dead bug.

Functional use of the anterior oblique system is used during the acceleration phase of throwing.

 

 

Longitudinal Sling:

The longitudinal sling system assists with pelvic stability. The muscles/fascia making up the longitudinal sling include:

  • Erector spinae (low back extensors)
  • Multifidus
  • Thoracodorsal fascia
  • Sacrotuberous ligament (ligament at the SI joint)
  • Biceps femoris (outer hamstring muscle)

pic 6An example of an exercise that would engage the longitudinal sling is the reverse boat pose in yoga or a superman exercise.

The longitudinal sling is functionally utilized during walking and running activities.

 

Lateral Sling:

The lateral sling is important for force closure across the pelvis, and also ensures positional control of the pelvis during single leg stance and walking. Muscles/fascia included in the lateral sling system are:pic 7

  • Gluteus medius and minimus
  • Opposite hip adductors (inner thigh muscles)

Exercises designed to promote activation of the lateral sling are often performed in a single leg stance position, ensuring correct core and pelvic control. Specific exercises for the lateral system include: step ups, step downs and side step ups.

The lateral sling is used functionally during walking and any single leg activity.

pic 8The final step to successful core retraining is to obtain full function. Performing functional movements while maintaining controlled trunk and limb movements in changing environments is the first step in functional retraining. Once you are comfortable with this activity, speed of activation and increased load can be added to challenge the core further. Further information and a staged exercise program can be discussed with your physiotherapist.

Diane Lee & Associates: training for the deep muscles of the core (Internet). South Surrey: D G Lee Physical Therapist Corp;  (cited 2016 Jan 12). Available from: http://www.dianelee.ca/article-training-deep-core-muscles.php