Functional Core Stabilization

Chronic Musculoskeletal
pain/chronic injuries in the spine
and lower extremity are caused
or perpetuated by muscle
imbalances/weaknesses in the
core musculature

Research indicates that 70-85%
of all athletes suffer from
recurrent low back pain. A
comprehensive core stabilization
program should be done will all
lower extremity rehabilitation
programs.

Individuals with a weak core
substitute/compensate during
dynamic functional movements
leading to overuse/chronic
injuries both upper and lower
extremity

Functional Anatomy Lumbo-
pelvic-hip Complex
The LPH complex musculature produces
force, reduces force, and stabilizes the
kinetic chain during functional movements
The core functions primarily to maintain
dynamic postural control by keeping the
center of gravity over our base of support
during dynamic movements.
Pelvic Girdle
29 muscles
attach to the
core (LPH
complex
unilaterally)


LPH Complex
Stabilization system
(Core System) if not
functioning
optimally will end
neuromuscular
substituting to utilize
the strength power
and neuromuscular
control in the rest of
the body
LPH Complex Cont.
Otherwise will get neuromuscular inhibition
and CNS will shut down prime movers if
LPH not stabilized, thus minimizing the
kinetic chain.
Most athletes have functional strength and
control in prime movers but not
stabilization in spine (C,T,L)
Definitions:
Function: Integrated proprioceptively
enriched mulidirectional movement
vs unidimentional, low proprioception, all three
planes
All functional exercises are triplanar (even
walking) appears unidirectional but need other
planes to stabilize (frontal & transverse).
All functional movements required
acceleration, deceleration & dynamic
stabilization (typically concentrate in concentric
and acceleration in rehab)
Definitions:
Functional Strength - ability neuromuscular
system to produce dynamic eccentric
concentric and dynamic isometric
stabilization contraction during all
functional movement patterns
Definitions:
Neuromuscular efficiency: the ability of
your entire kinetic chain to work as an
integrated functional movement
This will provide optimal dynamic stabilization
at right joint, right time, right plane of
movement
most athletes can produce the force but cannot
stabilize or control eccentrically thus increasing
stresses in different plane of movement and in
different joints (compensation)
Kinetic Chain -
When it works efficiently:
optimal control
distribute force appropriately
optimal efficiency during all movements
impact absorption/ground reaction forces
no excessive comp0ressive transitory force
shear in kinetic chain
dynamic joint stabilization
neuromuscular control
Example: Pelvo-Occular reflex
(Janda)
Cervical spine weak: during running fatigue
head will go into extension, thus to see
straight in from of you the pelvis tips
anteriorly
This changes length tension ratios of the
lower extremity, become less efficient, may
end up with hamstring injury
Core Stabilization Function
Remember 29 muscles connected to each
side of your pelvis. These work
synergistically with entire kinetic chain
Primary Function: maintain center of
gravity over base of support during dynamic
movement (Example gait cycle - loss of
balance)
Stability & control offers more
biomechanically correct position for
function of entire core and lower extremity
muscles
Patho-Kinesiological Model
This is a delicate balance a change in one of
these can cause injury
Example: articular dysfunction with change
length tension ration etc..
Muscle Fatigue
Ability to generate or maintain decrease
ability to require correct muscle
Ability to maintain dynamic muscle force
decreases
Example: fatigue running unable to stabilize
core: get shear forces and compressive
forces in lumbar spine:
- reason why see many LB comp0laints and
hamstring strains (actually attributed to weak
abdominals)
Transverse Abdominis and
Internal Obliques during
functional activity
Only 2 abdominal muscles that attach to the L-
spine
Attach thorocolumbar facia (L-spine) via lateral
rafia attach to transverse processes
Thus when they fire they create a tension affect
inherent STABILITY in L-Spine
These prevent rotational and transnational forces
If these muscles are not stabilized the Psoas is used
to create a compressive force and mimic stability
Transverse Abdominis and
Internal Obliques during
functional activity
Actually creates anterior shear force and
extension force
Leading to reciprocal inhibition of lower
abdominals
The pelvis will tip forward
Leading to reciprocal inhibition of the
gluteals (extensor mechanism)
This can cause hip internal rotation knee
overuse syndromes etc..
Basic Concepts of Core
Stabilization - Performance
Paradigm
Stretch/shortening cycle (natural visco-
elastic properties of muscles)
Every single movement (Dynamic
functional movement) more efficient the
more force can create and absorb)
efficiency: less wasted movements
Example walking
Every single movement we do is the
performance paradigm
Paradigm Shift: NO longer
looking to improve strength in
one muscle but improvement in
multidirectional neuromuscular
efficiency (firing patterns in
entire kinetic chain with complex
motor patterns). The body doesn't
just fire one muscle at a time for
movement

Basic Concepts of Core
Stabilization - Planes of
Movement
With any movement all three planes are
working together concurrently
Even through you may be moving in one plane
the other 2 planes must stabilize and work
eccentrically for stabilization
Example: Posterior Pelvic tilt laying on the
floor changes the relationship, thus when
standing he relationship again changes the
exercises have not been functional and will not
work in the altered position. Again it
changes when you lift one leg etc.
Basic Concepts of Core
Stabilization - Continuum of
Function
Movements are not isolated unidirectional
Must do movements and exercises in a
dynamic systematic program
Practically take the athlete from the
challenging position they can control in a
functional pattern and progress them from
there
Basic Concepts of Core
Stabilization - Open and Closed
Chain
Functional movement is a succession of
opening and closing the chain
Functional activity is therefore a timing
issue within opening and closing the chain
Need core stability to stabilize transition
Biomechnics: Three Phases
Pronation - deceleration/force reduction
phase (where most injuries occur due to
lack of eccentric control)
For rehabilitation need to look at this phase
what muscles are decelerating and stabilizing to
create a rehabilitation program
Biomechnics: Three Phases Cont.
Supination - acceleration phase/force
production phase (most % time)
Coupling - stabilization, ability to change
from pronation to supination phase
(stronger the core more efficient that thus
less time spend in this phase prevent
overuse injuries)
Muscle Function Cont.
Stabilization: Prone to develop weakness
and inhibition, less activated during most
movement patterns, fatigue easily, primarily
function during stabilization movement
Peroneals, anterior tibialis, posterior tibilalis,
VMO, gluteus medius/maximus, transverse
abdominis, int/ext obliques, serratus anterior,
rhomboids, middle, lower trap, deep neck
flexors, longus capitus
Sheringtons Law of Reciprocal
Inhibition: tight muscles will inhibit its
functional antagonist. Example:The
Psoas (most athletes) inhibit functional
antagonists - deep abdominal wall,
transverse abdomnis, internal oblique,
multifidi, deep transverse spinalis,
gluteus maximus. Thus the stabilization
and coupli8ng phase will be reduces
increasing the movement phase and
muscle forces and decreasing efficiency.

Muscle Functions - Abdomen:
Internal Oblique -
Decelerate transverse
plane rotation, frontal
plane and transverse
plane stability
Rectus Abdominis:
Decelerate Extension,
create pelvic stability
during dynamic
movement

External oblique -
Decelerate transverse
plane rotation some
extension
Muscle Functions - Abdomen:
Transverse Abdominis - The most important
abdominal muscle (attach to lumbar spine)
contract in feed forward mechanism
contract 1st before any other muscle
(research following back pain the transervse
abdominis is inhibited, thus when you move
for example an arm, your transverse
abdomnis does not stabilize thus the psoas
fires - compensation
Muscle Function: Lumbar Spine
Superficial Erector Spinae: Extends Spine
creates extension force and shear force at
L4-S1 works with the Psoas (when Psoas
tight it facilitates erector spinae further
increasing the shear forces and inhibit
posterior muscles)
Deep erector Spine: Posterior translation
and L4-S1, if weak or inhibited cannot
counterinteract affect or superficial erector
and get shearing forces
Muscle Function: Lumbar Spine
Transversal Spinalis Muscles (Rotatories,
Multifidi, interspinalis, interanversari)
Provide intrisic, intrasegmental stability
proprioceptive feedback since constantly
under compression and torsinal forces. If
these muscles are inhibited, loose the ability
to create dynamic stabilization from lack of
proprioceptive feedback.
Heads
1.Iliocastalis
Lumborum
Thoracis
Cervicis
2.Longissimus
Thoracis
Cervicis
Capitis
3.Spinalis
Thoracis
Cervicis
Capitis

SPINE MUSCLES
ANATOMY
Macro anatomy. Multifidus
(MF) is the largest and most
medial of the lumbar paraspinal
muscles. Each muscle consists
of five separate, overlapping
bands that form a triangle as
these bands run caudo laterally
from the midline.

Insertion: spinous process at
caudal tip.
Origin: transverse process at
mamillary process, iliac crest,
and sacrum (polysegmental: 2-4
segments below insertion at
spinous process).

Joint Dysfunction Example
Joint dysfunction example: lock up SI joint
plant and twist, Multifitus is inhibited
complains for low back pain, the erectors
will fire and attempt to stabilize (therefore a
muscle is doing opposite of its muscle
function). This is why pain syndromes are
perpetuated
Muscle Function: Hip
Musculature:
Gluteus Maximus: decelerate hip flexion,
decelerate hip internal rotation during heel
strike.
Psoas tightness creates inhibition of gluteus
maximus (anterior tilt)
Muscle Function: Hip
Musculature:
If the gluteus maximus is inhibited or wak
will loose ability to control femur, femur
will internally rotate:
Microtruma can be created on medial capsule
of knee
Patellar tendonitis non-contact ACL injuries
posterior tibial tendonitis, plantar facitis
Hamstrings become tight in an attempt to create
posterior stability of the pelvis (instead of
focusing on hamstring flexibility, work on
pelvic stabilization and flexibility will return)
Lack of flexibility is often a
phenomenon created by lack of
stability in an attempt to stabilize
the body for activity

Gluteus Maximus and minimus
are inhibited in most athletes due
to tight psoas (Summer, 1988).

Muscle Function: Hip
musculature
Gluteus medius: provides frontal plane
stabilization, decelerate femoral adduction, assist
in deceleration femoral internal rotation (during
closed chain activity)
VB/BB with patellar tendonitis originate from tight
psoas and lack of core strength
attempting to get triple extension during jumping, couldnt
extend through hip using gluteus maxiumus due to thigh psoas
Thus they hyperextend at the knee and drive the inferior pole
of the patella into the fat pad creating the inflammatory
response (Summer, 1988).

Muscle Function: Hip
Musculature
Adductors: frontal plane stability
Hip External Rotator: Create Pelvo-femoral
rhythm
Gemeli, Obturators, Piriformis help to
decelerate femur, If inhibited they become
extremely tight because they are attempting to
stabilize
Often we attempt to stretch these muscle where
a core program would eliminate the origin of
the problem
Force Couples
Saggital Plane: Psoas and superficial erector
spinae which create and extension force and
shear force int he lumbar spine
counteracted by transverse abdominis, internal
oblique multifidi, transversal spinalis groups,
gluteus maximums
Trend - most athletes the psoas and erector
overdeveloped inhibiting stabilizers
Frontal Plane: Gluteus Medius,
ipsilateral adductor and
contralateral quadratus lumborum
Example: weak gluteaus medius will cause
contralateral LBP, into knee pain on
opposite side
Force Couples Cont.
Transverse Plane Left Rotation - left
internal oblique, left adductor, right external
oblique and right external rotators of the hip
Example: synergistic dominance Weak
transverse abdominis and internal oblique the
same side adductor will become tight and
inhibit gluteus medius causing anterior knee
pain, posteior tib tendonitis etc. Down the
kinetic chain.

Principle of Core Training:
Postural Alignment: Primary Function -
misalignment will produce predictable
stresses, pain, chronic injuries, joint
dysfunction
Common Postural Dysfunction
Lower Cross System: Anterior Tilt in most
athletes increase lumbar lordosis
tight muscles movement groups muscles erector spinae
superifical psoas, upper rectus, rectus femoris,
sartorius, tensor facia latae, adductors
Weaker muscle/inhibited - stabilizing group deep
abdominal wall transverse abdominis, internal oblique
multifidus, deep erector spinae biceps femoris gluteaus
medius/maximus
muscle that decelerate femur are inhibited
Joint dysfunction illiosacral rotations, S1, L-spine, Tib-
fib joint, subtalar joint
Injury patterns: plantar faciiitis, patellar tendonis,
posterior tib tendonitis
Common Postural Dysfunction
Upper Cross System: Rounded Back/Forward
Head
Tight muscles pec major/minor, lat, upper trap,
levator, subscap, teres major, sternocleidomastoid,
erectus capitus, and scalenes
Weak muscle: rhomboids, middle.lwr trap, teres
minor , infraspinatus, posterior deltoid, deep neck
flexors
Joint dysfunction: Upper cervical, cervical
throricis, SC joint problems (which can cause
rotator cuff problems)
Common Postural Dysfunction
Pronation Distortion Syndrome: Flat feet
tight muscles: peroneals, lateral gastroc IT
band, Psoas
Weak muscles: intrinsic foot muscles,
anterior/post tibialis, VMO, bicep femoris,
piriformis, glut medius
muscles that control pronation are inhibited and
weak causing overuse injuries
Pronation Distortion Syndrome
Joint dysfunction: 1st MTB joint (EX: cause
anterior shoulder pain: stub toe and then
lack normal passive extension, shorten
stride, internal rotation of the femur,
causing pain up the core chain into
movements of the extremity). The same
can occur with sprain ankle and lock tibo-
talar joint
Through the kinetic chain,
muscle problems can lead to joint
problems and joint problems can
lead to muscle problems.

Postural Considerations
Many individuals have well developed
muscle strength and power to perform
specific activities, however few have
developed stabilization systems optimally
Optimal alignment of each segment in the
kinetic chain is a cornerstone for all
functional rehabilitation programs
Postural Considerations
If one segment in the kinetic chains is out of
alignment, then predictable patterns of
dysfunction will develop in other parts of
the kinetic chain
A weak core is a fundamental problem o
inefficient movement which leads to
injury
Low Back Pain & Rehabilitations
Transerve abdominis, multifitus, internal oblique
are inhibited in someone with LBP
Decrease in stabilization endurance can perform
the movement until fatigue. OK for 3x20 but once
start functional movement revert back to previous
positions
Increase interdisck pressure and compressive
forces with lack of pelvic stabilization
Think about athletes that lift and then have LBP
cause may not be stabilizing and can perpetuate
muscle imbalances creating hamstring dysfunction
etc.
Address through unstable ball training



Hiltons Law: any muscle that
crosses that joint will be
inhibited. With injuries the
individual will have a lot of joint
substitutions and muscle
imbalances

Muscle Imbalances
An optimal functioning core helps to prevent
the development of muscle imbalances
Optimal core neuromuscular efficiency allows
for the maintenance of the normal:
Length-tension relationships
Force-couple relationships
The path of instantaneous center of rotation
A strong stable core can improve
neuromuscular efficiency throughout the kinetic
chain by improving dynamic postural control
Assessment of the Core:
Core strength can be assessed using the
straight leg lowering test
Core power can be assessed using the
overhead medicine ball throw
Core muscle endurance can be assessed
using back extension
Core Stabilization to create
program:
Sport Demand Analysis
Demands of the individual sport
Demands of the athlete (player vs non-player)
Demands of the position/specialty
Guidelines for Core Training:
A comprehensive core stabilization training
program should:
progress from slow to fast
simple to complex
known to unknown
low force to high force
static to dynamic
Guidelines for core Training
Exercises should be safe, challenging, stress
multiple planes, incorporate a multi-sensory
environment, and activity specific
Put each athlete in the most challenging
environment they can control.
Guidelines for core Training
Change program often
ROM
Loading (Cable, tubing etc.)
Plane of motion
Body position, floor standing, one leg etc..)
speed of movement
duration
frequency
Abdominal Bracing Key
Transverse Abdominis - draw belly-button
into spine Make self skinny)
Pelvis tilts work rectus abdominis
avoid anchoring feet so as not to activate hip
flexors or psoas
Full ROM]Exercise profession
Stretch Antagonists between sets to prevent
inhibition (if working abdominal stretch hip
flexors between sets)
Exercise Progression
Stage I: Learning Abdominal Bracing
maintain stability
change duration and frequency
Stage II
Educate on daily use
Increase ROM and instability mainly uniplanar,
change body position
Exercise Progression
Stage III: instability
Maximize the use of functional activities with
abdominal bracing
Maximize multidirectional patterns and
unstable positions
Maximize frequency and duration changes
Stage IV:
Challenge the individual with high intensity
strength and power
Heads
1.Iliocastalis
Lumborum
Thoracis
Cervicis
2.Longissimus
Thoracis
Cervicis
Capitis
3.Spinalis
Thoracis
Cervicis
Capitis

SPINE MUSCLES
ANATOMY
Macro anatomy. Multifidus
(MF) is the largest and most
medial of the lumbar paraspinal
muscles. Each muscle consists
of five separate, overlapping
bands that form a triangle as
these bands run caudo laterally
from the midline.

Insertion: spinous process at
caudal tip.
Origin: transverse process at
mamillary process, iliac crest,
and sacrum (polysegmental: 2-4
segments below insertion at
spinous process).