Maximizing Core Retraining

03/18/2019

Jennifer Stone, PT, DPT, OCS, CAPP certified pelvic floor therapist Clinic Supervisor, Mizzou Therapy ServicesRangeline Program Director, Pelvic Health Certificate, Evidence in Motion

? Explain anatomy and physiology of the entire core and its interrelationship with the rest of the body.

? Assess for appropriate motor control of core musculature and identify sources of impairment if they exist.

? Name at least 3 options for use of manual therapy to provide a neuromotor "reset" to the core.

? Provide at least 3 examples of motor control retraining for patients regardless of impairment, beginning with very basic muscle activation and progressing all the way into motor control for high level athletic activities.

? Explain what the concept of "core stability" should look like and how to practically apply during exercise and athletic training.

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Floor to ceiling!

? What do we mean when we talk about the core?

? Muscles ? Strength? ? Anticipatory function? ? Do we understand how the core actually works?

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? Neck

? Deep neck flexors

? Trunk

? Rhomboids ? Lower/middle trapezius ? Transverse abdominus ? Multifidus ? Diaphragm ? Obliques ? Erector spinae ? Lattisimus dorsi (and on...)

? Pelvis

? Pelvic floor ? Hip adductors ? Gluteus medius

? Anticipatory control

? Core muscles (all of them) should fire. Every time we do anything. ? Example: multiple studies show the pelvic floor fires (under normal

circumstances) when you reach to open a door or get something off a shelf

? Motor control/coordination

? Is strength really all that important in the core? Or is coordination the key?

? Endurance

? Fast vs. slow twitch fibers ? We do have BOTH in our core-which to focus on?

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? History

? 1960s-1980s-situp/rectus abdominus city! ? 1990s-early 2000s-Paul Hodges early theories on motor control and the

role of transverse abdominus plus the development of lumbar CPRs including the stability category-PTs started teaching abdominal hollowing/bracing with TrA and teaching patients to "tuck and hold" to maintain support for lumbar spine ? Later 2000s-present-Hodges publishes more papers and states that PTs have taken his theories way further than he ever intended and we start realizing the story may not start and end with TrA. Diane Lee publishes her canister theory. At the same time, therapeutic neuroscience education becomes more popular-some people throw out core training entirely. ? Short answer: it's complicated and we may not have all the answers-and this is JUST for the lower core!!

? Dynamic mobile system which must all work together in order to provide ideal structure/function for spine and appendicular skeleton during movement

? Balloon example ? The key here is intra-abdominal pressure, NOT muscles holding the

skeleton still as we once thought ? This means that retraining the core WHILE MOVING is much more

important than we ever considered; does this mean we throw out TrA activation isometrics entirely? ? Motor control AND anticipatory training AND working with dynamic control for "big movements" have to be part of our core work for maximal function ? Note role of posture/alignment

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? Let's chat about the role of each of the major areas of the core in function...as with any good tour, we can start in the basement...

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