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Chronic Musculoskeletalpain/chronic injuries in the spine

and lower extremity are causedor perpetuated by muscle

imbalances/weaknesses in the

core musculature


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Research indicates that 70-85%

of all athletes suffer fromrecurrent low back pain. A

comprehensive core stabilization

program should be done will all

lower extremity rehabilitation

programs.


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LPH Complex

Stabilization system(Core System) if notfunctioningoptimally will endneuromuscularsubstituting to utilizethe strength power

and neuromuscularcontrol in the rest ofthe body


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Definitions: Function: Integrated proprioceptively

enriched mulidirectional movement

vs unidimentional, low proprioception, all three

planes

All functional exercises are triplanar (even

walking) appears unidirectional but need other

planes to stabilize (frontal & transverse).All functional movements required

acceleration, deceleration & dynamic

stabilization (typically concentrate in concentric

and acceleration in rehab)


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Definitions:

Functional Strength - ability neuromuscular

system to produce dynamic eccentric

concentric and dynamic isometricstabilization contraction during all

functional movement patterns


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Kinetic Chain -

When it works efficiently:

optimal control

distribute force appropriately

optimal efficiency during all movements

impact absorption/ground reaction forces

no excessive comp0ressive transitory forceshear in kinetic chain

dynamic joint stabilization

neuromuscular control


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Example: Pelvo-Occular reflex

(Janda) Cervical spine weak: during running fatigue

head will go into extension, thus to see

straight in from of you the pelvis tipsanteriorly

This changes length tension ratios of the

lower extremity, become less efficient, mayend up with hamstring injury


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Patho-Kinesiological Model

This is a delicate balance a change in one of

these can cause injury

Example: articular dysfunction with changelength tension ration etc..


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Muscle Fatigue Ability to generate or maintain decrease

ability to require correct muscle

Ability to maintain dynamic muscle force

decreases

Example: fatigue running unable to stabilize

core: get shear forces and compressive

forces in lumbar spine:

- reason why see many LB comp0laints and

hamstring strains (actually attributed to weak

abdominals)

T Abd i i d


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Transverse Abdominis and

Internal Obliques during

functional activityOnly 2 abdominal muscles that attach to the L-

spine

Attach thorocolumbar facia (L-spine) via lateral

rafia attach to transverse processes

Thus when they fire they create a tension affect

inherent STABILITY in L-Spine

These prevent rotational and transnational forces

If these muscles are not stabilized the Psoas is used

to create a compressive force and mimic stability


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Transverse Abdominis and

Internal Obliques during

functional activity Actually creates anterior shear force and

extension force

Leading to reciprocal inhibition of lowerabdominals

The pelvis will tip forward

Leading to reciprocal inhibition of the

gluteals (extensor mechanism)

This can cause hip internal rotation knee

overuse syndromes etc..


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Basic Concepts of Core

Stabilization - Performance

Paradigm Stretch/shortening cycle (natural visco-

elastic properties of muscles)

Every single movement (Dynamicfunctional movement) more efficient the

more force can create and absorb)

efficiency: less wasted movementsExample walking

Every single movement we do is the

performance paradigm


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Paradigm Shift: NO longer

looking to improve strength in

one muscle but improvement inmultidirectional neuromuscular

efficiency (firing patterns inentire kinetic chain with complex

motor patterns). The body doesn't

just fire one muscle at a time for

movement


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Stabilization - Planes of

MovementWith any movement all three planes are

working together concurrently

Even through you may be moving in one plane

the other 2 planes must stabilize and work

eccentrically for stabilization

Example: Posterior Pelvic tilt laying on the

floor changes the relationship, thus whenstanding he relationship again changes the

exercises have not been functional and will not

work in the altered position. Again it

changes when you lift one leg etc.


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Stabilization - Continuum of

Function

Movements are not isolated unidirectional

Must do movements and exercises in adynamic systematic program

Practically take the athlete from the

challenging position they can control in afunctional pattern and progress them from

there


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Stabilization - Open and Closed

Chain

Functional movement is a succession of

opening and closing the chain Functional activity is therefore a timing

issue within opening and closing the chain

Need core stability to stabilize transition


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Biomechnics: Three Phases

Pronation - deceleration/force reduction

phase (where most injuries occur due to

lack of eccentric control)For rehabilitation need to look at this phase

what muscles are decelerating and stabilizing to

create a rehabilitation program


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Biomechnics: Three Phases Cont.

Supination - acceleration phase/force

production phase (most % time)

Coupling - stabilization, ability to changefrom pronation to supination phase

(stronger the core more efficient that thus

less time spend in this phase preventoveruse injuries)


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Muscle Function Cont.

Stabilization: Prone to develop weakness

and inhibition, less activated during most

movement patterns, fatigue easily, primarilyfunction during stabilization movement

Peroneals, anterior tibialis, posterior tibilalis,

VMO, gluteus medius/maximus, transverseabdominis, int/ext obliques, serratus anterior,

rhomboids, middle, lower trap, deep neck

flexors, longus capitus


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Muscle Functions - Abdomen:

Internal Oblique -

Decelerate transverse

plane rotation, frontalplane and transverse

plane stability

Rectus Abdominis:

Decelerate Extension,create pelvic stability

during dynamic

movement

External oblique -

Decelerate transverse

plane rotation someextension


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Muscle Functions - Abdomen:

Transverse Abdominis - The most important

abdominal muscle (attach to lumbar spine)

contract in feed forward mechanismcontract 1st before any other muscle

(research following back pain the transervse

abdominis is inhibited, thus when you movefor example an arm, your transverse

abdomnis does not stabilize thus the psoas

fires - compensation


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Muscle Function: Lumbar Spine

Superficial Erector Spinae: Extends Spine

creates extension force and shear force at

L4-S1 works with the Psoas (when Psoas

tight it facilitates erector spinae furtherincreasing the shear forces and inhibit

posterior muscles)

Deep erector Spine: Posterior translationand L4-S1, if weak or inhibited cannot

counterinteract affect or superficial erector

and get shearing forces


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Muscle Function: Lumbar Spine

Transversal Spinalis Muscles (Rotatories,

Multifidi, interspinalis, interanversari)

Provide intrisic, intrasegmental stabilityproprioceptive feedbacksince constantly

under compression and torsinal forces. If

these muscles are inhibited, loose the abilityto create dynamic stabilization from lack of

proprioceptive feedback.


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Heads

1.Iliocastalis

Lumborum

Thoracis

Cervicis

2.Longissimus

ThoracisCervicis

Capitis

3.Spinalis

ThoracisCervicis

Capitis

SPINE MUSCLES

ANATOMY


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ANATOMY

Macro anatomy. Multifidus

(MF) is the largest and most

medial of the lumbar paraspinal

muscles. Each muscle consists

of five separate, overlapping

bands that form a triangle as

these bands run caudo laterally

from the midline.

Insertion: spinous process at

caudal tip.

Origin: transverse process at

mamillary process, iliac crest,

and sacrum (polysegmental: 2-4

segments below insertion at

spinous process).


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Joint Dysfunction Example

Joint dysfunction example: lock up SI joint

plant and twist, Multifitus is inhibited

complains for low back pain, the erectorswill fire and attempt to stabilize (therefore a

muscle is doing opposite of its muscle

function). This is why pain syndromes areperpetuated


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Muscle Function: Hip

Musculature: Gluteus Maximus: decelerate hip flexion,

decelerate hip internal rotation during heel

strike. Psoas tightness creates inhibition of gluteus

maximus (anterior tilt)



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Musculature:

If the gluteus maximus is inhibited or wakwill loose ability to control femur, femur

will internally rotate:

Microtruma can be created on medial capsuleof knee

Patellar tendonitis non-contact ACL injuries

posterior tibial tendonitis, plantar facitis

Hamstrings become tight in an attempt to create

posterior stability of the pelvis (instead of

focusing on hamstring flexibility, work on

pelvic stabilization and flexibility will return)


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Gluteus Maximus and minimus

are inhibited in most athletes due

to tight psoas (Summer, 1988).

M l F ti Hi


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musculature Gluteus medius: provides frontal plane

stabilization, decelerate femoral adduction, assistin deceleration femoral internal rotation (duringclosed chain activity)

VB/BB with patellar tendonitis originate from tightpsoas and lack of core strength

attempting to get triple extension during jumping, couldntextend through hip using gluteus maxiumus due to thigh psoas

Thus they hyperextend at the knee and drive the inferior poleof the patella into the fat pad creating the inflammatoryresponse (Summer, 1988).


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Musculature Adductors: frontal plane stability

Hip External Rotator: Create Pelvo-femoral

rhythmGemeli, Obturators, Piriformis help to

decelerate femur, If inhibited they become

extremely tight because they are attempting tostabilize

Often we attempt to stretch these muscle where

a core program would eliminate the origin of

the problem


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F t l Pl Gl t M di


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Frontal Plane: Gluteus Medius,

ipsilateral adductor and

contralateral quadratus lumborum

Example: weak gluteaus medius will causecontralateral LBP, into knee pain on

opposite side


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Force Couples Cont.

Transverse Plane Left Rotation - left

internal oblique, left adductor, right external

oblique and right external rotators of the hipExample: synergistic dominance Weak

transverse abdominis and internal oblique the

same side adductor will become tight and

inhibit gluteus medius causing anterior knee

pain, posteior tib tendonitis etc. Down the

kinetic chain.


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Principle of Core Training:

Postural Alignment: Primary Function -

misalignment will produce predictable

stresses, pain, chronic injuries, jointdysfunction


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Common Postural Dysfunction Lower Cross System: Anterior Tilt in most

athletes increase lumbar lordosis

tight muscles movement groups muscles erector spinaesuperifical psoas, upper rectus, rectus femoris,sartorius, tensor facia latae, adductors

Weaker muscle/inhibited - stabilizing group deepabdominal wall transverse abdominis, internal obliquemultifidus, deep erector spinae biceps femoris gluteausmedius/maximus

muscle that decelerate femur are inhibited

Joint dysfunction illiosacral rotations, S1, L-spine, Tib-fib joint, subtalar joint

Injury patterns: plantar faciiitis, patellar tendonis,posterior tib tendonitis


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Common Postural Dysfunction

Upper Cross System: Rounded Back/ForwardHead

Tight muscles pec major/minor, lat, upper trap,levator, subscap, teres major, sternocleidomastoid,

erectus capitus, and scalenes Weak muscle: rhomboids, middle.lwr trap, teres

minor , infraspinatus, posterior deltoid, deep neckflexors

Joint dysfunction: Upper cervical, cervicalthroricis, SC joint problems (which can causerotator cuff problems)


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Common Postural Dysfunction

Pronation Distortion Syndrome: Flat feet

tight muscles: peroneals, lateral gastroc IT

band, PsoasWeak muscles: intrinsic foot muscles,

anterior/post tibialis, VMO, bicep femoris,

piriformis, glut medius

muscles that control pronation are inhibited and

weak causing overuse injuries


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Pronation Distortion Syndrome

Joint dysfunction: 1st MTB joint (EX: cause

anterior shoulder pain: stub toe and then

lack normal passive extension, shortenstride, internal rotation of the femur,

causing pain up the core chain into

movements of the extremity). The samecan occur with sprain ankle and lock tibo-

talar joint


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Through the kinetic chain,

muscle problems can lead to joint

problems and joint problems canlead to muscle problems.


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Postural Considerations

If one segment in the kinetic chains is out of

alignment, then predictable patterns of

dysfunction will develop in other parts ofthe kinetic chain

A weak core is a fundamental problem o

inefficient movement which leads toinjury

L B k P i & R h bilit ti


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Low Back Pain & Rehabilitations Transerve abdominis, multifitus, internal oblique

are inhibited in someone with LBP Decrease in stabilization endurance can perform

the movement until fatigue. OK for 3x20 but oncestart functional movement revert back to previous

positions Increase interdisck pressure and compressive

forces with lack of pelvic stabilization

Think about athletes that lift and then have LBP

cause may not be stabilizing and can perpetuatemuscle imbalances creating hamstring dysfunctionetc.

Address through unstable ball training


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Muscle ImbalancesAn optimal functioning core helps to prevent

the development of muscle imbalances

Optimal core neuromuscular efficiency allows

for the maintenance of the normal:

Length-tension relationships Force-couple relationships

The path of instantaneous center of rotation

A strong stable core can improve

neuromuscular efficiency throughout the kineticchain by improving dynamic postural control


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Assessment of the Core:

Core strength can be assessed using the

straight leg lowering test

Core power can be assessed using theoverhead medicine ball throw

Core muscle endurance can be assessed

using back extension


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Core Stabilization to create

program: Sport Demand Analysis

Demands of the individual sport

Demands of the athlete (player vs non-player)Demands of the position/specialty


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Guidelines for Core Training:

A comprehensive core stabilization training

program should:

progress from slow to fastsimple to complex

known to unknown

low force to high forcestatic to dynamic


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Guidelines for core Training

Exercises should be safe, challenging, stress

multiple planes, incorporate a multi-sensory

environment, and activity specific Put each athlete in the most challenging

environment they can control.


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Guidelines for core Training

Change program often

ROM

Loading (Cable, tubing etc.)Plane of motion

Body position, floor standing, one leg etc..)

speed of movementduration

frequency


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Exercise Progression

Stage I: Learning Abdominal Bracing

maintain stability

change duration and frequency

Stage II

Educate on daily use

Increase ROM and instability mainly uniplanar,change body position


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Exercise Progression

Stage III: instability

Maximize the use of functional activities with

abdominal bracingMaximize multidirectional patterns and

unstable positions

Maximize frequency and duration changes

Stage IV:

Challenge the individual with high intensity

strength and power

SPINE MUSCLES


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Heads

1.Iliocastalis

Lumborum

Thoracis

Cervicis

2.Longissimus

ThoracisCervicis

Capitis

3.Spinalis

Thoracis

Cervicis

Capitis

SPINE MUSCLES

ANATOMY

l ifid


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Macro anatomy. Multifidus

(MF) is the largest and most

medial of the lumbar paraspinal

muscles. Each muscle consistsof five separate, overlapping

bands that form a triangle as

these bands run caudo laterally

from the midline.

Insertion: spinous process at

caudal tip.

Origin: transverse process at

mamillary process, iliac crest,

and sacrum (polysegmental: 2-4

segments below insertion at

spinous process)

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functionalcorestabilization-100605134846-phpapp01