The core muscles can be categorized as stabilizers or mobilizers. Stabilizers like the transversus abdominis and multifidus are deeply placed, have slow twitch fibers, and help provide stability. Mobilizers like the rectus abdominis are more superficial and have fast twitch fibers for movement. Chronic low back pain is associated with weakness in the transversus abdominis and multifidus as well as decreased flexibility. A core strengthening program focuses on training these local stabilizer muscles in three stages: 1) local segmental control, 2) closed chain exercises, and 3) open chain exercises and functional progression. Exercises target the transversus abdominis, multifidus, and glute

1. CORE MUSCLE
STRENGTHENING
AKASH JAINTH
MPT

2. The Core is like a muscular box
(Richardson, C., G. Jull, P. Hodges, and J. Hides.)
• Abdominals in the
front
• Para spinals and
gluteus in back
• Diaphragm roof
• Pelvic Floor and hip
girdle bottom

3. Conceptual model of control of
lumbopelvic stability
The model incorporates :
1. Passive subsystem.
2. Active subsystem.
3. Neural control
subsystem.

4. Neural control system
The system must activate muscles:
1. At the right time(recruitment time).
2. By the right amount(number of motor unit recruitment).
3. In the correct sequence(recruitment order).
4. Muscles turn off appropriately.

5. Trunk muscle categorization
(Richardson et al. 1992)
STABILISERS
Primary
• Transversus abdominis
• Multifidus
Secondary
• Internal oblique
• Medial fibres of external
oblique
• Quadratus lumborum
MOBILISERS
• Rectus abdominis
• Lateral fibres of external
oblique
• Erector spinae

6. Muscle categories
(Richardson et al. 1992)
STABILISERS
• Deeply placed
• Slow twitch nature
• Active in endurance
activities
• Selectively weaken
• Poor recruitment, may
be inhibited
MOBILISERS
• Superficial
• Fusiform
• Fast twitch nature
• Active in power activities

7. Transversus abdominis
TLF
IAP(intra abdominal pressure )
Reduce spinal compression force.
Increase spinal stability

9. Reduce spinal compression force.

10. Increase spinal stability

11. Multifidus

12. Limitations of the global system
Gardner-Morse and Stokes(1998): Global co-
activation increases the compressive lode on lumber
segments.
• The superficial trunk muscles generate torque at the trunk.
• This torque must be overcome by antagonist activation in
order to keep the spine upright, and this co activation
results in a compressive load on the spine.
(Lavender et al.1992, Mirka and Marras 1993,
Thelen et al 1995, Gardner-Morse and Stokes 1998) .

13. Radebold et al 2000
Increased co-contraction of the global muscles has
been detected in patients who develop low back pain
compared with normal pain-free subject.
Cholewicki et al 1997
Dysfunction in the passive stabilization system may be
indicated by increase level of trunk muscle co-activation.

14. • The superficial abdominal muscles depress the rib cage
and are involved in forced expiration.
( DeTroyer and Estenne 1988).
Increased activity of these muscles in individuals
with pain may lead to compromised respiratory function.
for example restricted movement of the chest wall. In
contrast, local muscle have limited effect on rib cage
motion.
( DeTroyer and Fstenne 1988)

15. CLBP FINDING
• MUSCLE WEAKNESS
Lumbar multifidus (LM)
Transversus abdominis (TrA)
Gluteus maximus
• DECREASE FLEXIBILITY

16. Activities of TrA

17. Relationship of TLF in transverse plane

18. Comparison B/W mean multifidus cross-sectional areas

19. Pressure biofeedback unit

21. Treatment procedure
(Richardson et.al. )
1. Warm up- Stationary bicycle (10 minute)
2. Self Stretching/Flexibility exercises-(3 set,10
repetition daily )
A. Single and double knee to chest from
supine position.
B. Cat camel .
C. Side bending in standing position with and
without contralateral arm elevation.
D. Low back sustained rotation from supine
position.

22. Knee to chest

25. Rotation from supine
position.

26. 3.Potential exercise
These sets of exercise will be given for six weeks, for
three days a week.
In this group treatment protocol divided in three
stages
Stage 1: local segmental control
Stage 2: closed chain segmental control
Stage 3: open chain segmental control and progression
into function.

28. Stage 1: local segmental control (TrA, LM)
Transverses abdominis
Position – prone
pressure biofeedback unit-
• Under the abdomen
• Navel in the centre
• Distal edge of the pad in line with the right and left ASIS
Pressure – 70 mmHg
Command- Relax the abdomen, normal breath, without
breathing in draw the abdomen towards the spine,
with verbal counting.

31. Only TrA works

32. Other muscles also working

33. Transverses abdominis

34. • Procedure: Explain that the muscle encircles the trunk;
and when activated, the waistline draws inward
.Palpation of the muscle is possible just distal to the
anterior superior iliac spine (ASIS) and lateral to the
rectus abdominis .
• When the internal oblique (IO) contracts, a bulge of the
muscle is felt;
• when the TrA contracts, flat tension is felt. The goal is to
activate the TrA with minimal or no contraction of the
IO. This is a gentle contraction.

40. Lumbar Multifidus
Position –prone
The thumb and/ or fingers gently but firmly deeply into
the muscle bellies adjacent to the spinous process in
order to facilitate the contraction
Command- TrA , plus
Gently swell out your muscles under my fingers
without moving your spine or pelvis; Hold the
contraction with verbal counting
Hold- 10sec
Repetition -10
Set - 3

42. Lumbar Multifidus

43. Stage 2: closed chain segmental control (TrA, LM )
A. Training individual part of antigravity weight
bearing holding position
a) Upper quadrant closed chain exercise
b) Trunk forward lean
.

44. Upper quadrant closed chain exercise Trunk forward lean

45. B. Weight bearing (closed chain) exercise in flexed
postures
Slow lunge
Semi-squat

46. Slow lunge Semi-squat

47. Stage 3: open chain segmental control and
progression into function (TrA, LM, )

48. Level - 1

50. Level - 2

51. Gluteus maximus exercises
Stage -1. Correct recruitment order
Patient lying prone with unilateral knee flex to 90
degree, hip externally rotated.
then corset action both glutei squeezed
together , then extend the hip on same side, hold the
position with verbal counting for 10 sec.

53. Stage-2. Increase strengthening

54. Stage 4- Cool- down: Stationary bicycle
(5 minute)

55. THANK YOU