failed understanding of what the core actually is. My athletes plead with me to lie down on the ground and perform planks and sit-up style exercises until their muscles ache. I realize they still hold the desire to attain those etched stomachs and I remind them that, in sports, the only time we are using our core with our backs on the ground is when we get knocked down and have to pull ourselves back up.
Recalling a discussion I had with a fellow therapist about how to approach exercise prescription, the question was posed “Aren’t we all athletes?” I contemplated this and came to the conclusion that we all have to have a certain amount of strength, endurance, stability, mobility, and drive to accomplish the tasks that we need for a given day. The same physics that apply to a sport played at a high level, apply to an individual moving boxes, completing ADLs, washing a car, or completing work tasks. The same spinal mechanics that I teach an athlete to use during a deadlift or back squat highly resemble the way I teach an adult patient with lower back pain to perform functional tasks in their home. The “everyday
athlete”became a premise that I framed my exercise prescription around. In this discussion of core strength and conditioning a hope to convey the importance of the core particularly as it applies to sports, but the fact that these concepts apply to what a patient requires in the clinic, should not be overlooked. My hope is that readers will find a high level of transferability to everyday practice in PT.
QUICK ANATOMY of the core
Anatomically the core can be broken into two groups: The deep stabilizers and the superficial prime movers. The deep stabilizers include the transversus abdominus and lumbar multifidus as the base, and also include the pelvic floor muscles, diaphragm, internal oblique, rotatores, and transversospinalis group. The superficial prime movers include, but are not limited to, the erector spinae, rectus abdominus, hip abductors, and the iliopsoas.
DEFINING the core:
“The Core” has been the subject of research studies since the later 1980’s. In this time, many definitions of core stability and core strength have been proposed. From this research, I gather the following definitions:
Core stability can be defined as a combination of the neurologic and musculoskeletal system to control the position of the spine and pelvis while completing a specified task.
Core strength can be defined as the maximal force at a specific velocity which can be generated by the synergistic group of muscles local to the trunk and pelvis.
Training for the Core
Definitions aside, the importance lays in how to train ‘the core.’ Do we train these muscles in healthy athletes as we would an elderly patient that has back pain in physical therapy? Is this level of training sufficient to enhance performance of the athlete? These rhetorical questions are
important to ask.
During a senior internship, a friend and fellow graduate of my doctoral program worked with a starting varsity offensive lineman with lower back pain. On the patient’s final day in therapy, my friend took him in the parking lot, put his truck in neutral, and had him push it around the parking lot. This friend was an athletic trainer and had a great deal of experience preparing injured athletes. My friend was scolded by his clinical instructor for this act, yet I would argue that this was the most functional test to determine whether the athlete could handle the forces required of him on the field. When developing a core strengthening plan for any athlete, even the everyday athlete, we must look at the functional requirements of the individual and decide if we have sufficiently prepared them for what they are requiring of their body. We should also promote functional tests to determine progress and discharge that resemble the needs of the athlete.
In my estimation, the core stability of a specific athlete should be developed prior to training for core strength and some amount of core stability training should be continued for injury prevention; however, we should not expect ground based core stability training to produce notable performance gains in our athletes. We must consider the requirements of thE athlete when designing a program for them.
Another concept to address concerning ‘the core’ is force production vs. force reduction. Force production takes place during acceleration components of skills, and force reduction takes place during deceleration. Although force production may be primary for throwing athletes and sprinters, training for force reduction will impact an athlete’s agility and resistance to injury greater than training for force production. We must also consider that force reduction training will carry over to the strength of the same muscles when required to produce force. One must also have force reduction that is equal and opposite of the force that they produce. Deficits in force reduction, in this case, will inevitably result in injury.
Due to my observation that most therapists can quickly devise a patient or client a series of plank and bridging exercises to address core stability, I will primarily address core strengthening exercises in the following text rather than core stability. I will also emphasize the force reduction component of core strength due to its many benefits.
Force reduction core strength may impact athletes more than any other form of training. When an athlete cuts on a field or court, their momentum will attempt to carry them in their initial direction of travel. It is the ability of the core muscles to reduce this force that will impact their performance the most. The core is our base. All four extremities and the head move off of this base and the better we can control this baseand the position of our center of mass, the more productive we can be moving off of it. In many sports we must also resist the forces placed upon us. Such is the case for a basketball player banging in the post, a football lineman vying for position on a play, or a player fighting for position against
an opponent in almost any field, court, or ice sport.
Any exercise that creates a lever arm at a specific joint segment in the spine or pelvis will require force reduction from core muscles to be performed correctly. Many plank and bridging exercises accomplish this task. But forces are low and require upwards of 30 seconds for fatiguing the athlete. Most athletic maneuvers happen in a second or fraction
thereof. In order to supply sufficient forces, we must then add a longer lever arm or higher load. Thus, force reduction exercises often use an extremity as a driver. The athlete will have a force applied through the distal end of an extremity and must resist this force. Cueing for force reduction exercises should emphasize the stability of the pelvis while the extremity is moving.
NEXT TIME WE WILL CATEGORIZE CORE EXERCISES AND TALK ABOUT SOME EXERCISES THAT FIT IN EACH CATEGORY!