Core Strengthening

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The musculature of the spine has been shown repeatedly to be most important in maintaining spinal stability during movements (10,25).

Function of core muscles: oppose the movements of limbs, hold spine together, and decrease lumbar shearing.

Muscle dysfunction in low back pain is a problem with motor control in the deep muscles related to segmental joint stabilization (23).

Back pain can occur as a consequence of deficits in control of the spinal segment when abnormal0)” title=”6″ onmouseover=”window.status=this.title; return true;” onmouseout=”window.status=”; return true;”>6).

Why is the core important?

When a limb is moved, reactive forces are imposed on the spine acting in parallel and opposing those forces producing the movement (3).
The spine is particularly prone to the effect of these reactive forces due to its multisegmental nature and the requirement for muscle contractions to provide stability of the spine (22).
Without muscular support and contraction, buckling of the spine occurs with compressive forces of as little as 2 kg (19).
Significant microtrauma of the lumbar spine will occur with rotation of as little as 2 degrees (22)
□ Multifidi contribute to control of the neutral zone (25).
Function of core muscles: oppose the movements of limbs, hold spine together, and decrease lumbar shearing.
Muscle dysfunction in low back pain is a problem with motor control in the deep muscles related to segmental joint stabilization (23).
Back pain can occur as a consequence of deficits in control of the spinal segment when abnormally large segmental motions cause abnormal deformation of ligaments and pain-sensitive structures (22).
- □ Loss of joint stiffness
- □ Increase in mobility and abnormal spinal motion
- □ Changes in the ratios of segmental rotations and translations

WHAT ARE CORE MUSCLES? ANATOMY/BIOMECHANICS OF THE “CORE”

Local paravertebral-multifidi
- Stabilizing role: Protecting articular structures, discs, and ligaments from excessive bending, strains, and injury.
- Multisegmental column is unstable and will buckle under compression at individual joints unless locally stabilized.
- Short muscles provide local support for longer muscles to work (2).
- Neutral zone control
  - □ The neutral zone is a region of intervertebral motion around the neutral posture where little resistance is offered by the passive spinal column (bones and ligaments).
  - □ Sensitive region for stabilization of joints (<A onclick="if (window.scroll_to_id) { scroll_to_id(event,'R22-70'rolonged activities, not absolute strength, is most important (18).
- Abdominals: transversus abdominis (TrA), internal and external obliques, and rectus abdominis
  - Contraction of abdominals (especially TrA), pelvic floor, and diaphragm correlates closely with increased abdominal pressure in a variety of postural tasks (7,15,16).
  - TrA: Critical in stabilization of lumbar spine (<A onclick="if (window.scroll_to_id) { scroll_to_id(event,'R7-70'); return false; }" onmouseover="window.status=this.title; retrectus abdominis.
  - In slow trunk flexion movements, the erector spinae lowers the trunk into flexion (eccentrically contract) against the action of gravity during slow movements (20).

Role: Balance external loads and minimize forces on the spine (2).

Only a very small increase in activation of the multifidi and abdominal muscles is required to stiffen the spinal segments — 5% maximal voluntary contraction (MVC) for activities of daily living and 10% MVC for rigorous activity (5).

Endurance of muscles to maintain spinal stability during prolonged activities, not absolute strength, is most important (18).

Abdominals: transversus abdominis (TrA), internal and external obliques, and rectus abdominis

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