CORE STABILITY An IntroductionBy Donna Sanderson-HullObjectivesl DefinitionslOriginslBenefitslTheory/Posture and anatomylResearchlPracticalWHAT IS CORE STABILITY?“The system the body uses to give spinal support and maintain muscular balance while at the same time providing a firm base of support from which other muscles can work to enable the body to undertake its daily tasks. It is through this system of joint integrity and support that the body is able to maintain its posture the position from which all movement begins and ends”Chek P. 2000CORE STABILITY“The ability to maintain neutral spine using the abdominal, back, neck and shoulder girdle muscles as stabilisers rather than movers”Orthopaedic view“That state of muscular and skeletal balance which protects the supporting structures of the body against injury or progressive deformity, irrespective of the attitude in which these structures are working or resting” Academy of Orthopaedic Surgeons 1947.NOT A NEW CONCEPTSTATICAlexander TechniquelPilatesDYNAMIClTai-chi/KaratelSwiss ball trainingALEXANDER TECHNIQUE 1869-1955lPRINCIPLESRE-EDUCATION OF KINAESTHETIC SENSEQUIETING THE MIND TO FOCUS ON THE MIND/BODY CONNECTIONESTABLISHING A GOOD HEAD AND NECK POSITIONJOSEPH PILATES 1880-1967lPRINCIPLESCONCENTRATIONALIGNMENTBREATHINGCO-ORDINATIONSTAMINA FITNESS PARAMETERSlCARDIOVASCULARlSTRENGTH / POWER/SPEEDlENDURANCElFLEXIBILITYlCORE STABILITYlPROPRIOCEPTION / NEUROMUSCULAR CONTROLParadigm Shift: No longer looking to improve strength in one muscle but improvement in multidirectional multidimensional neuromuscular efficiency (firing patterns in entire kinetic chain within complex motor patterns).The TheoriesSpinal StabilitylThe passively supported spine (bone and ligament will collapse under 20lb (9kg) of load.lMuscular components that contribute to lumbo-pelvic stability which take up the slackControl subsystem(Neural)Passive subsystem(spinal column)Spinal stabilityActive subsystem (spinal muscles)Adapted from Panjabi (1992)Neutral Zone ConceptEvery joint has a neutral zone or positionOverall internal stresses and muscular efforts are minimalA region of intervertebral motion around the neutral position where little resistance is offered by the passive spinal column (Panjabi 1992)Movement outside this region is limited by the ligamentous structures providing restraintControl of the Neutral ZoneLigaments - support end of range only- Can be unstable/over-stretchedMuscle - Can compensate for instability- Increase the stiffness of the spine- Decrease the neutral zone - Form basis for therapeutic intervention in treatment of spinal stabilityClinical instabilityA significant decrease in the capacity of the stabilising system of the spine to maintain the internal neutral zones within physiological limits which results in pain and disability (Panjabi)Patho-Kinesiological model (Shirley Sarhmann)lMuscular systemlArticular systemlNeural systemlAll three must work as an integrated unitlThe movement system requires optimum function of the core stabilisers resulting in precise arthokinematics and osteokinematics (Sarhmann 2000)Spinal StabilitylDemonstrated that submaximal levels of muscle activation adequate to provide effective spinal stabilisationlContinuous submaximal muscle activation crucial in maintaining lumbopelvic stability for most daily tasks.Benefits of Spinal StabilitylImprove Posture and prevent deformitieslMore stable Centre of Gravity and control during dynamic movementslcontribute to optimal movement patternslbreathing efficiencylDistribution of forces and absorption of forceslReduce stress on joint surfaces and painlInjury prevention and rehabilitationImproved PostureRe-education of stabilisersReduced stress on jointsReduced injuryIncrease function and sports performance.For Sporting PerformanceForces transmitted - trunk to the limbsCore muscles support the spine to transmit power from the trunk.Power is transferred for kicking and throwing activitiesIf the peripheral limbs are too heavy this will cause stress on the chassisANATOMY OVERVIEWLOCAL STABILISERSlIntertransversariilInterspinaleslMultifiduslTrAlLongissimus thoracis pars lumborumlIlliocostalis lumborum pars lumborumlQuadratus lumborum medial fibreslIO (insertion into TLF)GLOBAL STABILISERSlLongissimus thoracis pars thoracislIlliocostalis lumborum pars thoracislQuadratus lumborum lateral fibreslExternal obliques (Bergmark 1989)Comerford and Mottram, 2001STABILISING CORE MUSCLESlTHE INNER CORElTransversus abdominuslMultifiduslPelvic Floor MuscleslDiaphragmThe Outer Core SystemslAnterior Oblique ext and int obliques and contralateral hip adductors connected by anterior abdominal fascialPosterior Oblique Lat Dorsi and contralateral Glut Max connected by T/L fascialDeep Longitudinal Erector spinae and c/l sacrotubrous ligament and biceps femoris (connected by T/L fascia)lLateral Glut med and min and c/l