Does increasing Core Strength

aid in speed of Recovery?

Team 2 Robyn, Vikki and Susan
Core Strengthening-
The Core is like a box
Abdominals in the
front
Paraspinals and
gluteals in back
Diaphragm roof
Pelvic Floor and hip
girdle bottom



Lumbar Stability-
Passive and Active Stiffness
PASSIVE-ligaments and
osseous structures (facet
joints, pedicle, lamina,
pars interarticularis,
intervertebral disk, fascia)
ACTIVE-muscles
(paraspinals, quadratus
lumborum, abdominal
muscles, hip girdle
muscles, diaphragm,
pelvic floor)


INSTABILITY HAPPENS
WHEN PASSIVE OR
ACTIVE STRUCTURES ARE
DISRUPTED
Core Muscles
PARASPINALS:erector spinae-
group of 3 muscles; runs along
neck to lower back.
Multifidus-under erector spinae
they extend & rotate spine.
Multifidus-atrophy in people
with low back pain
QUADRATUS LUMBORUM-
usually works isometrically to
stabilize spine
HIP GIRDLE-transfers forces
from lower extremity to pelvis
and spine
Core Muscles-Abdominals
Transverse Abdominis-located under the obliques,is the deepest, wraps
around your spine for protection and stability. Activates before limb
movement in healthy people and is delayed in people with back pain
Internal Oblique-located under the external obliques-runs in the
opposite direction and increases intra-abdominal pressure
External Oblique-located on the side and front of the abdomen and
checks anterior pelvic tilt
Rectus Abdominis-located along front of abdomen -strap like muscle
over anterior abdominal wall, causes lumbar flexion
MOST EXERCISE PROGRAMS OVEREMPHASIZE RECTUS
ABDOMINIS AND INTERNAL OBLIQUE WHICH CAUSES AN
IMBALANCE WITH WEAKER EXTERNAL OBLIQUE
Core Muscle
Strength & Stability Test
Start in the plank position-elbows
on ground hold for 60 seconds
Lift right arm off the ground hold
for 15 seconds
Return right arm to ground and lift
left arm hold for 15 seconds
Return left arm to ground and lift
right leg hold for 15 seconds
Return right leg to ground and lift
left leg hold for 15 seconds
Lift left leg and right arm off
ground hold for 15 seconds

Return left leg and right arm to
ground
Lift right leg and left arm hold for
15 seconds.
Return to plank position hold for
30 seconds.
If you can complete the test fully
you have good core strength
If you can not complete the test
fully your core strength needs
improvement
Practice routine 3-4X a week until
you improve
START WITH CAT-CAMEL
This exercise allows
spinal segment motion
before more
aggressive exercise
STABILIZATION
EXERCISE-THE BIG 3
CURL UP
SIDE BRIDGE
BIRD DOG


CURL UP-
Breathe in, and zip and hollow.
(Breathing out): try to lift your
chest off the ground. This is a
subtle movement- only the spine
at the lower end of your chest
bends, and then only a little.
Even with this small movement,
your upper body has sufficient
weight to really challenge those
"abs."!
Keep the length and width in
front of the pelvis, and make sure
that the tail bone stays down on
the ground (pelvic neutral).
(Breathing in): slowly curl back
down.
Repeat three to five times each
side

STABILIZATION EXERCISE-
SIDE BRIDGE
Side Bridge
Lie on side, propped up on elbow,
with top foot in front of bottom so
both feet are on floor. Contract abs
as you raise body, forming a
straight line from toes to shoulders.
Do all reps, then switch sides.
Make it easier Lie with legs bent
behind you and raise torso and legs
resting on bottom knee.
Make it harder From Main Move,
rotate body to face floor, supporting
yourself on forearms and toes, legs
and torso in a straight line. Hold,
then rotate back to Side Bridge.
STABILIZATION EXERCISE-
BIRD DOG
1. Assume quadruped position.
2. Brace the abdominals, and at
first, practice lifting one hand
and the opposite knee just
clear of the floor while
balancing on the other hand
and knee.
3. When you're ready to do the
complete exercise, point the
arm out straight in front and
extend the opposite leg to the
rear
4. Hold for 10 seconds then
return to hands and knees on
ground position.


Shirley Sahrmann Core Building
These moves focus on stabilizing the pelvis and
strengthening the lower abdominal area, which is often
weakened by pregnancy.
These are progressive exercises, so you'll need to master
each exercise (performing 20 reps without losing your
abdominal contraction) before moving onto the next.
Take as much time as you need to progress, even if you
only do a few exercises during each workout

Basic Breath

Lie on your back, knees bent and arms at your sides.
Inhale and exhale a few times and focus on keeping a
neutral spine (don't flatten the back or arch the back, but
find a comfortable place in the middle).
Take a deep breath and while exhaling, tighten the abs
and pull the navel towards the spine.
Concentrate on contracting the muscles below the belly
button without flattening the lower back against the
floor.
When you're able to do this without arching or
flattening your back, you're able to stabilize the pelvis
and move on to the next exercise.
Sahrmann Exercise #1
Lie on the floor with the knees bent.
Perform the Basic Breath
Keeping one knee bent, slowly slide the other
leg out until it's parallel and just a few inches off
the floor.
Bring the leg back and repeat on the other leg.
Once you're able to complete 20 reps on each
leg, without losing the abdominal contraction,
move to the next exercise.
Sahrmann Exercise #2
Lie on the floor with the knees bent.
Perform the Basic Breath and lift one knee
towards the chest.
Straighten the leg so that it is parallel and
about 2-3 inches off the floor.
Bring the leg back to start and repeat with
the other leg for 5 or more reps.
Once you're able to complete 20 reps on
each leg, without losing the abdominal
contraction, move to the next exercise.


Sahrmann Exercise #3

Perform the Basic Breath as you bring the knees
up to a 90-degree angle.
Keep one leg bent and lower the other leg
towards the floor, tapping the floor with your toe.
Complete 1-5 reps on the same leg and then
switch sides.
Once you're able to complete 20 reps on each leg,
without losing the abdominal contraction, move to
the next exercise

Sahrmann Exercise #4

Perform the Basic Breath as you bring the knees
up to a 90-degree angle.
Keep one leg bent and extend the other leg out
until it's parallel, but not touching the floor.
Repeat on the other leg, working up to 10 reps on
each side.
Once you're able to complete 20 reps on each leg,
without losing the abdominal contraction, move to
the next exercise.

Sahrmann Exercise #5

Perform the Basic Breath and bring the legs
into the chest.
Straighten both legs so that they're
perpendicular to the floor.
Slowly lower both legs towards the floor,
going as far as you can without arching the
back.
Repeat for 5-10 reps, working up to 20 reps.
Additional core exercises
Controlled Trunk Twist-
external oblique muscles are
activated with control.

Physioball Exercises-
Pelvic bridging
Abdominal crunch
Modified push up
Prone Superman
Balancing while seated
Lunge- perform forward and
sideways. Add labile surface
for greater difficulty factor

Patients should be given
exercises in sitting, standing
and walking\standing positions
Strengthening for treatment of
other conditions in older adults

Across the spectrum it has been generally agreed that exercise in older
adulthood has a positive impact on morbidity, balance, mobility,
posture and prevention of falls

In surveying the literature of evidence-based research, it is evident that
further study and clinical trials are needed for conclusive treatment
programs involving exercise for older adults.
The research in the study of exercise for older adults is primarily
targeted to general strengthening utilizing aerobics, weight bearing and
resistance. In surveying the literature there is little mention of specific
core strengthening exercise but it appears that core strength is certainly
included in the general discussion of improved function in this age
group.

Osteoporosis
Osteoporosis is a disease characterized by a decline in bone mass and
architectural deterioration of bone tissue. Although both men and
women are at risk for osteoporotic changes, it is more common in
women and thus more research has been directed at reducing the
morbidity in women, particularly post-menopausal women. (1)
It has long been recognized that changes in bone mass occur more
rapidly with habitual inactivity and results in a downward spiral of
physiological changes including bone mass deterioration. Older
adults may find it increasingly difficult to continue the kinds of
activities that provide adequate load-bearing to maintain bone density
contributing to the decline. (3)

Osteoporosis Continued
Studies indicate that exercise interventions with individuals with low
bone mass density to reduce falls and fractures should include balance,
muscle strengthening and weight bearing to improve bone strength and
integrity. Balance related exercise and muscle strengthening to
increase lower extremity and back extensor strength were found to
have positive effects. (4)
No studies were found that addressed core strengthening in particular
for the treatment of low bone mass density but the relationship of
exercise intervention to the reduction in falls and fall related fractures
appears implicitly clear.


Sources
1. Suominen H., Muscle training for bone strength. Aging Clin Exp
Res. 2006 Apr; 18(2): 85-93. Abstract.
2. Kado, DM, The rehabilitation of hyperkyphotic posture in the
elderly. Eur J Phys Rehabil Med. 2009 Dec: 45(4): 583-93. Abstract.
3. No authors listed. American College of Sports Medicine position
stand. Osteoporosis and exercise. Med Sci Sports Exerc. 1995
Apr:27(4): i-vii.
4. D. de Kam, E Smulders, V Weerdesteyn, BCM Smits-Engelsman,
Exercise interventions to reduce fall-related fractures and their risk
factors in individuals with low bone density: a systematic review of
randomized controlled trials.

Parkinsons
Parkinsons disease is a progressive neurodegenerative disorder that
affects function, movement abilities and quality of life. People with
the disorder are twice as likely to have recurrent falls compared to
other older people, and as many as 65% will experience an injury
secondary to their falls, 33% will sustain a fracture. (1)
Historically physical medicine and rehabilitation have not been really
involved in Parkinsons disease and few articles have assessed the
value of these programs. (2)
Recent studies suggest that exercise improves some of the cardinal features of
this disease that often resist pharmacologic intervention, including gait,
posture and dysarthria. (3) Again no study was found that addressed the effect
of specific core strengthening exercise on those with Parkinsons disease.


Parkinsons Continued
Of four controlled studies with satisfactory methodology cited in a literature
review, it was concluded that exercise would be effective more by reducing
daily life disability than by improving Parkinson symptoms such as
bradykinesia or tremor. It was noted however that some evidence suggests
that exercise resulted in improvement in balance task performance and
postural stability. (4)
In a study protocol for an upcoming clinical trial it was noted that after a
review of the literature it was concluded that there is an urgent need to identify
cost-effective evidence based interventions for reducing falls and related
injuries for people with Parkinsons disease. (1)

Sources
1. Canning, Colleen G., et al. Exercise therapy for prevention of falls in
people with Parkinsons disease: A protocol for a randomized controlled trial
and economic evaluation. Address to Clinical and Rehabililtation Sciences
Research Group, The University of Sydney. 2009 Jan. Study Protocol.
2. Pelissier, J., Perennou D., Exercises program and rehabilitation of motor
disorders in Parkinsons disease. Rev Neurol (Paris). 2000: 156 Suppl 2 Pt
2:190-200.
3. Hirsch, Mark A., et al. Exercise for Management and Treatment of
Parkinson Disease. American Family Physician, 2009 June: Letter to the
Editor.
4. Dibble, LE, et al. The effects of exercise on balance in persons with
Parkinsons disease: a systematic review across the disability spectrum. J
Neurol Phys Ther. 2009 Mar;33)1):14-26.

References
Akuthota, Venu MD and Nadeler, Scott f< DO; Core Strengthening Arch
Phys med Rehabail Vol 85, Supple 1, March 2004
http://exercise.about.com_library_postpartumabs1.htm
Hodges PW, Richardson CA. Contraction of the abdominal muscles associated
with movement of the lower limb. Physical Therapy, February 1997
Hodges PW, Richardson CA. Relationship between limb movement speed and
associated contraction of the trunk muscles. Ergonomics, November, 1997
Arch Phys Med Rehabil Vol 85, Suppl 1, March 2004
http://sportsmedicine.about.com/od/bestabexercises/a/core_test.htm


Conclusion
Core strengthening programs have not been well researched.
Most studies are prospective, uncontrolled, case series.
In 2002 Nadler attempted an evaluation. LBP in male athletes
decreased 47%; female athletes LBP slightly increased, possibly due to
unsafe exercises ie. Roman chair and did not include recommended
exercises in transverse plane.
Core strengthening does appear to be effective in the treatment of back
pain (Cochrane), but no specific program showed a clear advantage.
Core strengthening has a theoretical basis in treatment and prevention
of various musculoskeletal conditions. Core strengthening programs
appear to be the cusp of innovative new research.