Inner core activation strategies
This video was taken at an FUNCTIONAL ANATOMIC PALPATION SYSTEMS™ Spine seminar in Toronto. Functional Anatomy Seminars™certified instructor Dr. Mike Chivers discusses strategies for optimal activation of the ‘inner’ core muscle groups. This is just one example of instruction provided over and above training in advanced soft tissue palpation, assessment, and treatment techniques offered at Functional Anatomy Seminars™
Much debate exists in the literature regarding the need for ‘inner core training’, such as Abdominal hollowing, as recommended by the ‘Queensland group’ which are a research group out of the School of Health and Rehabilitation Sciences, University of Queensland (Jull, Richardson, Hodges, Hides). Authors like Dr. Stu McGill, professor of spine biomechanics at the University of Waterloo, question the ability of the inner core muscle group (Transverse Abdominus, multifidii, perenial muscles, etc) to significantly contribute to lumbar stabilization, favouring the act of ‘Bracing’ which is the simultaneous contraction of all of the abdominal and lumbar spine musculature to increase spinal stiffness and stability.
Although it is difficult to question the research that demonstrates that inner core contraction does not significantly lead to spinal stability, we still employ a brief period inner core rehabilitation strategies with our patients before progressing to brace training and spinal strengthening. As is found in all areas of the body, muscles that are situated particularly close to joints, and those that tend to cross fewer articulations, tend to have a higher percentage of mechanoreceptors per cross sectional area as compared to the larger muscles which are located more superficially, and that tend to cross over many
articulations. Examples include the popliteus of the knee, the brachialis in the elbow, the longus coli & capitus and the suboccipitals in the cervical spine, etc. In the lumbar spine, the transversus abdominus and multifidii demonstrate similar findings when examined. Common to all of these structures is the importance in sending frequent afferent relays to the central nervous system concerning proprioceptive & kinesthetic positioning of the related articulations in order that the CNS can then generate appropriate motor programs for the safe execution of movement. Following injury, research dictates the need to not only heal tissue, but to re-establish good proprioception in order to ensure proper articular function in order to prevent chronicity and/or future injury. In cases of acute lumbar pain, we find that by practicing activation of the ‘inner core’ muscles in the initial stages of rehabilitation, the patients are able to execute stabilizing outer core exercises with less pain, greater intensity, and faster results. Theoretically, following the injury, we feel that it is beneficial to provide the CNS with as much afferent feed back as possible in order for it to accurately ‘regenerate’ sound motor strategies – the concept being that the more information we can offer the CNS to create a ‘plan,’ the better the plan will be. Especially in the initial acute stages where the patient is unable to perform outer core exercises (bird-dogs, plank’s, ‘safe’ crunches) due to pain, activation of inner core muscles, which can be done without pain, will help to prevent post injury inhibition. Further, we make it a habit of never assigning strengthening exercises too soon after tissue injury so as not to promote the development of aberrant compensation patterns.
Thus our strategy is to assign brief periods of inner core activation exercises such as hollowing, multifidii isometric contraction, kegal’s, etc (brief meaning we assign them for only as long as it takes for the patient to be able to perform them correctly)….which are quickly progressed to outer core training – Bracing in ‘neutral spine’ coupled with Cat-camels, Bird-dogs, side-planks, ‘safe’ crunch, etc., in order to regain spinal stability.
Note that we insist that even the inner core exercises be done in ‘neutral spine’……as we want the proprioceptive/joint positional afferent information going to the CNS to be optimal.