Muscles of the Core-Lumbo-Pelvic-Hip Complex

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Muscles of the Core-Lumbo-Pelvic-Hip Complex
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Core Muscles

• The term core refers to the Lumbo-Pelvic-Hip
  Complex (LPH)
• It is the center of the body and the beginning
  point for movement
• Comprised of about 29 muscles that attach to the
  spine and/or pelvis
• Involves structures of the lumbar, thoracic, and
  cervical spine, the pelvic girdle and the hip
  joint.

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Lumbo-Pelvic-Hip Complex

• The lumbo-pelvic-hip complex (core) functions
  primarily to maintain dynamic postural control by
  keeping the center of gravity over our base of
  support during dynamic movements

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Core Muscles

• Abdominals (Deep to Superficial)
• Transverse Abdominis
• Internal and External Oblique
• Rectus Abdominis
• Spinal Muscles (Deep to Superficial)
• Rotatores
• Semispinalis
• Mulitifidus
• Quadratus Lumborum
• Erector Spinae
• Latissimus Dorsi

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Core Muscles

• Hip Extensors Gluteus Maximus, Hamstrings
• Hip Abductors Gluteus Medius, Gluteus Minimus,
  Tensor Fascia Lata, Iliopsoas, and Sartorius
• Hip flexors Iliopsoas, Rectus Femoris, Tensor
  Fascia Lata and Pectineus
• Hip Adductors Gracilis, Adductor Magnus,
  Adductor Longus, Adductor Brevis, and Pectineus

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Transverse Abdominis

• The most important abdominal muscle
• Contracted first before any other muscle

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Transverse Abdominis

• The deepest layer of abdominal muscles
• It wraps around the trunk from front to back and
  from the ribs to the pelvis
• The muscle fibers run horizontally, similar to a
  corset or a weight belt
• It does not move the spine or pelvis
• O Thoracolumbar Fascia, Iliac Crest, Costal
  Cartilages of Ribs 7-12
• I Linea Alba, Pubic Crest
• A Facilitates forceful expiration of air from
  the lungs
• Stabilizes the spine
• Compression of abdominal contents

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Integrated Function of Transverse Abdominis

• Works synergistically with the internal oblique,
  multifidus, and erector spinae to stabilize the
  lumbo-pelvic-hip complex

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Transverse Abdominis Exercises

• Draw In (supine, quadruped, prone, seated,
  kneeling or standing)
• Attempt to pull the bellybutton through the spine
• Or imagine trying to zip up the worlds tightest
  pair of pants
• Attempt each position for five reps held for five
  to 10 seconds

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Internal and External Abdominal Oblique Muscles
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Internal Abdominal Oblique

• Deep to external oblique and lies just above
  transverse abdominis
• O Inguinal Ligament, Iliac Crest, and
  Thoracolumbar Aponeurosis
• I Last three ribs (10-12), Pubic Crest, Linea
  Alba
• A Flexion of Trunk
• Lateral Flexion of Trunk
• Contralateral Rotation of the Trunk
• Compression of Abdominal Contents

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Integrated Function of Internal Oblique

• Assists in eccentric deceleration of trunk
  extension
• Assists in eccentric deceleration of trunk
  rotation
• Works synergistically with the transverse
  abdominis, multifidus, and erector spinae to
  stabilize the lumbo-pelvic-hip complex

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External Abdominal Oblique

• Located externally in the abdomen with diagonal
  fibers
• Lateral to the rectus abdominis
• Pocket Muscles (put your hand into a coat
  pocket and your fingers would be pointing along
  the direction of the fibers)
• Its fibers meet latissimus dorsi at ribs 10-12

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External Oblique

• O Lower 8 ribs ( 5-12)
• I Anterior Iliac Crest of Pelvis and
  Abdominal Aponeurosis
• A Flexion of the Trunk
• Lateral Flexion of the Trunk
• Contralateral Rotation of the Trunk
• Compression of Abdominal Contents

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Integrated Function of External Obliques

• Assists in eccentric deceleration of trunk
  extension
• Assists in eccentric deceleration of trunk
  rotation
• Assists in dynamic stabilization of the
  lumbo-pelvic-hip complex

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External and Internal Obliques

• Force Couple
• Two separate muscle groups on opposing sides of
  the body work together to achieve the same
  movement goal.
• One movement will have two agonists on opposite
  sides of the body.

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How Obliques Cause Trunk Movement

• Trunk Flexion
• Right and Left sides of Internal and External
  Obliques
• Lateral Trunk Flexion
• Lateral flexion right Right External Oblique
  and Right Internal Oblique
• Lateral flexion left Left External Oblique and
  Left Internal Oblique

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How Obliques Cause Trunk Movement

• Trunk Rotation
• Rotation Right Left External Oblique and Right
  Internal Oblique
• Rotation left Right External Oblique and Left
  Internal Oblique

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Rectus Abdominis-Anatomy

• The Rectus Abdominis is a superficial muscle
  bisected by tendinous inscriptions that is
  covered by the rectus sheath which is formed by
  aponeurosis.

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The Rectus Abdominis is a superficial muscle
bisected by tendinous inscriptions that is
covered by the rectus sheath which is made up of
aponeurosis

• Tendinous Inscriptions
• Three fibrous bands that transect and divide the
  rectus abdominis.

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The Rectus Abdominis is a superficial muscle
bisected by tendinous inscriptions that is
covered by the rectus sheath which is made up of
aponeurosis

• Rectus Sheath
• Sheath (protective covering)
• Anterior and posterior sections
• Lays under and over RA

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The Rectus Abdominis is a superficial muscle
bisected by tendinous inscriptions that is
covered by the rectus sheath which is made up of
aponeurosis

• Aponeurosis
• Flattened tendons with a shiny, whitish-silvery
  color.
• Sparingly supplied with blood vessels and nerves.
  
• When dissected, are papery, and peel off by
  sections.

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Rectus Abdominis

• The two rectus sheaths (left and right) meet in
  the midline of the abdomen and form the linea
  alba
• Linea Alba The tendinous band along the midline
  of the rectus abdominis muscle.

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Rectus Abdominis

• Rectus means straight
• O Pubic crest
• I Xiphoid process of sternum and costal
  cartilages of 5th, 6th and 7th ribs
• A Trunk Flexion
• Compression of Abdominal Contents (expiration,
  vomiting, expulsion of feces from the intestines
  and urine from the bladder)
• Posterior Tilt of the Pelvis

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Integrated Function of Rectus Abdominis

• Assists in eccentric deceleration of trunk
  extension
• Assists in eccentric deceleration of anterior
  pelvic tilt
• Assists in dynamic stabilization of the
  lumbo-pelvic-hip complex

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Rectus Abdominis Exercises

• Common Mistakes Made
• Pulling the head with the hands (risking injury
  to the cervical vertebrae)
• Not pressing back to the floor
• Flexing the torso to a fully seated position
• When straight leg raises or full sit-ups are
  done, the movement is not trunk flexion but hip
  flexion.

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Multifidus

• A deep muscle located along the back of the spine
  very close to the midline.
• The deep fibers are short and span single
  vertebral segments.
• Functions together with transverse abdominis
  pelvic floor muscles to stabilize the low back
  and pelvis BEFORE movement of the arms and/or
  legs occurs

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Multifidus

• Important stabilizer of the back
• Studies have shown people who had low-back pain
  also had wasting of the multifidus muscle on the
  side of the back that matched the painful side.
  The studies also showed that over time back pain
  did improve.

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Multifidus

• O Sacrum, lumbar, and cervical transverse
  processes
• I Spinous Processes of all Vertebrae
• A Extension of Trunk and Neck
• Lateral Flexion of Trunk and Neck
• Contralateral Rotation of Trunk and Neck

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Integrated Function of Multifidus

• Assists in eccentric deceleration of trunk
  flexion
• Assists in eccentric deceleration of trunk
  rotation
• Assists in dynamic stabilization of the lumbar
  spine
• Provides proprioception (awareness or sense of
  where the body is in space-up, down, left,
  right) during dynamic movements which enhance
  neuromuscular efficiency

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Multifidus

• There are lots of exercises that strengthen the
  multifidus as well as the other back extensor
  muscles. The only problem is all the extensor
  muscles will contract with traditional back
  exercises
• The multifidus must first be isolated and
  re-activated through specific isometric exercises
  then followed up with functional exercises to
  further strengthen the muscles of the lower-back.

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Multifidus Exercises

• Prone Trunk Extension with Rotation
• Begin in a prone position
• Rest your forehead on your hands
• Retract your scapula
• Extend the lumbar spine and rotate the upper
  torso
• Keep scapula retracted

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Quadratus Lumborum

• This muscle is shaped like a square located in
  the back
• Anterior to quadratus lumborum are the colon,
  kidney, and diaphragm
• O Posterior Iliac Crest
• I 12th Rib and Transverse Process of L1-L4
• A Elevation of Pelvis
• Lateral Trunk Flexion
• Extension of Trunk
• Depression of 12th Rib

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Integrated Function of Quadratus Lumborum

• Assists in eccentric deceleration of lateral
  trunk flexion
• Works synergistically with the hip abductors and
  adductors as the primary frontal plane
  stabilizers

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Quadratus Lumborum

• The quadratus lumborum can elevate the pelvis
  sometimes called hip hiking.
• Do not confuse this with flexing the femur
• To feel how the pelvis moves using the quadratus
  lumborum stand with feet apart and weight equal
  on both feet. Shift your weight from side to side
  while lifting up your toe on the side that you
  are shifting away from.

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Quadratus Lumborum

• Pulls 12th rib inferiorly causing thoracic cavity
  to expand which creates more space for the lungs
  to expand

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Quadratus Lumborum Exercises

• Horizontal isometric side bridge which can be
  done from a knee supporting position on the floor
  or a more challenging version which utilizes a
  feet supported version.

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Erecter Spinae

• Makes the spine erect
• Divided into three longitudinal columns
• From lateral to medial they are
• Iliocostalis
• Longissimus
• Spinalis

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Erector Spinae

• Iliocostalis
• O Sacrum, Iliac Crest, and Ribs 3-12
• I Ribs 1-12 and Transverse Process of C4-C7

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Erector Spinae

• Longissimus
• OSacrum, Iliac Crest and Transverse Process of
  T1-T5
• I Ribs 4-12, Transverse Process of T1-T12 and
  Mastoid Process of Temporal Bone in Skull (behind
  ear)

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Erector Spinae

• Spinalis
• O Spinous Process of T11-L2 and C7
• I Spinous Process of T5-T12 and C2

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Erector Spinae

• Actions
• Extension of Trunk, Neck and Head
• Lateral Flexion of Trunk, Neck and Head
• Rotation of Trunk, Neck and Head
• Anterior Tilt of Pelvis

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Integrated Function of Erector Spinae

• Assists in eccentric deceleration of trunk
  flexion
• Assists in eccentric deceleration of trunk
  rotation
• Assists in eccentric deceleration of lateral
  trunk flexion
• Assists in dynamic stabilization of the lumbar
  spine during dynamic movements

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Exercises for Trunk Extensors

• Isometric Trunk Extensions on Floor
• Trunk Extensions on a SB
• Trunk Extensions on a Bench

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Exercises

• Trunk Extensions
• Muscles Worked Erector Spinae, Multifidus, and
  Semispinalis
• Common Mistakes Made hyperextending the back
  past a horizontal position, flexing the spine,
  and performing the reps too fast.

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Exercises

• Trunk Extensions
• Possible Risks
• By flexing (rounding your back) and
  hyperextending your spine during this exercise
  you allow your vertebrae to separate from each
  other. Through repeated repetition, there is a
  large possibility of slipping a disk through the
  vertebrae.
• To Perform Correctly
• Slowly bend forward at the waist as far as you
  can while keeping your back neutral. Do not round
  your back. Slowly raise your torso until your
  legs and upper body are in a straight line again.
  Do NOT arch your back past a straight line!

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Belts and Wraps

• Using Belts (knee and/or ankle wraps) For Every
  Exercise
• Common Mistakes Made Dependence of the weight
  belt for every exercise.
• Negative Effect Weak abdominals and lower back
  muscles
• Solution Avoid wearing the belt and lower your
  weight so the muscles you weakened due to belt
  use can recover. Most people use belts only for
  squats and power exercises. Even this is
  excessive, unless you are doing maximal weight
  loads

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Belts and Wraps

• Knee and elbow wraps should generally not be
  used. If you have an injury you should not be
  lifting, or should reduce the load.
• Belts can be important at certain times, such as
  when you are lifting heavy loads with which you
  can only do a few reps, and when you are learning
  form on power exercises.