Tuesday, October 20, 2015

Eight weeks to understanding THE CORE

Eight weeks to understanding THE CORE
WEEK 1: Let’s get acquainted, Core.
This just might be my favorite topic (nerdy, I know). It’s one of the most asked about concepts from people with various musculoskeletal problems. But what IS the CORE!?!
The Core is certainly a VIP (Very Important Part of your body). Let’s not insult it by thinking it plays only one role. In the 1980’s we wanted that six-pack! One single muscle, the rectus abdominis was our focus for toning our core. That muscle happens to cause forward flexion of the spine (remember 200 crunches/day, anyone?) But what about sideways, backwards, and rotational motions? Can you even move the spine well if your hips are weak and wobbly? What does The Core actually look like? It is passive structures (things that don’t move like bones and ligaments), neurologic structures, and active structures including all the muscles in between your shoulders and hips. Yep, everything between those 4 limbs. Whether you are concerned with diastasis recti (a split in your abdomen), back pain, SIJ pain, shoulder pain, elbow pain, or getting toned “abs”, this inclusive physical description of The Core is relevant for you. 
What roles does The Core play? A strong core has been linked to decreased low back pain, decreased pain with chronic rotator cuff injury in the shoulder, and decreased impact of diastasis recti among other things. It stabilizes joints, moves joints, decreases the compression load of spine, and transfers loads. So, the term “Core stability” that was coined in the late 90’s just doesn’t cover all the cool stuff your core does. Let’s clarify by saying core strength is the force produced by core muscles. And core stability is the foundation that those forces are able to move on…still with me? How about an example? A baseball pitcher strengthens his core muscles with specific individual exercises. However, he has good core stability when he is able to successfully transfer force from when he winds up his left leg, plants, rotates at the hip, then transfers that force through his core and into his right pitching arm. This load transfer occurred thanks to good range of motion of several joints, good coordination, and strong enough muscles that pull on the passive structures (bones, ligaments, and connective tissue). 
The most commonly referenced muscles for the core are located between the ribcage and pelvis. These muscles form a canister shape in the abdomen with a top, bottom, front, back, and sides. Let's call this THE ABDOMINAL CORE. They include:
-transverse abdominis (TrA) – deepest muscle in the front and side of abdomen
-rectus abdominis - the most superficial front abdominal muscle, aka six-pack muscle
-internal and external obliques – muscles on part of your front and side contributing to your waist
-multifidi - deep spine muscle adding to the back wall
-diaphragm – just underneath the ribcage, this forms top of the canister
- pelvic floor muscles – spanning the pubic bone to tailbone, this forms the bottom of the canister
Now, to give a sturdy “stable” base for these abdominal core muscles to work properly, you also need strong hip and shoulder girdle muscles. Therefore, all muscles from your hip, pelvis, abdomen, and shoulder girdle get to be included in this core-labeling party. 
Hopefully you can now see why there isn’t a set of 5 exercises I can give you to “strengthen your core”. You need to move, strengthen, relax (more on this later), and coordinate every muscle from your shoulders down to your feet. 
(Dear fellow biomechanical nerds, if you are freaking out right now thinking I’m focusing too much on muscles and ignoring the critical neuro side of the neuromuscular system, just bare with me. It’s a lot of info for a fb post!)
Over the next 8 weeks, I will address how you can strengthen specific muscles of your core. Stay tuned as this is only an introduction to this fascinating force transferring dynamic VIP! 
Week 1: Let’s get acquainted, Core.
Week 2: Alignment - build the scaffolding to support your weak spots while they heal and repair
Week 3: Diaphragm and what Queen Elsa got right
Week 4: Pelvic floor muscles
Week 5: Transverse abdominis and multifidus muscles
Week 6: Shoulder girdle and hip
Week 7: Functional core exercises
Week 8: Round robin demonstration of CTS Physical Therapists’ favorite core exercises. 
Phew! Overwhelmed yet? Let’s take this one step at a time. This week’s tip: focus on stretching your hips, low back, thoracic spine and shoulder in a pain free way (in as many directions as you can) so that you can be ready to get into good alignment next week. Good alignment is essential for maximum muscle strength! Snap a photo. I’d love to see your favorite stretch!
Enough typing for now. Time for me to take a movement break and enjoy a stroll with the fam.
Happy Moving!
Crystal Hazelton, PT, MPT, OCS
This article is not medical advice. If you have pain, consult your physical therapist or physician.