Core Stability for Back and SI Core Stability for Back and SI Pathologies Pathologies 58th Eastern Athletic Trainers’ Association’s 58th Eastern Athletic Trainers’ Association’s Annual Meeting and Clinical Symposium Annual Meeting and Clinical Symposium Philadelphia, Pa 2006 Philadelphia, Pa 2006 Michael Higgins PhD, ATC/PT,CSCS Michael Higgins PhD, ATC/PT,CSCS
Stabilizing Systems Stabilizing Systems • 3 Subsystems • 3 Subsystems – Passive – Passive • Vertebrae • Vertebrae • Discs • Discs • Ligaments • Ligaments – Active – Active • Muscle and tendons that apply force to the • Muscle and tendons that apply force to the spine spine – Neural – Neural
Trunk Stabilizers Trunk Stabilizers • Attach directly to the vertebrae • Attach directly to the vertebrae • Are all important • Are all important • Importance depends on activity • Importance depends on activity • Unisegmental • Unisegmental • Multisegmental • Multisegmental
Target Muscles Target Muscles • Unisegmental • Unisegmental – Force transducers – Force transducers – Provide feedback on – Provide feedback on spinal position spinal position – Work closely with neural – Work closely with neural system system EXAMPLES: EXAMPLES: Multifidus Multifidus – – Intertransversi muscles Intertransversi muscles – – Interspinalis muscles Interspinalis muscles – –
Rotators and Intertransversari Rotators and Intertransversari • Small cross- • Small cross- sectional areas sectional areas • Contribution to • Contribution to rotation is minimal rotation is minimal • Vertebral position • Vertebral position sensors sensors
Longissumus, Iliocostalis and Longissumus, Iliocostalis and Multifidus group Multifidus group • Divided into pars thoracic • Divided into pars thoracic and pars lumborum and pars lumborum • Pars thoracics have a • Pars thoracics have a strong extensor moment strong extensor moment with low compressive with low compressive force force • Pars lumborum • Pars lumborum generates posterior generates posterior shear forces that support shear forces that support reaction anterior shear reaction anterior shear force of the upper force of the upper vertebrae vertebrae
Multifidus Multifidus • Forces only affect • Forces only affect small areas of the small areas of the spine spine • Produce extension • Produce extension torque torque
Target Muscles Target Muscles • Multisegmental muscles • Multisegmental muscles – Produce and control spinal – Produce and control spinal motion motion Examples: Examples: – Transversus Abdominis – Transversus Abdominis – Rectus Abdominis – Rectus Abdominis – Lumbar Erector Spinae – Lumbar Erector Spinae – Quadratus Lumborum – Quadratus Lumborum – Obliques – Obliques
Transversus Abdominis Transversus Abdominis • Inner surfaces of • Inner surfaces of cartilage of lower six cartilage of lower six ribs to linea alba by ribs to linea alba by aponeurosis aponeurosis • Abdominal hollowing • Abdominal hollowing • Draw abdomen up • Draw abdomen up and in and in • Incorporate into the • Incorporate into the exercise program exercise program
Rectus Abdominis Rectus Abdominis • Pubic crest and • Pubic crest and symphisis to 5 th , 6 th symphisis to 5 th , 6 th and 7 th rib costal and 7 th rib costal cartilage cartilage • Major trunk flexor • Major trunk flexor • All sections of the • All sections of the rectus are activated rectus are activated together together • No functional • No functional separation appears to separation appears to exist between upper exist between upper and lower abs* and lower abs* *Lehman, McGill, 2001
Erector Spinae Erector Spinae • Superman exercises • Superman exercises – > 4000N of spinal – > 4000N of spinal compression compression • Quadruped exercises • Quadruped exercises – Minimizes spine load – Minimizes spine load
Quadratus Lumborum Quadratus Lumborum • Attach to TP of all • Attach to TP of all lumbar vertebrae, lumbar vertebrae, pelvis and rib cage pelvis and rib cage • Acts as a buttress • Acts as a buttress to lateral instability to lateral instability • Appears to be • Appears to be highly involved in highly involved in spine stability spine stability
Internal/External Oblique Internal/External Oblique (Anterior view) (Anterior view) • Anterior and lateral • Anterior and lateral fibers fibers • IO has upper and • IO has upper and lower anterior fibers lower anterior fibers • Lower anterior fibers • Lower anterior fibers support and support and compress lower compress lower abdominal viscera abdominal viscera with TA with TA
Internal/External Oblique Internal/External Oblique (Posterior view) (Posterior view) • Obliques are • Obliques are regionally activated regionally activated • Increase activity when • Increase activity when spine is axially spine is axially compressed* compressed* *Juker, McGill and Kropf, 1998
Internal/External Oblique Internal/External Oblique • Assists with active • Assists with active expiration^ expiration^ • Creates “hoop • Creates “hoop stresses” and stresses” and stiffness with TA stiffness with TA to assist with to assist with spine stability spine stability ^Henke, et. al., 1988
Internal/External Oblique Internal/External Oblique (hoop stress) (hoop stress)
Training Training
Goals of Training Goals of Training • Produce high levels of muscle • Produce high levels of muscle activation activation • Low level of spinal loading • Low level of spinal loading • Consider strength, endurance and • Consider strength, endurance and neuromuscular factors neuromuscular factors
Stabilization Myths Stabilization Myths • Sit ups • Sit ups – Replicates potential injury mechanism – Replicates potential injury mechanism – Cause increase compression of lumbar – Cause increase compression of lumbar spine and discs spine and discs – Do not press low back against floor – Do not press low back against floor • Leg raises • Leg raises – Increase psoas activiation and spine – Increase psoas activiation and spine compression compression
Stabilization Myths Stabilization Myths • Strength • Strength – Poor association with low back health – Poor association with low back health • Range of Motion • Range of Motion – Increased ROM may lead to greater risk of – Increased ROM may lead to greater risk of back injury back injury – Must have enough stability for all motions – Must have enough stability for all motions • Endurance • Endurance – Most important in preventing back dysfunction – Most important in preventing back dysfunction Biering-Sorensen. Spine 9:106-119, 1984
Strength vs. Endurance Strength vs. Endurance • Many traditional weight training • Many traditional weight training approaches for other joints are not approaches for other joints are not applicable for the back. applicable for the back. • Motor control important for spine • Motor control important for spine stability stability – Motor control errors resulting in – Motor control errors resulting in improper muscle forces increase with improper muscle forces increase with fatigue fatigue
Advanced Exercise Advanced Exercise
EXTENSION EXTENSION
Hyper vs. Reverse Curl Hyper vs. Reverse Curl • Hypers tend to focus on larger erector muscles • Hypers tend to focus on larger erector muscles • Reverse curl activate the smaller muscle groups • Reverse curl activate the smaller muscle groups that attached segmentally that attached segmentally
Hypers vs Reverse Curl Hypers vs Reverse Curl • Focus on where the axis of movement • Focus on where the axis of movement is occurring (ie; hips or lumbar spine) is occurring (ie; hips or lumbar spine)
Physioball Use Physioball Use • Liable surfaces have been found to cause more • Liable surfaces have been found to cause more activity in the core musculature while increasing activity in the core musculature while increasing spinal loading* spinal loading* *Vera-Garcia, Grenier, and McGill. 2000 *Vera-Garcia, Grenier, and McGill. 2000
Cable Extensions Cable Extensions • Pull thrus • Pull thrus – Maintain neutral – Maintain neutral spine spine – Start with no or – Start with no or very light weight very light weight – Progress to – Progress to stepping in stepping in different directions different directions
Lat Pull Downs Lat Pull Downs • Will enhance spine • Will enhance spine stabilization by stabilization by increasing the increasing the demand of the spinal demand of the spinal extensor muscles extensor muscles and the Latissimus and the Latissimus Dorsi Dorsi • May want to do • May want to do standing (basketball) standing (basketball)
Bridges Bridges • Great for glute • Great for glute activation activation • Single leg • Single leg • Progress to liable • Progress to liable surfaces surfaces
Romanian Deadlift (RDL) Romanian Deadlift (RDL) Right Wrong • Head up/chest up • Head up/chest up • Bend from hips • Bend from hips • Glute and hamstring • Glute and hamstring
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