Basic concepts on Core muscles, myths on core muscles packed essentially for a Physiotherapist's understanding

2. LECTURE OUTLINE
• Why Core?
• Core Stability Vs Core Strength
• Core Controversies
53rd IAPCON, Shimla

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4. • Human spine
–Performs seemingly conflicting functions
• Handles large loads
• Motions in multi planes
• Protection of delicate structures
53rd IAPCON, Shimla

5. 80% of
population
experiences
back pain at
some point
rotational
stress to the
GH joint when
there is a 20%
loss of trunk
stability
Kibler 2001
53rd IAPCON, Shimla

6. • Mechanical / Functional instability
–Commonest cause for LBP
–Commonly limited to osseoligamentous
insufficiency
–Increased range of neutral zone
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7. • Core serves as
–Muscle corset
–Center of kinetic chain
–Power house
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8. • Classification of muscles acting on LS spine
based on its characteristics
–Local
–Global
Bergmark, A,1989
53rd IAPCON, Shimla

9. MUSCLE CHARACTERISTICS
LOCAL GLOBAL
Placement
Anatomical type
Fiber type
Activity enhanced
Poor Recruitment
Activation
Deeply placed
Aponeurotic
Type I
Endurance
Inhibited / Weakness
Low resistance levels
Superficial
Fusiform
Type II
Power
Shorten / tighten
High resistance levels
53rd IAPCON, Shimla

10. CORE MUSCULATURE
Local (Stabilizers) Global (Mobilizers)
Primary Secondary
Transversus abdominis
(TrA)
Multifidi
Medial fibers of External
Oblique
Internal Oblique
Quadratus lumborum
Diaphragm
Lumbar portion of
Iliocostalis & Longissmus
Pelvic floor muscles
Lateral fibers of External
Oblique
Rectus abdominis
Psoas major
Erector spinae
Thoracic portion of
Iliocostalis
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11. • Lumbo - pelvic stability enhanced by increase in
–IAP
–Tension in TLF
–Compressive forces on joint segments
• Is a combined function of various local & global
muscles
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12. • Motor control mechanism
–Strategies adapted by CNS to control & maintain
spinal stability against perturbing forces &
conditions
• 2 strategies (Hodges, 2003)
–Feedback
• Reflex muscle response
53rd IAPCON, Shimla

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Shimla

14. –Feed forward
• Paved way for concept of Anticipatory Postural Adjustments
(APA)
–TrA & multifidus contract
• 30 ms before movements of shoulder
• 110 ms before movements of lower limb
53rd IAPCON, Shimla

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16. • All 3 sub systems
–Conceptually separate
–Functionally interdependent
53rd IAPCON, Shimla

17. • Role of local muscles in motor control
–Stiffness to control segmental translation
–No or minimal change in length during functional
movements
–Anticipatory recruitment leading to protective
stiffness
–Activity continuous & independent of direction of
movement
53rd IAPCON, Shimla

18. • Role of global muscles in motor control
–Generates force to produce or control movement
–Has concentric, isometric or eccentric functions
–Activity non continuous & direction dependent
Allison GT et al, 2008
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20. • Indiscriminate & haphazard use
• Core stability
–Ability to limit excess movement & maintain
structural integrity
–Muscular control required around LPH region
to maintain functional stability
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21. • Paul Hodges (2003)
–3 stages / 8 steps
I. Cognitive
II. Associative
III. Automatic / Autonomous
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22. 1. Independent activation of transversus abdominis and
multifidus
2. Independent co-activation of transversus abdominis
and multifidus
3. Improve precision
4. Co-ordination of breathing
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23. 5. Function: static tasks
6. Function: Light dynamic tasks
7. Local and global co-activation
8. Specific functional retraining
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25. • Core musculature demonstrate
–Dramatic physiological changes
• Pregnancy
• Postpartum
• ObesitY
Fast, A., et al., 1990
Gilleard, W.L., et al, 1996
53rd IAPCON, Shimla

26. • Damage to abdominal musculature does not seem to
be detrimental to spinal stability or contribute to
LBP
Mizgala, C.L., et al, 1994
Simon, A.M., et al., 2004
53rd IAPCON, Shimla

27. Muscle-by-muscle activation does not exist
Georgopoulos, A.P., 2000
53rd IAPCON, Shimla

28. • Core exercises not designed to challenge onset
time of synergists
• No study till date to prove core exercises resets
onset time in LBP patients
Urquhart, D.M et al, 2005
Hall, L., et al., 2007
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29. • No study to date has demonstrated that LBP is
due to spinal instability
–Despite a decade of research in this area it
remains a theoretical model
Earl Lederman, 2010
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30. Core - Is it limited to spine?
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32. 10/15/2017 53rd IAPCON, Shimla

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34. Tha nk
yo u53rd IAPCON, Shimla