What is Core Stability?: The term ‘core stability’ is used to describe the body’s ability to stabilise the spine and to balance the workload between the deep and superficial muscles of the trunk. The muscles that stabilize, align and move the trunk are predominantly; the abdominals, the back muscles and pelvic floor.
The ‘core’ muscles operate at an unconscious level in healthy individuals to protect and stabilize the joints before movement occurs. Good core stability is using the right muscles at the right time at the right intensity to control the trunk appropriately for the task at hand. The muscles of the back/trunk are either:
- Stabilisers: local/close to the spine.
Attach directly into the lumbar spine at each level
Turn on before you move to support the spine and pelvis
Turn on and stay on as you move
Work at a low intensity and stay on for long periods of time
Work independently of the global movement muscles
The stabiliser muscles include; Transversus Abdominus (TA), multifidus (MF), Internal Oblique (IO) and the pelvic floor muscles. The co contraction of these muscles help to stabilise the lumbar spine (low back).
- Mobilisers: global/further away from the spine and usually spread over multiple joints.
Global muscles are very important for movement of the limbs and trunk. Their job is to move the body. They generate a lot of force, move the body then relax.
Dysfunction: From the first episode of back pain the deep stabilisers change how they function. The spine and pelvis are no longer protected by the deep stabilisers as well as they should be. The deep stabilisers now:
- Have delayed activation, turning on after you start to move
- Turn on and off as you move – working as the global muscles work rather than all the time
- Work in short bursts rather than staying on as you move
When the deep stabilisers don’t work well to stabilise the spine, the brain recruits the global muscles to compensate. Pain around the lower back and pelvis or groin often results from these compensatory strategies. Treating the painful areas often only gives short term relief. To treat the pain effectively you need to stop the reason why the compensations occur by improving the deep stabiliser muscles.
Assessment: Assessing and treating issues with core stability involves assessing both the local and global systems. It is important to find what is underactive, what is overactive and make the muscles function more normally. Generally there is a deficit in the local system that needs to be improved and the subsequent compensatory strategies of the global muscles reduced. It is this reduction in the compensatory strategies that will generally make you feel better.
Treatment: Practitioners at The Back and Body Clinic have had extensive postgraduate training aimed both at using manual techniques and also teaching specific exercises to help retrain optimal use of the core muscles. This is an important part of treatment/ rehabilitation and goes hand in hand with other pain relieving techniques.
Core stability training begins with learning to activate the stabiliser muscles effectively. Exercises can then be built on this foundation and progressed as appropriate. Core stability exercises can be progressed by either attending Pilates classes or through our physiotherapists. Progressive exercises may include using a gym ball or other equipment. Ultimately it is important to carry out core exercises that are functional to transfer to everyday activities in order to try to reduce pain and increase function.