Skip to main content
Core stability
Core stability
Stability of the spine is maintained by three components:
- 1
st component is “Ligamentous structures”: It provides the most stability
by passive restraint toward the end of the range of motion.
- 2
nd component is “Muscles surrounding the spine”: Muscle activity can
create sufficiently stable joints.
- 3
rd component is “Neural control system: It coordinates muscle activity to
respond to both expected and unexpected forces.
Factors causing instability of the spine
Instability could be a result of tissue damage, making the segment more difficult to
stabilize, insufficient muscular strength or endurance, or poor muscular control.
Core stability
Core stability means the muscular control used to maintain stability around the
lumbar spine and pelvis.
What are muscles provide core stability?
There are two types of muscle used when stabilizing the lumbar spine and pelvis:
- Local postural muscles (Deep muscles): These are the deeper muscles in the area. They are known as the core
muscles. They attach directly to the lumbar vertebrae and surrounding
thoracolumbar fascia tensing and relaxing to provide stability to the area.
The main postural muscles are:
- Multifidus
- Transverse abdominus
- Diaphragm
- Pelvic floor muscles
- Global dynamic muscles (superficial muscles):
These are the large torque producing muscles which connect the pelvis to
the thoracic cage providing more general stabilization to the area along with
trunk movement. Overuse of these muscles can decrease the function of the
local postural muscles. These muscles are:
- Rectus abdominus
- Internal oblique
- External oblique
- Erector spinae (iliocostalis & longissimus)
Core stability concept:
- The strength of the muscles is not so much important as their ability to fire
and activate during specific movement sequences to stabilize the low back
and pelvis giving a stable base from which force can be generated through
the limbs to run, jump, kick….
- Lack of sufficient coordination in core muscles can lead to decreased
efficiency of movement and compensatory patterns, causing strain and
overuse injuries.
Values of core stability exercises:
- Help to reduce the risk of injury resulting from bad posture.
- Keep abdominal muscles very strong.
- Maintain good posture.
- Prevent postural problems as back pain.
- Make abdominal muscles so efficient during labour.
- Improve muscle balance.
- Teaches the muscles to work together efficiently and effectively.
- Enhances neuromuscular efficiency throughout the body and neuromuscular
control for efficient movement and physical positioning.
- Improves spinal and postural control in static and dynamic positions.
Graduations of core stability exercises
- Learn the patient to activate the deep (core) stabilizing musculature while in
the neutral position.
- Add extremity motions to load the global musculature while maintaining a
stable neutral spine position (dynamic stabilization).
- Increase repetitions to improve holding capacity (endurance) in the
stabilizing musculature
- Increase load by change lever arm or add resistance to improve strength
while maintaining a stable neutral spine position.
- Progress to movement from one position to another in conjunction with
extremity motions while maintaining a stable neutral spine (transitional
stabilization).
- Use unstable surfaces to improve the stabilizing response and improve
balance.
Important note:
- It is essential to be able to properly activate the deep core muscles
(Multifidus, Transversus abdominus, Diaphragm, Pelvic Floor) before any
progression is attempted otherwise the global stabilizers will be used to
compensate.
- If an exercise is too difficult go back and master a simpler exercise and then
progress.
Core stability exercise program for sedentary women
1-Activation of core muscles
a) The transverses abdominis muscle
Transversus abdominis is the deepest of the abdominal muscles and wraps
around the abdomen between the lower ribs and top of the pelvis, functioning
like a corset.
a. Activation of transverse abdominus
Drawing-in Maneuver:
Position of the woman:
Crook lying position (Hook-lying)
Palpation:
2 inches medial to (ASIS) and 1 inch distal (just lateral and deeper to the rectus
abdominis).
Command:
“Breath in, breath out, and when near maximal exhalation, draw your belly
button to toward your spine” (contraction should feel like a light tension
under your fingertips, not a contraction that pushes your fingers out).
Another command
“Imagine a line that connects the two pelvic bones try to draw in the muscle
along this line”
Woman self-palpation
ask the woman to place two fingers on transverse abdominus and one hand on
superficial abdominal muscles.
Woman should be able to hold the contraction for 10 seconds and repeat for 3 sets
of 10 repetitions 3 - 4 times per day.
Substitutions
- Posterior tilting of the pelvis
- Bulging of the abdomen
- Depression of the rib cage
- Breath holding
- Fingertips being pressed out by a strong muscular contraction (internal
oblique).
b. Activation of Multifidus muscle
Multifidus is a deep muscle that has a segmental attachment on
each single vertebra.
Position of the woman:
Prone or side-lying.
Palpation:
by thumbs or index fingers immediately lateral to the spinous processes
of the lumbar spine.
Command:
“swell the muscle out against my finger”.
- Facilitation techniques include using the drawing in maneuver and gently
contracting the pelvic floor muscles.
- Palpate each spinal level so comparisons in the activation of the multifidus (Mf)
muscle can be made between each segment as well as from side to side.
Stabilizer Pressure Biofeedback
If a patient has difficulty activating the core muscles, we could use stabilizer
pressure biofeedback to assist her.
2. Add extremity motions (Stabilization with progressive limb loading)
After the woman learnt how to activate the core muscles, we can progress by ask
her to do extremity movement while maintain the contraction of core muscles.
Always start with easy, supportive movement then progress to the more loading
movements.
a. Exercises to load the upper limb muscles
1.One arm movement:
Position of the woman:
Crock lying neutral spine position with keeping the lumbar spine flat.
Command:
Lift one arm overhead slowly. Return it to the start position while lifting the
other arm overhead slowly. Continue by alternating right and left sides.
2. Both arms movements:
Position of the woman:
Crock lying neutral spine position" Lie on your back with knees bent and
feet on the bed, keep your lumbar spine flat".
Command:
Lift both arms overhead slowly. Return it to the starting position.
b. exercises to load the abdominal and lower limbs muscles
1-Abdominal Draw In with Heel Slide (Knee bent):
2. Abdominal Draw In with Knee to Chest
3. Abdominal Draw In with Double Knee to Chest:
4. leg lift graduation
5. Arm/Leg Raise:
c. Exercises to load back extensor muscles
1. Hamstring Rises:
Position of the patient:
Quadriped position.
Command:
- a) Raise one leg behind you until you cannot lift it higher without rotating your
hips or arching your back. The movement should be slow and controlled.
- b) Return the leg to the floor and repeat to the other side.
- c) Complete 15 repetitions on one leg and repeat on the other leg.
2. Quadriped Opposite arm/leg:
Position of the patient:
Quadriped position.
Command:
- a) Raise your right arm out in front of you and raise your left leg out behind you,
keeping it straight.
- b) Hold for 30 seconds and then repeat on the other side.
3. Superman:
Position of the patient:
Prone lying position on the mat with arms and legs extended.
Command:
Retract shoulder blades down and in towards the midline of your spine and draw
in abdominal muscles; maintaining this position, lift opposite arm and opposite
leg ensuring that your hips stay in contact with the floor; hold for 3-5 seconds and
opposite sides. Repeat 10-20 times.
3-Increase endurance capacity in the stabilizing musculature
In this stage we do the same exercises in stage 2 with increasing the repetitions
of exercise while maintain the core muscles control
4-Increase strengthening in the stabilizing musculature
In this stage we do the same exercises in stage 2 with increasing the load on the
global muscles while maintain the core muscles control, this can be achieved by
adding weights.
5 Transitional stabilization:
change from one position to another in conjunction
with extremity motions while maintaining a stable neutral spine
6. Use unstable surfaces to improve the stabilizing response and improve
balance.
1-Supine hip twist on physio-ball:
Position of the woman:
Lie on your back on the floor with hips and knees bent to 90 degrees over a physioball.
Command:
Draw in your abdominal muscles and maintain throughout exercise; rotate knees to
one side keeping hips in contact with the floor; pull knees back to center and repeat
on opposite side; Repeat 10-20 times on each side.
2-Wide Squats with Core Ball:
a) Stand with the core ball between the body and the wall, with the core ball
resting in the lower part of the back.
b) Bring legs out past shoulder width, with feet at a 45° angle.
c) Slowly squat down until thighs are parallel to the floor.
d) Repeat for 10 repetitions. Perform 2-4 sets with 30 seconds rest in between sets.
3- Exercise while sitting in physio- ball
