Your SlideShare is downloading. ×
0
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Core stability
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Core stability

6,031

Published on

Published in: Technology, Business
1 Comment
10 Likes
Statistics
Notes
No Downloads
Views
Total Views
6,031
On Slideshare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
553
Comments
1
Likes
10
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. P. Ratan KhumanM.P.T. (Ortho & Sports)
  • 2. Contents • Terminology • Describe the functional approach to kinetic chain rehab. • Explain the concept of the core. • Anatomical relationships between the musculature of the core. • Review how the core functions to maintain postural alignment and dynamic postural equilibrium during functional activities. • Organize a procedure for assessing the core. • Create the rationale for core stabilization training. • Set up the guidelines for core stabilization training. • Demonstrate appropriate exercises for each of the four levels in core stabilization training,6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 2
  • 3. Terminology  Function – It is an integrated multidimensional movement.  Functional strength – It is the ability of the neuromuscular system to reduce force, produce force, and dynamically stabilize the kinetic chain during functional movements, upon demand, in a smooth coordinated fashion.  Neuromuscular efficiency – It is the ability of CNS to allow agonists, antagonists, synergists, stabilizers, and neutralizers to work efficiently and interdependently during dynamic kinetic chain activities.6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 3
  • 4. Functional Approach To Kinetic Chain Rehab  Traditionally, rehab has focused on isolated absolute strength gains utilizing single planes of motion.  However, all functional activities are tri-planar & require acceleration, deceleration & dynamic stabilization.  Movement might appear to be one-plane dominant, but the other planes need to be dynamically stabilized to allow for optimal neuromuscular efficiency.  The fact is that we train force reduction, force production and dynamic stabilization to occur efficiently during all kinetic chain activities.6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 4
  • 5. Functional Approach To Kinetic Chain Rehab Cont…  A dynamic core-stabilization training program should be a key component of all comprehensive functional CKC rehabilitation programs.  A core stabilization program will improve dynamic postural control ensure appropriate muscular balance and joint arthrokinematics around the lumbo-pelvic-hip complex.  Allow for the expression of dynamic functional strength and improve neuromuscular efficiency throughout the entire kinetic chain.6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 5
  • 6. WHAT IS THE CORE…?  The “CORE” is defined as the lumbo-pelvic-hip complex.  It is the location of our COG & where all movt begins.  Efficient core allows for –  Maintenance of normal length-tension relationships  Maintenance of normal force couples  Maintenance of optimal arthrokinematics  Optimal efficiency in entire kinetic chain during movement  Acceleration, deceleration, dynamic stabilization  Proximal stability for movement of extremities6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 6
  • 7. The Core  Functions & operates as an integrated unit Entire kinetic chain operates synergistically to produce force, reduce force & dynamically stabilize against abnormal force  In an efficient state –  The CORE enables each of the structural components to operate optimally through:  Distribution of weight  Absorption of force  Transfer of ground reaction forces6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 7
  • 8.  Neuromuscular efficiency –  Ability of CNS to allow agonists, antagonists, synergists, stabilizers & neutralizers to work efficiently & interdependently  Established by combination of postural alignment & stability strength  Optimizes body’s ability to generate & adapt to forces  Dynamic stabilization is critical for optimal neuromuscular efficiency  Rehab generally focuses on isolated single plane strength gains in single muscles  Functional activities are multi-planar requiring acceleration & stabilization  Inefficiency –  Results in body’s inability to respond to demands  Can result in repetitive microtrauma, faulty biomechanics & injury  Compensatory actions result6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 8
  • 9. Functional Anatomy  Global (dynamic, phasic) muscles –  They are the large, torque-producing muscles.  Link the pelvis to the thoracic cage and provide general trunk stabilization as well as movement.  Rectus abdominis, external oblique and the thoracic part of lumbar iliocostalis  Local (postural, tonic) muscles –  They attach directly to the lumbar vertebrae.  Responsible for providing segmental stability and directly controlling the lumbar segments during movement.  Lumbar multifidus, psoas major, quadratus lumborum, the lumbar parts of iliocostalis and longisimus, transversus abdominis, the diaphragm and the posterior fibers of internal Oblique6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 9
  • 10. 6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 10
  • 11. Functional Anatomy Cont… 29 muscles attach to core Lumbar Spine Muscles Transversospinalis group Erector spinae  Rotatores  Iliocostalis  Interspinales  Longissimus  Intertransversarii  Spinalis  Semispinalis Quadratus lumborum  Multifidus Latissimus Dorsi6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 11
  • 12. 6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 12
  • 13.  Transversospinalis group –  Poor mechanical advantage relative to movement production  Primarily Type-I muscle fibers with high of muscle spindles Optimal for providing proprioceptive information to CNS   Inter/intra-segmental stabilization  Erector spinae –  Provide inter-segmental stabilization  Eccentrically decelerate trunk flexion & rotation  Quadratus Lumborum –  Frontal plane stabilizer  Works in conjunction with gluteus medius & TFL  Latissimus Dorsi –  Bridge between upper extremity & core6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 13
  • 14. Functional Anatomy Cont…  Abdominal Muscles –  Rectus abdominus  External obliques  Internal obliques  Transverse abdominus  Work to optimize spinal mechanics  Provide sagittal, frontal & transverse plane stabilization6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 14
  • 15. 6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 15
  • 16. Functional Anatomy Cont… Hip Musculature – Psoas –  Closed chain vs. open chain functioning  Works with erector spinae, multifidus & deep abdominal wall  Works to balance anterior shear forces of lumbar  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 cycle6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 16
  • 17. Hip Musculature cont…  Gluteus medius –  Frontal plane stabilizer  Weakness increases frontal & transverse plane stresses (patellofemoral stress)  Controls femoral adduction & IR  Weakness results in synergistic dominance of TFL & quadratus lumborum  Gluteus maximus –  Hip extension & ER during OKC, concentrically  Eccentrically hip flexion & IR  Decelerates tibial IR with TFL  Stabilizes SI joint  Faulty firing results in decreased pelvic stability & neuromuscular control6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 17
  • 18. Hip Musculature cont…  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 planes6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 18
  • 19. Diaphragm and pelvic floor  Diaphragm serves as the roof of the core.  Stability is imparted to the lumbar spine by contraction of the diaphragm and increasing intra-abdominal pressure.  Ventilatory challenges on the body may cause further diaphragm dysfunction and lead to more compressive loads on the lumbar spine.  Thus, diaphragmatic breathing techniques may be an important part of a core strengthening program.6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 19
  • 20. CORE STABILIZATION TRAINING CONCEPTS  A specific core strengthening program can:  IMPROVE dynamic postural control  Ensure appropriate muscular balance & joint arthrokinematics in the lumbo-pelvic-hip complex  Allow for expression of dynamic functional performance throughout the entire kinetic chain  Increase neuromuscular efficiency throughout the entire body  Spinal stabilization –  Must effectively utilize strength, power, neuromuscular control & endurance of the “prime movers”  Weak core = decreased force production & efficiency  Protective mechanism for the spine  Facilitates balanced muscular functioning of the entire kinetic chain  Enhances neuromuscular control to provide a more efficient body positioning6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 20
  • 21. Postural Considerations  Core functions to maintain postural alignment & dynamic postural equilibrium  Optimal alignment = optimal functional training and rehabilitation  Segmental deficit results in predictable dysfunction  Serial distortion patterns  Structural integrity of body is compromised due to malalignment  Abnormal forces are distributed above and below misaligned segment6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 21
  • 22. Neuromuscular Considerations  Enhance dynamic postural control with strong stable core  Kinetic chain imbalances = deficient neuromuscular control  Impact of low back pain on neuromuscular control  Joint/ligament injury  neuromuscular deficits  Arthrokinetic reflex  Reflexes mediated by joint receptor activity  Altered arthrokinetic reflex can result in arthrogenic muscle inhibition  Disrupted muscle function due to altered joint functioning6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 22
  • 23. Assessment of The Core  Muscle imbalances  Arthrokinematic deficits  Core  Endurance  Neuromuscular control  Strength  Power  Real-time Ultrasound Imaging  Overall function of lower extremity kinetic chain6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 23
  • 24. CORE ENDURANCE TEST6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 24
  • 25. Core Endurance Tests  4 endurance tests advocated are –  Prone bridges  Lateral bridges  Torso flexor  Torso extensor  Other Test –  Single-legged squat Test  The bridge tests are functional.  They assess strength, muscle endurance and how is the ability to control the trunk by the synchronous activation of many muscles.6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 25
  • 26. Prone Bridge Endurance Test  Primarily assesses the anterior and posterior core muscles.  It is performed by supporting the bodys weight between the forearms and toes  The pelvis in the neutral position and the body straight  Failure occurs when client loses neutral pelvis and falls into a lordotic position with anterior rotation of the pelvis.6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 26
  • 27. Lateral Bridge Endurance Test  It assesses the lateral core muscles.  Legs are extended and the top foot placed in front of the lower foot for support.  Support themselves on one elbow & feet while lifting hips off the floor to create a straight line over their body length.  The uninvolved arm is held across the chest with the hand placed on the opposite shoulder  Failure occurs when the patient loses the straight posture and the hip falls towards the table.6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 27
  • 28. Torso Flexor Endurance Test  It is time based test, how long the patient can hold a position of seated torso flexion at 60°.  The client sits at 60° with both hips & knees at 90°, arms folded across chest with the hands placed on the opposite shoulder, & toes secured under toe straps or by examiner  Failure occurs when the athletes torso falls below 60°.6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 28
  • 29. Torso Extensors Endurance test  The test is performed in prone position of the client.  The client is at the edge with upper body out of the table while securing pelvic & leg.  Failure occurs when the upper body falls from horizontal into a flexed position.6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 29
  • 30. Mean Endurance times (in sec) in Young Healthy Subjects (mean age 21 yrs) Men WomenExtension 161 185Flexion 136 134Side Bridge (R) 95 75Side Bridge (L) 99 78Flexion/Extension Ratio 0.84 0.72 6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 30
  • 31. Single-legged Squat Test  The test is used as an indicator of lumbo-pelvic-hip stability.  It is functional test, requires control the body over a Single weight-bearing lower limb  It is frequently used clinically to assess hip and trunk muscular coordination and/or control.6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 31
  • 32. CORE NEUROMUSCULAR TEST6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 32
  • 33. Abdominal Neuromuscular Control Test Supine with hips & knees in 90 Pressure cuff placed under lumbar spine (L4-5) & raised to 40 mmHg Performs drawing in maneuver (belly button to spine) Lower legs until pressure decreases Assesses lumbar spine moving into extension (ability of lower abs wall to stabilize the lumbo-pelvic-hip complex)  Hip flexors begin to work as stabilizers  Increases anterior shear forces & compressive forces at L4-L5  Inhibits transversus abdominis, internal oblique & multifidus6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 33
  • 34. 6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 34
  • 35. CORE STRENGTH TEST6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 35
  • 36. Straight-Leg Lowering Test  Supine with knees in extension  Pressure cuff placed under lumbar spine (L4-L5) & raised to 40 mmHg with knees extended, hips to 90  Performs drawing in maneuver (belly button to spine) & then flattens back maximally into the table & cuff  Gradually lower legs to table while maintaining flat back  The test is over when the pressure in the cuff decreases.  The hip angle is then measured with a goniometer to determine the angle.6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 36
  • 37. 6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 37
  • 38. Core Power Test6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 38
  • 39. Backwards, overhead medicine ball jump & throw  The client is instructed to hold a 4-kg medicine ball between their legs as they squat down.  Instructed to jump as high as possible while simultaneously throwing the medicine ball backward over their head.  The distance is measured from a starting line to the point where the medicine ball stops.  This is an assessment of total body power production with an emphasis on the core.6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 39
  • 40. Lower Limb Functional Profiles  Isokinetic tests  Balance tests  Jump tests  Power tests  Sports specific functional tests  Kinetic chain assessment must assess all areas of potential deficiency6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 40
  • 41. Ultrasound imaging  Ultrasound imaging is also used as an assessment technique.  The real-time ultrasound imaging is a means of assessing muscle size and activity.  Most emphasis has been on the assessment the transversus abdominis and multifidus muscles.  These measures have been shown to be valid.6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 41
  • 42. Core Stabilization Training6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 42
  • 43. Guidelines for Core Stabilization Training Program 1. The program should be based on science. 2. The program should be systematic, Progressive & functional. 3. The program should begin in the most challenging environment the athlete can control. 4. The program should be performed in a proprioceptively enriched environment.6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 43
  • 44. Program Variation  Plane of motion  Range of motion  Loading  (physioball, med. ball, body blade, weight vest, tubing)  Body position  Amount of control & speed  Feedback  Duration and frequency (sets, reps, time under tension)6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 44
  • 45. Exercise Selection.  Safe  Challenging  Stress multiple planes  Proprioceptively enriched  Activity specific/ sports specific6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 45
  • 46. Exercise Progression  Slow to fast  Simple to complex  Stable to unstable  Low force to higher force  General to specific  Correct execution to increased intensity6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 46
  • 47. Questions to Ask Yourself  Is it dynamic?  Is it multi-planar?  Is it multidimensional?  Is it proprioceptively enriched?  Is it systematic?  Is it progressive?  Is it activity-specific?  Is it based on functional anatomy & science?6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 47
  • 48. Abdominal “Draw In” Maneuver Aim –  To use the correct muscles in response to command “draw in” your abdominal without moving spine or pelvis & hold for 10 sec while breathing normally.  To activate Transversus abdominis + lumbar multifidus Patient best position –  The 4-point kneeling position is best position to teach the action6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 48
  • 49.  Procedure –  Ask the patient to take a relaxed breath in & out & then draw the abdomen up towards the spine without taking a breath.  The contraction must be performed in a slow and controlled manner.  At the same time contracts the pelvic floor and slightly anteriorly rotates the pelvis to activate the multifidi.6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 49
  • 50. Core Stabilization Training Program  4 levels to core stabilization training program –  Level 1 = Stabilization  Level 2 = Stabilization & strength  Level 3 = Integrated stabilization strength  Levcl4 = Explosive6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 50
  • 51. Level I: Stabilization6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 51
  • 52. Level II: Stabilization & Strength6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 52
  • 53. Level II: Stabilization & Strength6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 53
  • 54. Level III: Integrated Stabilization Strength6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 54
  • 55. Level IV: Explosive Stabilization6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 55
  • 56. References  Prentice, W.E. (2004). Rehabilitation Techniques for Sports Medicine & Athletic Training, 4th ed.  Peter Brukner & Karim Khan with colleagues. Clinical sports medicine, 3rd ed6/19/2012 Ratankhuman M.P.T. (Ortho & Sports) 56

×