CORE STABILITY

INTRODUCTION
• Core is described as a box with the abdominals in the
front,paraspinals and gluteals in the back,diaphragm as the
roof,pelvic floor and hip girdle musculature as bottom and hip
abductors and rotators laterally.
• It is the lumbopelvic hip complex.
• It is the location of COG and where all movements begin.
Efficient core allows for:
• Maintenance of normal length-tension relationships
• Maintenance of normal force couples
• Maintenance of optimal arthrokinematics
• Optimal efficiency in entire kinetic chain during movement
• proximal stability for movement of extremities
In an efficient state:
the core enables each of the structural components to operate
optimally through
• Distribution of weight
• Absorption of force
• Transfer of ground reaction forces
FUNCTIONAL ANATOMY
Global (dynamic,phasic) muscles:
• They are the large torque producing muscles
• Link the pelvis to the thoracic cage and provide general trunk stabilization as
well as movement.
• Rectus abdominis,external obliques and thoracic part of lumbar iliocostalis
Local (postural,tonic) muscles:
• They attach directly to the lumbar vertebrae.
• Responsible for providing segmental stability and directly controlling the
lumbar segments during movements.
• Lumbar multifidus,psoas major,quadratus lumborum,the lumbar parts of
iliocostalis and longissimus,transverse abdominis,diaphragm and the
posterior fibers of internal oblique.
 29 muscles attach to core
Lumbar spine muscles

Transversospinalis group: Erector spine:

• Rotators Iliocostalis
• Interspinalis Longissimus
• Intertransversarii Spinalis
• Semispinalis Quadratus lumborum:
• Multifidus Latissimus dorsi:
Abdominal Muscles:
• Rectus abdominals
• External oblique
• Internal oblique
• Transverse abdominus
Hip Musculature:
• Psoas
• Gluteals
• Hamstrings
Diaphragm and pelvic floor
CORE STABILIZATION TRAINING
CONCEPTS
A specific core strengthening programe can:
• Improve dynamic postural control
• Ensure appropriate muscular balance and joint arthrokinematics in
the lumbar-pelvic-hip complex
• Allow for expression of dynamic functional performance throughout
the entire kinetic chain
• Increase neuromuscular efficiency throughout the entire body.
ASSESSMENT OF THE CORE
Muscle imbalances
Arthrokinematic deficits
Core
• Endurance
• Neuromuscular control
• Strength
• Power
• Real time ultrsound imaging
Overall function of lower extremity kinetic chain
CORE ENDURANCE TESTS
4 endurance tests advocated are:
• Prone bridges
• Lateral bridges
• Torso flexor
• Torso extensor
Other tests:
• Single legged squat test
The bridge tests are functional. They asses strength,muscular
endurance and how is the ability to control trunk by the synchronous
activation of many muscles.
PRONE BRIDGE ENDURANCE TEST
• Primarily asses the anterior and
posterior core muscles.
• It is performed by supporting the
body’s weight between the
forearms and toes.
• The pelvis in the nutral position
and body straight.
• Failure occurs when client loses
nutral pelvis and falls into a
lordotic position with anterior
rotation of the pelvis.
LATERAL BRIDGE ENDURANCE TEST
• It asses the ateral core muscles
• Legs are extended and the top foot placed in
front of lower foot for support.
• Support themselves on one elbow and feet
while lifting hips off the floor to create a
straight line over their body length.
• The uninvolved arm is held across the chest
with the hand placed on the opposite
shoulder.
• Failure occurs when the patient loses the
straight posture and the hip falls towards the
table.
• Mean endurance time(R) MEN:95sec
WOMEN:75sec
(L) MEN:99sec WOMEN:78sec
TORSO FLEXOR ENDURANCE TEST
• It is time based test,how long the
patient can hold position of seated
torso flexion at 60 degrres.
• The client sits at 60 degrees with
both hips and knees at 90
degrees,arms folded across chest
with the hands placed on the
opposite shoulder and toes secured
under the toe straps or by examiner.
• Filure occurs when the athelet’s torso
falls below 60 degrees.
• Mean endurance time MEN: 136sec
WOMEN:134sec
TORSO EXTENSORS ENDURANCE TEST
• The test is performed in prone
position of the client.
• The client is at the edge with
upper body out of the table
while securing pelvic and leg.
• Failure occurs when the upper
body falls from the horizontal
into flexed position.
• Mean endurance time
MEN:161sec
WOMEN:185sec
SINGLE LEGGED SQUAT TEST
• Test is used as an indicator of
lumbo-pelvic-hip stability.
• It is functional test,requires
control the body over a single
weight bearing lower limb.
• It is frequently used clinically to
asses hip ad trunk muscular
control and/or control.
ABDOMINAL NEUROMUSCULAR
CONTROL TEST
• Supine with hips and knees in 90
• Pressure cuff placed under lumbar spine(L4-5) and raised to 40mmHg
• Performs drawing in maneuver(belly button to spine)
• Lower legs until pressure decreases
• Asses lumbar spine moving into extension
Hip flexors begins to work as stabilizers
Increases anterior shear forces and compressive forces at L4-5
Inhibits transversus abdominis,internal oblique and multifidus
CORE STRENGTH TEST
Straight Leg Lowering Test:
• Supine with knees in extension
• Pressure cuff placed under the lumbar spine(L4-5) and raised to
40mmHg with knees extended and hips to 90
• Performs drawing in maneuver and then flattens back maximally into
the table and cuff.
• Gradually lower legs to table while maintaining flat back.
• Test is over when the pressure in the cuff decreases.
• The hip angle is then measured with goniometer.
ULTRASOUND IMAGING
• Also used as assessment technique
• Means of assessing muscle size and activity.
• Most emphasis is on the assessment of transverse abdominis and
multifidus.
• Ultrasound imaging may improve treatment from two perspectives: as
a measure of muscle dysfunction and outcome, and as a tool for
provision of feedback.
CORE MUSCULATURE EXERCISES
1)Curl-ups:
• Patient lies supine with the hands
supporting the lumbar region.
• Do not flatten the back to the
floor.
• One leg is bent with the knee
flexed to 90°.
• Do not flex the cervical spine.
• Leave the elbows on the floor
while elevating the head and
shoulders a short distance off the
floor
2)Side bridges:

(a) In the beginning, position the

patient on the side supported by
the elbow and hip. The free hand
is placed on the opposite shoulder
pulling it down.

(b) The torso is straightened until

the body is supported on the
elbow and feet
3)Bird dog exercise.
• The bird dog position is with
hands under the shoulders and
knees directly under the hips.
• Initially, simply lift one hand or
knee a couple of centimeters off
the floor.
• The patient can progress to
raising the opposite hand and
knee simultaneously, then
raising one arm or leg at a time
and then raising the opposite
arm and leg simultaneously, as
shown.
4)Clam
b)Supine bridging with leg
extension

5)Bridging a)supine bridging

EXERCISE PROGRESSION
• Slow to fast
• Simple to complex
• Stable to unstable
• Low force to higher force
• General to specific
• Correct execution to increased intensity
REFERENCES
• Peter Brukner and Karim Khan with collegues.Clinical sports
medicine,3rd edition.