“The core can be described as a muscular box with the abdominals in the front, paraspinals and gluteals at the back, the diaphragm at the top and the pelvic floor at the bottom.” (1) In truth the core is a very complex system consisting of 29 pairs of muscles within this “box”. This can be further grouped into the following anatomical divisions:

• Transversospinalis group
• Erector spinae group
• Quadratus lumborum
• Latissimus dorsi
• Abdominal group
• Psoas group
• Gluteal group
• Hamstring group

A more simplified way to think about the core is to think about the body (trunk) without the arms and leg

 

Function

 

The main function of the core is simply to link the upper and lower body especially during movement. Ideally this link should be stable. This stable base should be seated in the lumbo-pelvic region of the body. Stability in this region is crucial to provide a foundation for movement of the upper and lower limbs, to support load and to protect the spine.

When this system works as it should there is proper force distribution and the ability to generate maximum force with minimal compressive, translational or shearing forces at the joints of the kinetic chain. Panjabi defined core stability as: “the capacity of the stabilizing system to maintain the intervertebral neutral zones within physiological limits.”

 

How?

 

It is vital to understand that there is a difference between core strength and core stability. Core stability is a result of the 29 pairs of muscles working together in a very precise and timely manner whereas core strength is the strength or weakness of each individual muscle. According to Gray Cook of Functional Movement Screen people often confuse the issue. Someone may be doing a crunch and they’ll tell you that they are working on their core stability where they are in fact working on abdominal strength. Core stability at its essence requires great motor control.

This “system” of producing stability consists of the following parts:

1. Neuromuscular control
2. The passive subsystem (ligaments and bones)
3. The active subsystem (muscles)

So it’s vital to note that spinal (core) stability is not only a function of muscular strength but that it also relies heavily on proper and timely sensory input which alerts the central nervous system, providing constant feedback and allowing refinement of movement. These tiny adjustments are what provide stability. Of course strength is an important factor in having good core stability but it is worth remembering that all strength is a gift from the neurological system. If the neurological system is impaired for one reason or another the strength of some or all of the core musculature will be reduced. An example of this will be back pain or pain after an operation.

This is a very complex system with the bones and ligaments acting as a constant and the neuromuscular system providing information causing the muscle system to change constantly from one millisecond to another.

There has been a lot of focus on what some consider the “deep core”. This is made up of the transversus abdominus and the multifidus muscle group. Another school of thought by biomechanists like Stuart McGill emphasize larger prime mover muscles such as the abdominal obliques and quadratus lumborum muscles in providing stability. My belief is that they are all important and even if some only work for a split second during certain movements they play an important role in that particular system. At the very least they act as a link and if you remove one link the chain is irreversibly compromised.

It is important to note that we have two types of muscle fibres making up the core system. Slow-twitch and fast-twitch fibres. The local muscle system (the deep layer) is made up primarily of slow-twitch fibres. These muscles are shorter in length and control inter-segmental movement and they respond well to changes in posture and extrinsic loads.

Fast twitch fibres on the other hand comprise the global subsystem (the superficial muscle layer). These muscles are long and possess large lever arms, allowing them to produce large forces and thus big movements. They are sometimes also known as prime movers. What makes these muscles unique is that they not only produce movement but also act as stabilizers in the core.

 

Why should I have a strong core?

 

• A strong core benefits everyday movements and protects you while carrying out these activities of daily living. Generally one would not even pay attention to these everyday acts of living until you have an injury or you pick up an injury performing one of these actions, something as simple as picking up a towel from the floor.
• Movement related to your job. When mentioning this one would immediately think of manual labour, lifting, carrying etc. What about sitting for 8 – 10 hours a day? A strong core will not only assist you in coping with this but also help and prevent you getting weaker and weaker which will eventually lead to an injury.
• A strong core will help combat back pain.
• A strong core will assist in sports and recreational activities. So apart from protecting your back during something like a golf swing it will also improve your performance by providing a stable base which allows for greater force production in the upper and lower extremities.
• A strong core will aid your balance and stability. Again this might be something one takes for granted until you lose your natural ability as a result of injury or old age.
• Good posture. As a result of the western way of living, sitting for hours on end looking down at cellular phones etc., people are developing poor posture. More often than not the initial changes take place in the lumbo-pelvic region which can then move up the spinel eading to changes to the natural curves of the spine and causing strain on the soft tissue structures surrounding the bones and eventually even degeneration and bony changes. A strong core helps combat poor posture.

 

How do I train my core?

 

It is important to remember that exercise for core stability is more than strengthening the muscles of the trunk. If you are recovering from an injury there will most probably be insufficient coordination in the core musculature. This can lead to decreased function and compensatory movement patterns. This will again predispose you to a recurring injury. As such the motor relearning of the inhibited muscles may end up being more important than pure strength training. It is probably best to get professional help in situations like these.

Even if you aren’t recovering from an injury your core exercise program should be done in stages with gradual progression. This is especially true for people who are returning to physical activity after a long sedentary period.

The first stage should focus on correcting mobility issues. Any muscle imbalances or restrictions in mobility should be corrected by restoring normal muscle length. If you sit for many hours daily chances are that your hip flexors have shortened. When this happens it generally causes an inhibition in the opposing muscle (antagonist) in this case it is the gluteus maximus muscles which will become inhibited. This is just one example of changes which needs to be addressed. Postural muscles also have a tendency to become tight as a result of constant activation against the forces of gravity.

During the second stage activation of the deep core musculature should be taught through lumbo-pelvic stability exercises.

Once these exercises have been mastered one can progress by adding a stability ball in sitting and lying.

Finally, there should be transitioning to standing with functional movement exercises that promote balance and precise movement. The role of advanced core stabilization is to train functional movements rather than individual muscles. There are those who preach that functional training can only take place in the transverse plane (rotation). I believe that is a bit one-dimensional.

 

Food for thought

 

1. To me it seems that there are two schools of thought at the moment in using instability to train core stability. There have been a good number of studies which suggest that unstable modalities like the use of a stability ball lead to greater muscle activation. On the other hand there is a school of thought which suggests that training on unstable surfaces aren’t functional and does not relate to what we do in real life. They even suggest that by taking the body that far out of its comfort zone you may even cause “shock” which can lead to inhibition. According to Behm (3) training programs which must prepare athletes for a wide variety of postures and external forces should include exercises with a destabilizing component. However, he also states that these kinds of exercises are not recommended as the primary exercises for hypertrophy, absolute strength or power, especially in trained athletes. For athletes, ground based free-weight exercises with moderate levels of instability should form the foundation of exercises to train the core musculature. It should be noted though that instability resistance exercises can play an important role in rehabilitation and periodization.
2. In his paper “The myth of core stability” Lederman states the following: “Core stability exercises are no more effective than, and will not prevent injury more than, any other forms of exercise.” He goes as far as to suggest that there may even be a potential danger of damaging your spine with continuous tensing of the trunk muscles …… you decide.
3. Is what you are doing promoting core stability through training this complex system as a whole or are you trying to isolate specific muscles and strengthen them? Is it possible to have strong core muscles and yet little or no core stability?

 

Conclusion

 

Core stability is a product of three systems integrating to produce a complex mechanism which changes with the smallest variations in movement. There are many factors which may cause dysfunction from tightness, pain, muscle weakness poor motor control, structural changes and even poor posture. If you aren’t sure if your core is compromised or don’t know where to start see your health care practitioner.

 

References

 

1.  Akuthota V. et al. Core stability exercise principles. Curr. Sports Med. Rep. Vol. 7, No. 1, pp. 39-44, 2008.
2. Willardson J.M. Core stability training: Applications to sports conditioning programs.J of Strength & Conditioning research, 21 (3), 979-985, 2007.
3. Crisco J.J. et al. Stability of the human ligamentous lumbar spine. Part 2: experiment. Clin Biomech, 7:27-32, 1992.
4. Behm D.G. et al. Muscle force and activation under stable and unstable conditions. J. Strength Con. Res. 16:416-422. 2002.
5. Behm D.G. et al. The use of instability to train core musculature. Appl. Physiol. Nutr. Metab. 31(1):91-108. Feb. 2010.
6. Hibbs A.E. et al.  Optimizing performance by improving core stability and core strength. Sports Med 38(12): 995-1008. 2008.
7. E. Lederman. The myth of core stability. CPDO online journal. June 2007:1-17

The role of the Biokineticist in the treatment of chronic and recurring injuries

 

In order for us to make sense of the role that exercise can play in the rehabilitation of injuries it is important to distinguish between different types of injuries based on the initial cause, the severity of and duration of the injury.

Chronic injuries refers to injuries which are of long duration and which are usually slow to develop such as Achilles tendinitis as opposed to acute or traumatic injuries such as a fractured bone from a direct trauma.

Overuse injuries are caused by overexerting the body through the use of incorrect exercise practices and not allowing for enough rest in between sessions. The athlete places too much stress on the body with insufficient time for it to recover. This is a very common pattern amongst Comrades runners who start running faster, more regularly and longer distances in February and March of each year.

Recurring injuries are injuries that get better with rest and treatment but which reappear when the person returns to the event that caused it.

At this time it is good to remember that your Biokineticist is an exercise specialist with an Honours degree trained in the clinical prescription of exercise for the prevention and rehabilitation of injuries.

It is also important to understand the role of the doctor and the physiotherapist on the continuum of rehabilitation. If you get injured, regardless of whether it was caused by direct trauma such as a rugby tackle or by pushing too hard and too fast during training, your first stop should be a physician. Depending on the severity of the injury you may go to the emergency care at the hospital or go to see your general practitioner. The doctor is considered the first phase on the continuum and will diagnose the condition and decide which intervention will be best. Options include the prescription of medicine, an operation, immobilization, rest or physiotherapy.

Physiotherapists are considered part of the first and second phase of rehabilitation. Physiotherapists have been recognised as first line practitioners since 1985 and this means that it is recognized that they are able to diagnose and treat injuries. Physiotherapists make use of various modalities including hands on techniques to reduce pain and swelling and to improve range of motion and function. They also play an important role in educating the patient in living and coping with the injury. It is vital to understand that the clinical prescription of exercise also falls within the scope of practice for Physiotherapists. It is in this regard where Biokineticists and Physiotherapists share common ground.

Biokineticists apply exercise in what is known as the third or final phase of rehabilitation. It is also sometimes known as the strength phase. It is vital to understand how your Biokineticist can help you to address the cause of your chronic and recurring injuries. Biokineticists see patients with recurring and chronic injuries generally after they have been treated by the doctor or physiotherapist and the symptoms have been greatly reduced.

Unlike traumatic or overuse injuries the cause of your recurring and chronic injury is not always clear. You have intrinsic and extrinsic forces influencing your body. If these forces are out of balance or if they cause your body’s musculoskeletal system to become unbalanced it can lead to chronic or recurring injuries. Intrinsic forces which can cause injury are muscle imbalances in strength and flexibility, biomechanical anomalies such “knock knees” etc. Extrinsic forces could include wearing the wrong shoes, running on the camber of the road or only running in one direction around a track.

Please note that chronic and recurring injuries do not only apply to athletes but also to people at work and home. The way we move and sit and work can all lead to chronic injuries such as neck and back pain. These movement patterns cause imbalances over time, and this leads to pain. There is not necessarily a pathology but there is pain which is mechanical in nature. These types of injuries are recognised by the fact that the pain diminishes after rest and tends to get worse as the day or the week progresses.

A skilled Biokineticist will be able to determine through a thorough consultation and scientific assessment what the cause of your chronic and recurring injuries are. By looking for the cause of the problem and by not just chasing the symptoms the biokineticist will be able to address the cause and educate you in managing the problem going forward.

Once it has been established what is wrong the Biokineticist can then address the problem in a structured way by applying clinical exercise as a tool in correcting the problem.

Athletic body in balance. Gray Cook.

The components of physical fitness

 

When asked what physical fitness is most people would reply: “being able to run far”.The truth is that physical fitness is a far more complex component of wellness.

It is commonly accepted that physical fitness is a product of 10 different components. Some of these are health related and some are skills related.

The 10 components of fitness are:

1. Cardio-respiratory capacity which is the ability of the body to take in oxygen (respiration) and deliver it to the cells (circulation). Oxygen is vital in the production of energy at cellular level, especially during low intensity, long duration exercises. Systems which aid the uptake and distribution of oxygen are the cardiovascular system including the heart, arteries, veins and capillaries, respiratory system, including the lungs and the blood, that acts as the transport system. The long term adaptation of cardio-respiratory exercise is a stronger heart which works more efficiently. This leads to increased cardiac output and a decrease in the resting heart rate. The lungs can also increase in size and become more efficient at diffusing oxygen and carbon dioxide. The benefits of having a good and healthy cardio-respiratory capacity is a decreased risk of cardiovascular disease, an improved blood pressure profile, improved glucose tolerance, the enhanced ability to perform activities of daily living, work and sport and decreased levels of anxiety and depression.
2. Muscular capacity covers the spectrum of muscular capability. This includes muscular endurance which is the ability to apply force over a long period of time or the ability to do a high number of muscular contractions without rest, muscular strength which is the ability to produce maximum force in one contraction, and finally muscular power which is the ability to produce force very quickly. This is an important component in sports that require explosive movement e.g. Olympic weightlifting, Basketball etc. The benefits of having a good muscular capacity are a decreased risk of injury, improved performance in sport and recreation, an increased basal metabolic rate and better joint stability and posture.
3. Flexibility refers to the range of movement in any specific joint. This is probably one of the most neglected components of fitness. Our bodies are designed to be balanced with regard to strength and flexibility. It is possible to have a very strong but short muscle but it is also possible to have a weak and long muscle. Ideally you want a strong but flexible muscle. The benefits of being flexible are a reduced risk of injury, more efficient movement and better posture.
4. Body composition refers to the ratio that you have between your fat free mass (muscle, bone, organs, blood and fluids) and fat mass (adipose tissue deposited under the skin and around organs.) The long term benefits of improving your body composition profile are a decreased risk of cardiovascular disease, improved basal metabolic rate and improved function.
5. Balance is the ability to maintain a specific body position in either a stationary or dynamic (moving) situation. Static balance is the ability to maintain a constant position while stationary. Dynamic balance is the ability to maintain equilibrium while moving. The ability to balance is a function of multiple reflexes involving the eyes, the balance organs in the ear, pressure receptors in the skin and muscle proprioceptors. Good balance is an essential component for the successful performance in many sports, especially those which require sudden changes in movement such as gymnastics and tennis. Balance also plays a vital part in the prevention of injury. It is an important consideration during rehabilitation and training for peak performance, and it is a component that has to be added to any programs for the elderly.
6. Co-ordination is the ability to integrate the sensory system, nervous system and the musculoskeletal system in order to perform complex movement. This component is a very relevant sport specific component and may involve numerous large muscle groups working together in different planes of motion to achieve a specific goal such as a golf swing.
7. Agility is the ability to change the position of the body in space rapidly and accurately without loss of balance. Agility is a product of muscular power, reaction time, coordination and dynamic flexibility. It is recognized as a basic component of performance and is important in sports where objects or opponents have to be avoided such as rugby or downhill slalom.
8. Reaction time is a skills related ability which underlies tasks in which the athlete must react as quickly as possible between the moment of receiving a stimulus and initiating a response e.g. a sprint start in the 100 meter sprint.
9. Speed is the ability to perform a movement in a short period of time. This could relate to the athlete moving quickly as a whole such as sprinting 100 meters, or to a limb or body part moving quickly such as a jab in boxing. Some sports measure speed as the determining factor in performance and in others the ability to perform movements quickly will give the athlete an advantage over his competitors.
10. Mental capacity in sport is the ability to concentrate and focus during training and competition. It is a vital component during training and will assist in positive training effects. “Practice does not make perfect, perfect practice makes perfect.” Focus and concentration are vital components during competition and quite often make the difference between coming first or second. Just think of the racing driver and the powers of concentration it requires not only to stay safe but also to beat his competitors, or the golfer playing the last hole on day four of a major tournament.

Now that you have been introduced to the components of physical fitness it is worth noting that cardiorespiratory capacity, muscular capacity, flexibility and body composition are considered primary or health-related fitness components. Balance, coordination, agility, reaction time, speed and mental capacity are considered secondary or skills-related fitness components.

I firmly believe that any exercise program should incorporate cardiovascular, strength and flexibility exercises as a base, regardless of whether the program is designed for health or maximum performance. Distance runners should not shy away from doing strength training and those involved in heavy resistance training should also do endurance training.

It is vital to understand your needs and the components that you have to target. You also need to know that there are very specific ways to measure these components of fitness and even more importantly there are scientific ways to train these. Your Biokineticist is the person most qualified in the South African market to help you on your journey to excellence.

Kent, M. The Oxford Dictionary of Sport Science and Medicine, Oxford University Press; 1994.

www.bringithomepersonaltraining.com

Canadian Fitness Professionals (Can-Fit-Pro).  Foundations of Professional Personal Training. Human Kinetics; 2012.