CORE STABILIZATION TRAINING IN REHABILITATION

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CORE STABILIZATION TRAINING IN REHABILITATION
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KINETIC CHAIN REHABILITATION

• DEFINITIONS
• Functional kinetic chain rehabilitation
• a comprehensive approach that strives to improve
  all components necessary to allow a patient to
  return to a high level of function.
• While caring for the affected area remains the
  foremost ,clinicians have developed interventions
  to treat the whole as well as the part.

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KINETIC CHAIN REHABILITATION

• DEFINITIONS
• Functional strength
• 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.

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KINETIC CHAIN REHABILITATION

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

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KINETIC CHAIN REHABILITATION

• SO
• BY TRAINING THE CORE
• Improve dynamic postural control
• Ensure appropriate muscular balance
• Ensure appropriate joint arthrokinematics at the
  hip/pelvis/lumbar spine
• Allow for dynamic functional strength
• Improve neuromuscular efficiency throughout
  kinetic chain.

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WHAT IS THE CORE?

• CORE
• The lumbo-pelvic-hip complex
• CoG is located
• Beginning point for all movement
• 29 muscles that attach to the lumbo-pelvic-hip
  complex

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CORE STABILIZATION TRAINING CONCEPTS

• core of body similar to foundation of a house.
• Connects kinetic chain (lower to upper body)
• therefore, strong, efficient movements

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CORE STABILIZATION TRAINING CONCEPTS

• benefits of strong core musculature
• Protective of spine
• Gain strength, power, endurance and neuromuscular
  control
• If extremities are strong and core is weak ,
  there will not be enough force created to produce
  efficient movements
• A weak core is a fundamental cause of inefficient
  movements that may lead to injury

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FUNCTIONAL ANATOMY

• POSTERIOR MUSCLES
• ANTERIOR MUSCLES
• HIP MUSCLES

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FUNCTIONAL ANATOMY

• POSTERIOR MUSCLES
• ERECTOR SPINAE
• Dynamic intersegmental stabilization
• Eccentrically decelerates forward flexion
  rotation
• QUADRATUS LUMBORUM
• stabilizer

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FUNCTIONAL ANATOMY

• POSTERIOR MUSCLES
• LATISSIMUS DORSI
• Is bridge between upper and lumbo-pelvic-hip
  complex

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FUNCTIONAL ANATOMY

• ANTERIOR MUSCLES/ ABDOMINALS
• RECTUS ABDOMINUS
• EXTERNAL OBLIQUES
• INTERNAL OBLIQUES
• TRANSVERSE ABDOMINUS
• Abdominals operate as an integrated functional
  unit
• When functioning efficiently , they offer
  sagittal, frontal and transverse plane
  stabilization

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FUNCTIONAL ANATOMY

• RECTUS ABDOMINUS
• 6 pack
• Eccentrically decelerates trunk extension and
  lateral flexion
• Dynamically stabilizes trunk in functional
  movements

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FUNCTIONAL ANATOMY

• EXTERNAL OBLIQUES
• Concentric opposite side rotation
• Concentric lateral flexion ( same side)

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FUNCTIONAL ANATOMY

• INTERNAL OBLIQUES
• Concentric rotation ( same side)
• Concentric lateral flexion (same side)

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FUNCTIONAL ANATOMY

• TRANSVERSE ABDOMINUS (probably most important
  muscle )
• Increase intra-abdominal pressure
• Dynamic stabilization
• Active during all trunk movements

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FUNCTIONAL ANATOMY

• HIP MUSCULATURE
• PSOAS
• GLUTEUS MEDIUS
• GLUTEUS MAXIMUS
• HAMSTRINGS

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FUNCTIONAL ANATOMY

• PSOAS
• If tight, increase shear on L4/L5

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FUNCTIONAL ANATOMY

• GLUTEUS MEDIUS
• If weak,
• Can increase shear _at_ lumbo-pelvic, tibio-femoral
  and patello-femoral joints
• Can lead to tightness of the ITB and the lumbar
  spine

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FUNCTIONAL ANATOMY

• GLUTEUS MAXIMUS
• Major SI joint stabilizer

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FUNCTIONAL ANATOMY

• HAMSTRINGS
• Work synergistically with ACL

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POSTURAL CONSIDERATIONS

• serial distortion patterns?
• Predictable patterns of dysfunction that occur
  when one segment of the kinetic chain is out of
  alignment. Therefore, there is a break in the
  kinetic chain.

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MUSCULAR IMBALANCES

• the interplay of many muscles about a joint is
  responsible for the coordinated control of
  movement.
• Therefore, changes in strength, length, etc of
  muscles has an effect on other muscles about the
  same joint (and other joints). This can cause
  problems with normal movement patterns which
  could lead to increased susceptibility of injury.

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MUSCULAR IMBALANCES

• i.e. tight psoas causes reciprocal inhibition of
  glut max, TrA, multifidus and internal obliques.
• May decrease normal lumbo-pelvic hip stability

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NEUROMUSCULAR CONSIDERATIONS

• Injury to one ligament/structure alters function
  of other muscles crossing same joint.
• i.e., swelling in kneeaffects rectus femoris at
  both knee and hip
• Therefore, can alter hip mechanics

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ASSESSMENT OF THE CORE

• tests that can be used
• 1. erector spinae
• Prone lumbar extension. Lying on a table Hold at
  30 degrees for as long as possible.

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Core Testing

• 2. upper abdominals
• straight leg lowering test, bp cuff under
  L4-L5,cuff raised to 40 mmHg, legs are extended
  while hip flexed to 90 degrees . Athlete draws in
  (TrA) and then flattens back into table . The
  athlete then lowers their legs to the table while
  maintaining a flat back . Test is over when
  pressure in the cuff decreases below 40 mmHg.
  Measure hip angle

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ASSESSMENT OF THE CORE

• 3. Lower abdominals
• bent knee lowering test, same as above but now
  knees flexed to 90 degrees.
• 4. core power
• Overhead medicine ball throw, hold medicine ball
  between legs and squat down , then jump as high
  as possible while throwing the medicine ball
  backwards over their head. measure distance ball
  travels

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Med ball throw
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Transversus Abdominis

• The main muscles of lumbo-pelvic stability are
  the Transversus Abdominus, the Pelvic Floor
  muscles, and the Multifidus. Many other muscles
  play a role too. These muscles are too deep to be
  obvious, so you need special training to learn
  how to activate them. The following exercise
  teaches how to activate the transversus
  abdominus-

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TrA

• Lie in the relaxation position and find pelvic
  neutral (back not too arched ) . Put your hands
  on the area of your abdomen that would be covered
  by the front part of a bikini / Speedo. For the
  time being, we shall call this the bikini
  patch. Have your thumbs touching at the navel,
  and your fingers touching at the midline, about 6
  cm below the navel.

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• Now imagine that you have to zip up a very tight
  pair of jeans -
• Hollow the area under you thumbs and fingers
  toward your spine. There may only be a very small
  movement. (maintain Pelvic and Chest Neutral)
• Now imagine (if it hasnt already happened), that
  the area under your fingers is being zipped
  together like that tight pair of jeans! (keep the
  rest of your body relaxed, maintain Pelvic and
  Chest Neutral!)

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• Up until now you had no awareness of the
  Transversus abdominis. It is a deep, slow moving,
  postural muscle. The Transversus abdominis can
  and indeed should be working at 2 to 20 of
  maximum contractile force during all your waking
  hours. Note Your breathing will undoubtedly feel
  restricted, by Transversus abdominis contraction

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SCIENTIFIC RATIONALE FOR CORE STAB. TRAINING

• Need to train properly. need to stabilize pelvis,
  increase EMG activity when drawing in manoeuvre
  was performed prior to core training
• Therefore, dont inhibit TrA
• If not trained properly, can increase interdisc
  pressures and compressive forces in the lumbar
  spine. ( traditional curl ups increase
  intra-dicscal pressure)

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CORE STABILIZATION

• Primary slow twitch muscles
• Respond best to time under tension
• Contraction lasts from 6 20 seconds

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GUIDELINES

• Systematic, progressive, and functional
• Begin in most challenging environment the athlete
  can control
• Perform in a proprioceptively enriched environment

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PROGRAM VARIATION

• Plane of motion
• Range of motion
• Loading parameter
• Body position
• Speed of movement
• Amount of control
• Duration
• Frequency

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EXERCISE SELECTION

• Safe
• Challenging
• Stress multiple planes
• Proprioceptively enriched
• Activity-specific

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EXERCISE PROGRESSION

• Slow to fast
• Simple to complex
• Stable to unstable
• Low force to high force
• General to specific
• Correct execution to increased intensity