What is up with my CORE

What is up with my "CORE"?

by Sallie Rediske, MPT

Every few years, there is a big exercise craze that sweeps the nation. Most recently, the fitness magazines have been purporting the benefits of "core stabilization". Core stabilization, as reported in the popular media, seems to be the cure-all for every muscle ache and pain you have every experienced.

So, what is "core stabilization"? Does core stabilization really have the effect that everyone claims?

Not surprisingly, there are some very different opinions about what the term "core stabilization" means. One definition frequently used simply refers to the strengthening of the trunk in order to promote a stable base on which to move the arms, legs, and head. Often, "a stable base" is unfortunately synonymous with "stiff" or "rigid". A quick search on Yahoo for "core stabilization" indicates that the majority of the first ten sites listed use this definition. These various sites promote strengthening of the trunk muscles, with little to no differentiation. These various roles of the different trunk muscles, functional use of these muscles or quality of contraction other than to stiffen or tone. The techniques presented include a variety of ways including gym ball exercises, abdominal and back exercises, Pilates, and use of resistance bands.

In physical therapy and other professions the term "core stabilization" has taken on a more specific meaning relating to the coordination and strength of the deepest muscles in our body. These muscles are often termed "intrinsic" muscles. This means that these muscles are located entirely within a body part controlled by the specific muscle group. Much of the research done on these muscles and their function has been done by Paul Hodges, Carolyn Richardson and Julie Hides presented in a fascinating clinical book called "Therapeutic Exercise for Lumbopelvic Stabilization" (Churchill Livingston 2004).

The prime muscle involved with this interpretation of core stabilization is an amazing muscle known as the transverse abdominis (TA). The TA is the deepest of all abdominal muscles - it runs transversely around the abdomen, creating a gentle corset-type effect when contracted. It has connective tissue connections with its neighboring core muscle group, the pelvic floor (the deep muscles between your legs that stop urine and fecal leakage and "keep our insides in us") and has additional connective tissue connections with the deep muscles that surround the vertebrae (think of what a chicken neck looks like with the muscles left on...). It has more connections that blend into connective tissue of the shoulders and the hips.

The TA, pelvic floor muscles and deep spinal muscles are not power muscles. They are postural muscles that should work to some degree all of the time at a relatively low level of activity. This is in contrast to a muscle like our bicep that may not work at all, but then be required periodically to lift very heavy objects. Unlike the muscles that you can easily feel underneath your skin, these deep muscles are not easily palpable and can be challenging to sense the contraction of the muscles both by an outside observer and by the individual doing the contracting.

The function of the core muscles is to stabilize structures, but not produce gross movement of the truck or extremities. This means that movement of our joints occurs because of the bigger muscles that are located more closely to the surface of our bodies, while the core muscles "keep the vertebrae stacked on top of each other", "keep us from leaking when we aren't ready" and "keep our insides in". One of the most fascinating features of these deep core muscles is how when contracted in a coordinated manner, they don't prevent fluid, well distributed movement through the rest of our body. Compare this to the rigid body that is often produced in the individual that participates in aggressive abdominal crunches and back exercises - the person can develop a wooden-like trunk with only appendages that appear to move.

In Hodges, Richardson and Hide's work, they disclose that in those with injuries, often the core muscles have "been turned off". They have demonstrated in these cases, the more superficial muscles often take over and attempt to stabilize the spine, internal organs, etc., but are inherently less effective. Clinically, the person that has this experience often has a stiff trunk with pain due to over-reliance on these inefficient stabilizers. Fortunately, they have proven that with the proper training, these muscles can be "revived". The challenge is, however, to find a method that promotes the coordinated development of the deep muscles without "over-powering" them and continuing to utilize the more superficial only. This is where physical therapy comes in.

Physical therapists can help you identify whether or not your core muscles are activating and if not, how to find them and effectively use them in daily tasks. It is only then, once this very important foundation is established, that physical therapists progress this basic training with specialty approaches such as Pilates, FeldenKrais and Tai Chi. Other physical therapists will use more familiar methods such as gym ball exercises, resistance band exercises and weight training to advance coordinated use of these deep core muscles. Overlooking the importance of these deep muscles in your "Core Stabilization" program can result in loss of range of motion, pain and stiffness and increased risk of injury.

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