Core Muscle Strengthening

In the Athlete

Robert Donatelli PhD PT OCS

National Director Sports Rehab
Physiotherapy Associates
Richardson et al. Therapeutic Ex. For Spinal
Segmental Stabilization in Low Back Pain
Churchill Livingstone
 Dynamic Rotational
Movements and Forces
Core Muscles initiate
and attenuate forces
generated by the
rotational movements of
athletic performance
Core Muscles of the
Glenohumeral, Scapula,
Thoracic Spine, Lumbar
Spine, Pelvis, and Lower
Leg.
 Gait is a series of Rotations
that produce Ambulation
Rotations start at T5-6
Lumbar rotations
Pelvic rotations
Femoral rotations
Tibial rotations
Subtalar torque conversion
Inman-Human Walking
 Core Rotational Movements
Shoulder complex
rotation of the humerus,
scapula, and clavicle
Spine- intersegmental
rotators
Pelvis and Femur-
internal and external
rotators
Tibia and Subtalar
pronation and
supination
 Core
Lumbar-Pelvic-Hip Complex
Location of the centre of
gravity
29 Muscles that attach to the
pelvic complex
Ideal length tension and
force couple
Optimal neuromuscular
efficiency
Optimal acceleration,
deceleration, dynamic
stability.
 Joint Stabilization

Intricate inter-relationship and precise control

between several muscles acting on the joint to
protect it during functional movements. Little is
know about individual muscle contribution to joint stability
Muscles that do not contribute to movement
are designed to stabilize
Muscle Stiffness function of muscle most
closely related to joint protection and support
Johansson et al. Clin Ortho Rel Res, 1991
 Muscle Stiffness

Intrinsic stiffness viscoelastic properties in the

muscle
Existing bonds between actin and myosin =
excitability of the motor neuron pool = primary
spindle afferents set by the degree of stretch of
the muscle and the activity of the fusimotor
neurons
Sensory properties of the ligament = fusimotor
spindle system = muscle stiffness, coordination,
and position sense
 Joint Stability, Muscle Stiffness
and Kinesthetic Sense
Control of muscle recruitment for joint
stability depends on motor patterns from
the cortex and feedback system
Muscle similar to a spring - resist
deformation & return to original position
Muscle stiffness is increased great force
needed to change the length
 Stabilizers
Generate small forces short length is ideal
for increasing joint stiffness.
Rotator cuff muscles act as dynamic
ligaments to control humeral head position
Vastus medialis obliquus controls patella
position.
Gluteus medius controls the femoral head in
the actebulum
Spine- Multifidus - Transverse Abdominus
 Categorization of lumbar
and Abdominal muscles
Local system Global system
Intertransversarii Longissimus thoracis
Interspinalis Iliocostalis lumborum
Longissimus thoracis thoracis
Iliocostalis lumborum Rectus abdominus
Multifidus Obliquus externus and
internus
Quadratus lumborum
Transverse Abdominis
Hip Abductors/
Extensors/ Rotators
 Local and Global Muscles
Local muscles are capable of controlling the
stiffness and intervertebral relationship of the
spinal segments and the posture of the lumbar
spine.
Global muscles are involved in moving the
spine and transferring load directly between
the thoracic cage and the pelvis. Balance
external loads applied to the trunk so that the
residual forces can be handled by the local
muscles
 Local Muscle
Transverse Abdominus
Produces a drawing
in of the abdominal
wall, resulting in an
increased pressure
within the abdominal
cavity and an
increased tension in
the thoracolumbar
fascia
 Transverse Abdominus
and
Perturbation
Activation is linked to the control of reactive
moments produced by the limb movements eg.
The transverse abdominus was active 30ms
before the prime mover of the shoulder and
110ms with leg movement
Active in the control of the spinal stability
Perturbation to the trunk results in preparatory
spinal motions to dampen forces. Trans
Abdominus acts to maintain a stable
intersegmental orientation allowing movement
Transverse Abdominus
 Muscle Function
Panjabi et al concluded that the
intersegmental multifidus gave significant
advantage to the neuromuscular system for
controlling the stability of the lumbar segments.
Muscle forces were found to stiffen the motion
segment multifidus responsible for reducing
ROM in all directions except rotation.
All 3 lumbar muscles provide antigravity
support to the spine in upright posture
Multifidus - extension from
flexed position
 Core Muscles - Local
Lumbar Muscles- High proportion of Type I fibres
Multifidus - Cover the lumbar facets
Longissimus thoracis pars lumborum Connect the
lumbar vertebrae to the ilium
Iliocostalis lumborum pars lumborum Help to
form the iliolumbar ligament
All three muscles contribute to the support and
control of the orientation of the lumbar spine and
the stabilization of the lumbar spine.
 Pelvic Stability Femoral

Rotators-Global
External Rotators
Piriformis, super/inf gemellus, Obturator
internus and externus, quadratus femoris
Gluteus Max in terminal swing
Iliopsoas, sartorius, pectineus, biceps femoris
Internal Rotators
Medial hamstrings, anterior portion of gluteus
medius and tensor fascia
 Pelvic Myofascial System
Three Myofascial Systems and Muscles
Thoracolumbar Lats, internal abdominal
obliques, transverse abdominus, Gluteus
max. erector spinae, multifidus
Abdominal Fascia external oblique ,
transverse abdominus. Pect major, serratus,
rectus abdominus
Fascia lata gluteus max, tensor fascia,
quads, hamstings, and hip adductors
 Low Back Pain
Delayed on set of muscle activity of the
transverse abdominus with movement of a limb
in all directions
Change in transverse abdominus control occurs
irrespective of the specific pathology (motor
control not endurance or strength)
Fatigue of the paraspinal muscles is more
prevalent in low back pain patients. Elite and
highly trained athletes dysfunction of the
multifidus
 Assessment of Muscle
Multifidus palpation of
asymmetry
Paraspinal muscle
strength and pelvic
stability
Bridge and single knee
extension
All fours extending
opposite arm and leg
Side lying hip raise with
knees extended
Multifidus
Quadratus/Paraspinalis
 Testing Global Muscles
Manual muscle testing for hip
Abductors (leg drop test)
Extensors (knee flexed hip extended)
Adductors (eccentric loading)
Rotation of the femur (isokinetic testing or
manual muscle testing for int/ext rotn)
 Joint Stability Linked thru Co-
Contraction and Co-activation
Protection of the joint from unexpected loads
Maximizing joint congruency
Equalizing pressure distribution over articular
surfaces Centering the joint
Stress absorption
Decreased reciprocal inhibition and allows
antagonistic muscles to increase tension at the
same time. Snyder-Mackle et al JBJS 1991
 Exercise for active joint
stabilization
Co-contraction closed chain exercises
Use slow controlled CKC exercises
Focus on joint position rather than
control of force
Use unstable base for exercise, neutral
joint position, low force levels
No not over train co-contraction of large
torque-producing muscles
 Warnings of Co-contraction

High levels of muscle co-contraction may

produce harmful levels of joint
compressive forces.
May compromise freedom of movement
and cause rigidity
 Inadequacy of Unidirectional
Strength Training
Unidirectional
isometrically training of
the quads over 8 weeks significantly
decreased contraction of the hamstrings
Carolan & Catarelli J Applied Physio 1992
Hypertrophy of antagonist inhibits the
anagonist. Baratta et al. Am J Sports Med 1988
 Exercises for Spinal Stability
Perturbation training
unexpected movements of
the upper and lower
extremity activates the
transverse abdominus to
stabilize the spine by
responding to afferent
stimuli.
Overhead throws using a
medicine ball
Balance activities eg
dynamic edge, tilt boards,
shuttle balance system.
 Exercises for Pelvic Stability

Rotation Strength training

Femoral rotations - Isokinetics, pulleys
sitting or diagonal pattern standing
Dynamic Edge lateral movements with
resistance to rotation
Pelvic rotations - Plyoball sitting and
kneeling/ Medicine Ball standing throws
and sit-ups with medicine ball
 Dynamic EMG of Trunk
Muscles
Watkins, Uppal, Perry, Pink:
Am J Sports med 1996
Findings demonstrated the
importance of trunk
muscles in stabilizing and
controlling the loading
response for max power
and accuracy in golfers
swing
Muscle: Abdominal
oblique, rectus, Gluteus
max, and erector spinae.
 Transfer of Torque in Function

Watkins et al, Spine 1989

Gluteus maximus and
lumbar paraspinalis fire
bilaterally
Abdominal oblique and
rectus fire contralaterally
Analyze torque transfer
overhead throwing-
Baseball pitchers
 EMG analysis Baseball Swing

Baseball Batting an EMG

study
Shaffer, Jobe, Pink, Perry.
Clin Orthop 93
Peak activity of the vastus
medialis, hamstrings, gluteal
muscles, erector spinae,
abdominal obliques
Low muscle activity of
supraspinatus and serratus
Power in the swing is initiated at
the hip and the trunk -
Strengthening indicated
Low EMG activity of the 4
scapulohumeral
 EMG analysis of the L.E. during
pitching in High School
Yamanouchi T, Kurume Med K, 1998
Findings were consistent with the
observation that pitching tends to lead to
adductor muscle disorders
Strengthening the adductor and its
antagonist abductor can directly influence
the capability for pitching and can reduce
the risk for adductor disorders.
 Muscle Imbalances
Gluteus Medius CKC movements - decelerates
femoral adduction/Internal rotn
Weakness of Gluteus medius Increase frontal and
tranverse plane stress to PFJ and Tib/Fem joint
increase pelvic tilt
Tightness of IT band and Pirformis causing
external rotation posture of LE
Tightness of LS and Quadratus/ Collapse medial
arch
 Muscle Imbalances
Tightness of Psoas increases anterior shear
force and compression at L4-5
Inhibits gluteus max, multifidus, deep
erector spinae, internal obliques, transverse
abdominus
Extensor mechanism dysfunction during
functional movement patterns
Sharmann, Janda, Lewit
 Summary
Evidence that some muscles, rather than
contributing to movement of the joint system,
are designed for joint stabilization
Transverse abdominus & Multifidus, like the
vastus medialis obliquus of the knee have
primary roles that do not include production of
movement Stabilization
Local stability muscles do not take part in
movement, provide support while movement
occurs
 Case Presentation
Professional Baseball Player c/o chronic Low
back, hip and pelvis pain with specific
movements such as: Baseball swing, sprinting,
and sitting long periods
Asymmetry of the iliac crest right was elevated
Lumbar spine ROM limited in side bending
right rotation left - Quadratus area trigger pts
R Hip limited into internal rotation 50% deficit
Over pronation of the midtarsal and subtalar jt