Corestability stabilizace jádra plus cvičení

CORE STABILITYP. Ratan KhumanM.P.T. (Ortho & Sports)

05/02/2023 Ratankhuman M.P.T. (Ortho & Sports) 2

Contents• Terminology • Describe the functional approach to kinetic chain

rehab.• Explain the concept of the core.• Anatomical relationships between the

musculature of the core.• Review how the core functions to maintain

postural alignment and dynamic postural equilibrium during functional activities.• Organize a procedure for assessing the core.• Create the rationale for core stabilization

training.• Set up the guidelines for core stabilization

training.• Demonstrate appropriate exercises for each of

the four levels in core stabilization training,


Terminology Function – It is an integrated

multidimensional movement.Functional strength – It is the ability of the

neuromuscular system to reduce force, produce force, and dynamically stabilize the kinetic chain during functional movements, upon demand, in a smooth coordinated fashion.

Neuromuscular efficiency – It is the ability of CNS to allow agonists, antagonists, synergists, stabilizers, and neutralizers to work efficiently and interdependently during dynamic kinetic chain activities.


Functional Approach To Kinetic Chain Rehab

Traditionally, rehab has focused on isolated absolute strength gains utilizing single planes of motion.

However, all functional activities are tri-planar & require acceleration, deceleration & dynamic stabilization.

Movement might appear to be one-plane dominant, but the other planes need to be dynamically stabilized to allow for optimal neuromuscular efficiency.

The fact is that we train force reduction, force production and dynamic stabilization to occur efficiently during all kinetic chain activities.


Functional Approach To Kinetic Chain Rehab Cont…

A dynamic core-stabilization training program should be a key component of all comprehensive functional CKC rehabilitation programs.

A core stabilization program will improve dynamic postural control ensure appropriate muscular balance and joint arthrokinematics around the lumbo-pelvic-hip complex.

Allow for the expression of dynamic functional strength and improve neuromuscular efficiency throughout the entire kinetic chain.


WHAT IS THE CORE…?The “CORE” is defined as the lumbo-pelvic-

hip complex.It is the location of our COG & where all movt

begins.

Efficient core allows for –Maintenance of normal length-tension

relationshipsMaintenance of normal force couplesMaintenance of optimal arthrokinematicsOptimal efficiency in entire kinetic chain

during movement Acceleration, deceleration, dynamic stabilization

Proximal stability for movement of extremities


The Core Functions & operates as an

integrated unitEntire kinetic chain operates

synergistically to produce force, reduce force & dynamically stabilize against abnormal force

In an efficient state –The CORE enables each of the

structural components to operate optimally through:Distribution of weightAbsorption of forceTransfer of ground reaction forces


Neuromuscular efficiency – Ability of CNS to allow agonists, antagonists, synergists,

stabilizers & neutralizers to work efficiently & interdependently

Established by combination of postural alignment & stability strength

Optimizes body’s ability to generate & adapt to forces Dynamic stabilization is critical for optimal neuromuscular

efficiency Rehab generally focuses on isolated single plane strength gains in single

muscles Functional activities are multi-planar requiring acceleration & stabilization

Inefficiency – Results in body’s inability to respond to demands Can result in repetitive microtrauma, faulty biomechanics &

injury Compensatory actions result


Functional AnatomyGlobal (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 oblique and the 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 movement. Lumbar multifidus, psoas major, quadratus lumborum, the

lumbar parts of iliocostalis and longisimus, transversus abdominis, the diaphragm and the posterior fibers of internal Oblique



Functional Anatomy Cont…

29 muscles attach to core

Lumbar Spine Muscles

Transversospinalis group Rotatores Interspinales IntertransversariiSemispinalisMultifidus

Erector spinae IliocostalisLongissimusSpinalis

Quadratus lumborum

Latissimus Dorsi



Transversospinalis group –Poor mechanical advantage relative to

movement productionPrimarily Type-I muscle fibers with high of

muscle spindles Optimal for providing proprioceptive

information to CNS Inter/intra-segmental stabilization

Erector spinae – Provide inter-segmental stabilizationEccentrically decelerate trunk flexion &

rotationQuadratus Lumborum –

Frontal plane stabilizerWorks in conjunction with gluteus medius &

TFLLatissimus Dorsi –

Bridge between upper extremity & core



Abdominal Muscles –Rectus abdominusExternal obliques Internal obliquesTransverse abdominus

Work to optimize spinal mechanicsProvide sagittal, frontal & transverse plane

stabilization




Hip Musculature –Psoas –

Closed chain vs. open chain functioning

Works with erector spinae, multifidus & deep abdominal wall Works to balance anterior shear

forces of lumbarCan reciprocally inhibit gluteus

maximus, multifidus, deep erector spinae, internal oblique & transverse abdominus when tight Extensor mechanism dysfunction

Synergistic dominance during hip extension Hamstrings & superficial erector

spinae May alter gluteus maximus function,

altering hip rotation, gait cycle


Hip Musculature cont… Gluteus medius –

Frontal plane stabilizer Weakness increases frontal &

transverse plane stresses (patellofemoral stress)

Controls femoral adduction & IRWeakness results in synergistic

dominance of TFL & quadratus lumborum

Gluteus maximus – Hip extension & ER during OKC,

concentricallyEccentrically hip flexion & IRDecelerates tibial IR with TFLStabilizes SI jointFaulty firing results in decreased

pelvic stability & neuromuscular control


Hip Musculature cont… Hamstrings –

Concentrically flex the knee, extend the hip & rotate the tibia

Eccentrically decelerate knee extension, hip flexion & tibial rotation

Work synergistically with the ACL to stabilize tibial translation

All muscles produce & control forces in multiple planes


Diaphragm and pelvic floorDiaphragm serves as the roof of the core. Stability is imparted to the lumbar spine by

contraction of the diaphragm and increasing intra-abdominal pressure.

Ventilatory challenges on the body may cause further diaphragm dysfunction and lead to more compressive loads on the lumbar spine.

Thus, diaphragmatic breathing techniques may be an important part of a core strengthening program.


CORE STABILIZATION TRAINING CONCEPTS

A specific core strengthening program can:IMPROVE dynamic postural controlEnsure appropriate muscular balance & joint

arthrokinematics in the lumbo-pelvic-hip complexAllow for expression of dynamic functional

performance throughout the entire kinetic chainIncrease neuromuscular efficiency throughout the

entire bodySpinal stabilization –

Must effectively utilize strength, power, neuromuscular control & endurance of the “prime movers” Weak core = decreased force production & efficiency

Protective mechanism for the spineFacilitates balanced muscular functioning of the entire kinetic

chainEnhances neuromuscular control to provide a more efficient

body positioning


Postural Considerations Core functions to maintain postural

alignment & dynamic postural equilibriumOptimal alignment = optimal functional

training and rehabilitationSegmental deficit results in predictable

dysfunctionSerial distortion patterns

Structural integrity of body is compromised due to malalignment

Abnormal forces are distributed above and below misaligned segment


Neuromuscular Considerations Enhance dynamic postural control with strong

stable coreKinetic chain imbalances = deficient

neuromuscular controlImpact of low back pain on neuromuscular controlJoint/ligament injury neuromuscular deficits

Arthrokinetic reflex Reflexes mediated by joint receptor activityAltered arthrokinetic reflex can result in arthrogenic

muscle inhibition Disrupted muscle function due to altered joint functioning


Assessment of The Core Muscle imbalancesArthrokinematic deficits Core

EnduranceNeuromuscular controlStrengthPowerReal-time Ultrasound Imaging

Overall function of lower extremity kinetic chain


COREENDURANCE TEST


Core Endurance Tests4 endurance tests advocated are –

Prone bridges Lateral bridgesTorso flexor Torso extensor

Other Test –Single-legged squat Test

The bridge tests are functional.They assess strength, muscle endurance and how is

the ability to control the trunk by the synchronous activation of many muscles.


Prone Bridge Endurance Test Primarily assesses the anterior and posterior

core muscles.It is performed by supporting the body's

weight between the forearms and toesThe pelvis in the neutral position and the

body straightFailure occurs when client loses neutral

pelvis and falls into a lordotic position with anterior rotation of the pelvis.


Lateral Bridge Endurance TestIt assesses the lateral core muscles. Legs are extended and the top foot placed in

front of the lower foot for support.Support themselves on one elbow & 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.


Torso Flexor Endurance Test It is time based test, how long the patient can

hold a position of seated torso flexion at 60°.The client sits at 60° with both hips & knees

at 90°, arms folded across chest with the hands placed on the opposite shoulder, & toes secured under toe straps or by examiner

Failure occurs when the athlete's torso falls below 60°.


Torso Extensors Endurance testThe 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 & leg. Failure occurs when the upper body falls

from horizontal into a flexed position.


Mean Endurance times (in sec) in Young Healthy Subjects (mean age

21 yrs)Men Women

Extension 161 185Flexion 136 134Side Bridge (R) 95 75Side Bridge (L) 99 78Flexion/Extension Ratio 0.84 0.72


Single-legged Squat TestThe 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 assess hip and trunk muscular coordination and/or control.


CORE NEUROMUSCULAR TEST


Abdominal Neuromuscular Control Test

Supine with hips & knees in 90°Pressure cuff placed under lumbar spine (L4-5) &

raised to 40 mmHgPerforms drawing in maneuver (belly button to spine)Lower legs until pressure decreasesAssesses lumbar spine moving into extension (ability

of lower abs wall to stabilize the lumbo-pelvic-hip complex)Hip flexors begin to work as stabilizersIncreases anterior shear forces & compressive forces at L4-

L5Inhibits transversus abdominis, internal oblique &

multifidus



CORE STRENGTH TEST


Straight-Leg Lowering Test

Supine with knees in extensionPressure cuff placed under lumbar spine (L4-L5) &

raised to 40 mmHg with knees extended, hips to 90°Performs drawing in maneuver (belly button to

spine) & then flattens back maximally into the table & cuff

Gradually lower legs to table while maintaining flat back

The test is over when the pressure in the cuff decreases.

The hip angle is then measured with a goniometer to determine the angle.



Core Power Test


Backwards, overhead medicine ball jump & throw

The client is instructed to hold a 4-kg medicine ball between their legs as they squat down.

Instructed to jump as high as possible while simultaneously throwing the medicine ball backward over their head.

The distance is measured from a starting line to the point where the medicine ball stops.

This is an assessment of total body power production with an emphasis on the core.


Lower Limb Functional ProfilesIsokinetic testsBalance testsJump testsPower testsSports specific functional tests

Kinetic chain assessment must assess all areas of potential deficiency


Ultrasound imagingUltrasound imaging is also used as an

assessment technique.The real-time ultrasound imaging is a means

of assessing muscle size and activity. Most emphasis has been on the assessment

the transversus abdominis and multifidus muscles.

These measures have been shown to be valid.


Core Stabilization Training


Guidelines for Core StabilizationTraining Program

1. The program should be based on science.2. The program should be systematic,

Progressive & functional.3. The program should begin in the most

challenging environment the athlete can control.

4. The program should be performed in a proprioceptively enriched environment.


Program VariationPlane of motion Range of motion Loading

(physioball, med. ball, body blade, weight vest, tubing)

Body positionAmount of control & speed Feedback Duration and frequency (sets, reps, time

under tension)


Exercise Selection.SafeChallengingStress multiple planes Proprioceptively enrichedActivity specific/ sports specific


Exercise ProgressionSlow to fast Simple to complexStable to unstableLow force to higher forceGeneral to specificCorrect execution to increased intensity


Questions to Ask Yourself Is it dynamic?Is it multi-planar?Is it multidimensional?Is it proprioceptively enriched?Is it systematic?Is it progressive?Is it activity-specific?Is it based on functional anatomy &

science?


Abdominal “Draw In” Maneuver Aim –

To use the correct muscles in response to command “draw in” your abdominal without moving spine or pelvis & hold for 10 sec while breathing normally.

To activate Transversus abdominis + lumbar multifidus

Patient best position –The 4-point kneeling

position is best position to teach the action


Procedure –Ask the patient to take a relaxed breath in & out &

then draw the abdomen up towards the spine without taking a breath.

The contraction must be performed in a slow and controlled manner.

At the same time contracts the pelvic floor and slightly anteriorly rotates the pelvis to activate the multifidi.


Core Stabilization Training Program 4 levels to core stabilization training

program –Level 1 = Stabilization Level 2 = Stabilization & strength Level 3 = Integrated stabilization strength

Levcl4 = Explosive


Level I: Stabilization


Level II: Stabilization & Strength


Level II: Stabilization & Strength


Level III: Integrated Stabilization Strength


Level IV: Explosive Stabilization


References Prentice, W.E. (2004). Rehabilitation

Techniques for Sports Medicine & Athletic Training, 4th ed.

Peter Brukner & Karim Khan with colleagues. Clinical sports medicine, 3rd ed

Date post:	13-Apr-2017
Category:	Health & Medicine
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Corestability stabilizace jádra plus cvičení

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