Tag Archives: Physiotherapy

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.

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Injury Prevention and Physiotherapy

By Cassandra Kroner, PT

best-chicago-group-step-class.jpgIt is a common misconception that you only need to see a physiotherapist if you have an injury or pain. Physiotherapists have a wide range of skills, and recognizing the risk for future injury is one of them. Injury prevention is applicable to all individuals, regardless of their activity level, from the office worker to the athlete, and especially for those with previous injuries that could reoccur.

Repetitive Strain Factors

  • Occupation
  • Training errors
  • Age
  • Excessive or repetitive loads
  • Inappropriate footwear
  • Structural abnormalities
  • Muscle control
  • Core stability
  • Joint alignment
  • Muscle strength and flexibility imbalances
  • Previous injury
  • Posture

In general there are two types of injuries – traumatic and repetitive strain. Traumatic injuries are easier to understand, as they are the result of a singular event that causes damage. On the other hand, repetitive strain injuries occur when stressors that normally do not cause harm are repeated to the point of causing micro trauma that builds over time until the tissue becomes inflamed and injured. These injuries tend to begin subtly, and gradually increase in severity. Combined with the multi-factorial list of possible contributing factors, repetitive strain injuries can be challenging to diagnose and treat. However, in most cases repetitive strain injuries can be avoided with a good injury prevention and maintenance program.

A Common Factor: Muscle Imbalance

When an individual is involved in one specific sport or has a repetitive aspect to their job, the muscles are put under a great deal of strain to repeatedly perform the same movements. Sedentary jobs involving prolonged postures can have similar effects with certain muscles constantly working for long periods. Over time, muscle imbalances develop as the muscles that are being used the most continue to get strong while the reciprocating muscles become lengthened and weak. These muscle imbalances can cause movement restrictions that affect performance and increase stress on the body. Increased stress on muscles, joints and ligaments eventually leads to a repetitive strain injury.

15250-a-young-woman-stretching-outdoors-before-exercising-pv-630x390.jpgThe First Steps Toward Injury Prevention

Getting started on the road to injury prevention is as simple as booking an appointment with a physiotherapist. If you are unsure how injury prevention could apply to you or if you could be at risk for injury, speaking with a physiotherapist can help clarify your needs and goals. The same expert assessment skills physiotherapists use to diagnose injury will be used to proactively assess for risk factors that could lead to future injury. Your lifestyle, the demands of your job, and the specific sports or activities you participate in will be considered, along with the assessment findings, to develop an individualized treatment plan. This plan could involve manual therapy to correct joint restrictions or muscle length imbalance, strength and flexibility exercises, correction of movement patterns, and education.

By addressing several predisposing factors to injury, the body is optimally prepared to handle the demands of the workplace or sport. This can translate to decreased frequency and severity of future injuries, with the added benefit of a shortened recovery time in the event an injury does occur. Don’t wait for an injury to strike to take charge of your health!

BodyTech Physiotherapy

The Sitting Solution

By Carla Cranbury, PT

Let’s face it, we sit a lot. Between working, commuting, and watching television, the Canada Health Measures Survey found that most Canadian adults spend 9 hours and 48 minutes of their waking time being sedentary. Most of us know that physical activity is good for us, but did you know that just sitting less (regardless of exercise) can also be beneficial in the long term?

A study published in 2009 followed more than 17 000 Canadians for 12 years. Over the twelve years they compared the participants’ daily sitting time and leisure time physical activity with mortality rates of various causes. What they found was that the amount of daily sitting time was positively associated with mortality rates from all causes, except cancer. Basically the more people sit, the higher the risk of mortality. This even includes people who are physically active, showing that high amounts of sitting time cannot be compensated for with exercise, even if it exceeds the current minimum physical activity recommendations.

Other studies have echoed similar findings. A seven year study reported that people who spend less than half their time sitting have a lower risk of mortality than those who spend more than half their day sitting. Another six year study reported that women who spend 16+ hours sitting per day have an elevated risk for cardiovascular disease compared with women who sit for less than 4 hours a day.

These studies are not to say that physical activity is not important – it still is, and it is still beneficial for your health. Physical activity also contributes to decreased time spent sitting.  What these studies are saying is the physiology associated with excessive sitting is different than the physiological benefits of exercise, and therefore excessive sitting cannot be compensated for with periods of exercise.

So now that you know, what can you do?

If you work at a desk most of the day, sitting can be hard to avoid. Some options are:

  • Ask your work if they can accommodate an ergonomically sound standing desk
  • Take frequent breaks from sitting to walk around
  • Go for a walk on your lunch break
  • Walk to your co-workers desk to talk to them instead of sending an email
  • Park at the back of the parking lot to get a few extra steps
  • Take the stairs!
  • Take frequent standing breaks throughout the day
  • Discover new ways to be active during your leisure time – ditch the TV and get outside

It’s the small changes to your daily routine that can add up and make a big difference. The best time to start is today!

BodyTech Physiotherapy

References

Katzmarzyk, Peter T. et al. “Sitting Time And Mortality From All Causes, Cardiovascular Disease, And Cancer”. Medicine & Science in Sports & Exercise 41.5 (2009): 998-1005. Web.

“Directly Measured Physical Activity Of Adults, 2012 And 2013”. Statcan.gc.ca. N.p., 2017. Web.

Manson, J.E., P. Greenland, and A.Z. LaCroix. “Walking Compared With Vigorous Exercise For The Prevention Of Cardiovascular Events In Women”. ACC Current Journal Review 12.1 (2003): 29. Web.

Weller, Iris and Paul Corey. “The Impact Of Excluding Non-Leisure Energy Expenditure On The Relation Between Physical Activity And Mortality In Women”. Epidemiology 9.6 (1998): 632-635. Web.

Physiotherapy for Carpal Tunnel Syndrome

Carpal Tunnel Syndrome
Carpal Tunnel Syndrome is pain, numbness, and tingling, in the wrist and hand particularly in the thumb, index and middle finger. This syndrome affects approximately 3-6% of the general population. The carpal tunnel is a small passageway at the wrist that tendons and the median nerve run through as they travel into the hand. The tunnel is surrounded by bone and connective tissue so it does not easily stretch or expand, making structures within it susceptible to irritation which can cause the median nerve to be compressed. If left untreated and the condition worsens, symptoms may progress to include weakness in the hand.

Causes and Risk Factors
A combination of several of the following factors can increase the risk of developing carpal tunnel syndrome:

  • Chronic stress on wrist/hand – typically affecting the dominant hand, often due to working posture or repetitive motions (eg. using computers for several hours a day, assembly-line workers, musicians, using vibrating power tools)
  • Trauma to the wrist (eg. fracture, sprain) – can cause damage to the nerve or swelling to other structures that will narrow the carpal tunnel
  • Pregnancy – hormonal changes can affect tendons and cause swelling
  • Arthritis – bony growths into the tunnel narrow the space
  • Congenital Predisposition – women and smaller individuals may have narrower carpal tunnels, reducing space for the nerve
  • Diabetic or Metabolic Disorders – negatively affect the body’s nerves

Symptoms
The most common symptoms of carpal tunnel syndrome include:

  • Gradual onset of pain, burning, tingling, numbness or itching in the palm, thumb and/or index and middle fingers
  • Feeling of weakness and swelling in the hand, with difficulty grasping small items, making a fist and performing fine motor tasks
  • Urge to shake out the hand to relieve the tingling sensations

In the early stages, symptoms will often be intermittent. However, as the condition worsens symptoms are more severe and begin to persist for longer periods of time. Pain and numbness tends to be worse at night for a lot of individuals.

Treatment
It is advised to seek treatment from a professional as soon as carpal tunnel symptoms arise as the condition will not typically resolve on its own.

Medication: Over the counter anti-inflammatory drugs (eg. Ibuprofen) may provide short term relief from mild symptoms. Corticosteroid injections are a much stronger anti-inflammatory, and may also be a temporary option to help relieve pressure and symptoms for those with relatively mild symptoms.

Physiotherapy: Seeking help from a registered physiotherapist is one of the best options for treatment of carpal tunnel syndrome. Physiotherapy will include manual therapy on your wrist to improve the mobility of the joints and stretch tight muscles and tendons in the wrist and fingers, helping to remove any scar tissue buildup that may hinder recovery. The Physiotherapist will also incorporate nerve gliding techniques to help improve the mobility of the median nerve through the carpal tunnel. Ultrasound may be used over the carpal tunnel area to reduce inflammation which helps to relieve symptoms. Your physiotherapist may also suggest a brace or splint to immobilize the wrist while working or performing aggravating activities. They will provide education about activity modification to avoid aggravating positions, such as holding the wrist in a flexed (bent) position. Your physiotherapist will also prescribe specific stretching and strengthening exercises for the fingers, thumb, hand and arm to progress through later stages of recovery. They will provide education on proper posture while working to prevent relapse.

Surgery: With very severe cases of carpal tunnel syndrome where nonsurgical treatment does not provide any relief, surgery may be an option. The surgery typically consists of cutting the roof of the carpal tunnel, to provide more room for the tendons and median nerve and decrease compression. Full recovery back to original strength in the hand may take 6-12 months.

While carpal tunnel is a relatively common condition, it is often misdiagnosed, thus it is a good idea to seek treatment from a registered physiotherapist upon the onset of symptoms in order to have the best chance of full recovery and to prevent irreversible damage. Your physiotherapist will be able to recommend appropriate treatment options, whether that be manual therapy, bracing, or if necessary, surgical intervention.

BodyTech Physiotherapy

Tennis Elbow

Tennis Elbow

Lateral epicondylitis, more commonly referred to as “tennis elbow”, is a term used to describe pain just above the elbow joint on the outer side of the arm. Contrary to popular belief, tennis elbow is not a condition that is exclusive to tennis players or athletes. The term tennis elbow was coined from the fact it can be a significant problem for as many as 50% of tennis players during their careers. However, less than 5% of reported cases of tennis elbow result from playing tennis!

More specifically, tennis elbow is a tendinopathy at the origin of the extensor carpi radialis brevis tendon (the tendon that is responsible for wrist extension). This tendinopathy is due to degeneration of, or damage to the tendon causing inflammation and subsequently, pain. In order to understand what causes tennis elbow, it is important to first understand tendons and how they function. Tendons are like “ropes” made of collagen tissue. They are flexible, but do not stretch when pulled. It is the job of the tendon to connect muscle to bone. In the case of tennis elbow, the area on the bone where the tendons attach, just above the elbow on the lateral side (or outer side) of the arm, are sometimes incapable of handling the force of the arm muscles. Strong forces or sudden impact to the tendons at this point of attachment are what cause damage, like small tears in the fibers of the tendon (similar to a rope becoming frayed).

Activities that exacerbate tennis elbow symptoms are those that involve repetitive motion of the arm, forearm, wrist, and hand. Movements that are commonly associated with the development of tennis elbow are: lifting, gripping something tightly in combination with inward or outward rotation of the forearm, jerky throwing motions, swatting with the hand, and simultaneous rotation of the forearm and bending of the wrist. Racquet sports may be the most “popular” activity to associate with tennis elbow, but as previously mentioned most cases are the result of a wide range of actions that include, but are not limited to: painting/plastering, excessive and repetitive use of a computer mouse, carpentry work, gardening and repetitive lifting and carrying.

Tennis elbow can be suspected when performing routine tasks, such as gripping objects or turning doorknobs, become painful. A physician or physiotherapist can diagnose tennis elbow by discussing symptoms and examining the affected arm. Diagnostic tests are not typically necessary for an accurate diagnosis, however, a physician may request an X-ray or MRI imaging if symptoms do not improve with treatment.

Treatment options for tennis elbow include modifying activities that exacerbate symptoms. Movements that cause an increase in pain should be avoided to help allow the tendon to heal. Pain management is also important to consider. Anti-inflammatory painkillers are commonly used for some symptomatic relief, however physiotherapy remains the most successful tool in the treatment of tennis elbow long-term. A physiotherapist will perform manual therapy on the affected arm, to mobilize the underlying stiff joints and tight structures. Modalities such as ice, and ultrasound, as well as taping may be used to ease pain and encourage healing. A physiotherapist will implement stretching and strengthening exercises to help restore normal function of the arm, and also prevent tennis elbow from occurring in the future.

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What is Trauma?

Physiotherapy is an effective tool to treat injuries that can range anywhere from minor to catastrophic. Occasionally, regardless of the severity of the injury, some people experience symptoms such as hypersensitivity or emotional stress as a product of, or in addition to, their physical trauma. For some, these psychological and emotional stressors can act as a difficult obstacle to overcome, and can actually hinder the success of physical injury recovery. Physiotherapists will often recognize these psychological and emotional symptoms, and will recommend the injured person see a qualified therapist who specializes in dealing with trauma. Working with a therapist is a great adjunct to physiotherapy and helps the client to achieve their recovery goals. The following article is a guest blog post by John Roche from Transformation Counselling

What is Trauma?

Trauma. It’s one of those words that gets thrown around without ever really being explained. Derived from the Greek word for “wound,” trauma could refer to an overwhelming psychological experience or the psychological imprint left by such an experience. Either way, it’s important to know how to recognize trauma and post-traumatic stress and how to recover from them.

Trauma is caused by an overwhelming experience in which someone perceives their survival to be threatened and/or their fundamental beliefs about themselves and the world are shattered. Sexual assault, military combat, child abuse, car accidents, and natural disasters are well-known examples of traumatic events.

Lesser known instances of trauma involve what’s called “attachment trauma.” Children’s development is extremely dependent on the attentiveness and responsiveness of their “attachment figures” (usually parents), and if an attachment figure is not attuned and responsive to the needs of a child, then, as far as that child’s brain is concerned, its survival is threatened and it will adapt accordingly.

Post-traumatic symptoms are painful and overwhelming, but, as scary as they are, they’re simply the result of the brain’s adaptation to traumatic situations. From an evolutionary perspective, this adaptation is an attempt to ensure the person’s survival, which is pretty much the brain’s number one priority.

Imagine that every brain has its own smoke detector. When it’s functioning properly, this smoke detector alerts us to legitimate threats and cues the release of protective firefighters who come and rescue us: heightened alertness, a pounding heart and restricted digestion to make sure we have plenty of energy to fight or run away, rage to help us fight off attackers, or, as a last resort if escape or self-defence aren’t possible, a freeze response like a deer in headlights.

Trauma hyper-sensitizes the smoke detector. At the slightest hint of smoke, these firefighters come rushing in to put out a fire that doesn’t actually exist.

People who have experienced trauma therefore tend to struggle with anxiety, rage, concentration difficulties, digestive issues, feelings of disconnectedness, and hypersensitivity to perceived threats. Understandably, survivors of trauma also tend to feel depressed, develop addictions as a means to escape their pain, and avoid anything that might trigger their smoke detectors.

Faced with such nightmarish symptoms, trauma survivors tend to imagine they’re broken. In reality, their brains have done exactly what they were supposed to do: adapt to threat and facilitate survival. Once upon a time, these adaptations made perfect sense and helped them survive. Unfortunately, such adaptations persist beyond the traumatic event and cause pretty major problems.

Recovery from trauma is essentially about training the brain to re-establish an internal sense of safety and leave behind survival adaptations that are no longer necessary. EMDR therapy in particular has been proven to be extremely effective at eliminating post-traumatic symptoms by healing trauma at its roots.

If you’re a survivor of trauma, you are not crazy. Your brain has actually done exactly what it was intended to do and, as unbelievable as it may sound, full recovery is possible. If you’re ready to get on with your life, contact us today to get started.


John Roche, MDiv, MSW, RSWheadshotsfull-9edit

John is a therapist with two Master’s degrees in counselling and three years of clinical experience. He has specialized trauma training in both Cognitive Behaviour Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR). In his spare time, he loves to hike, reflect on the meaning of life, and eat nachos.

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