‘THE CORE’ is probably the most overused term in health and exercise therapies. Flick your television on to any shopping channel and someone will be selling a new piece of kit that will improve it. I too thought I knew what Core Control was all about, until about seven years ago when someone finally tested me properly. I mean I was pretty strong, I could do countless sit ups and leg raises, I’d not long finished playing squash competitively and still enjoyed a high club level so I was fit too. How did I not know how to control my core?
The fitness industry shows signs that it is catching up on core control, having spent the last couple of decades fixated on abdominal crunches. Unfortunately, as with many modern issues, the subtlety needed to do the Core justice often gets overlooked. A classic example is what I call the Pilates Posture, where the person does too much ‘Core’ work in a flexed lumbar spine position, which results in a flat back posture and a pair of glutes that hang off them like a pair of wet pajamas.
The Pilates example is one where the client presents extremely strong in core control but is dysfunctional none-the-less. However, clients present more commonly with a total lack of control. So how do we assess core control in the world of Functional Exercise?
Obviously the signs and symptoms that present are a big clue and these can be very wide-ranging. Poor core control presents as Low Back Pain, SIJ dysfunction, bladder weakness, over pronation of the foot, medial rotation of the femur leading to knee problems, shoulder injury, forward head carriage leading to TMJ issues and headaches, poor ability to recuperate post exercise, and the list goes on; sciatica, lumbar disc herniation, gait instability, movement instability in sports, recreation and activities of daily living, need I continue?
These days Abdominal Distension is a common presenting sign of core problems. However in these cases I usually look deeply into nutritional issues. Nine times out of ten this distension starts with irritation within the digestive system or a large amount of visceral fat expanding the abdominal cavity so exercise is a secondary issue to diet.
With signs and symptoms so wide spread it is clear that core control is often present in a wide variety of musculoskeletal pain. So here are a couple of simple assessments that can tell you at what degree the control is limited.
Transverse Abdominis Isolation.
Transverse Abdominis (TVA) is one of the major players in core control and probably the easiest to assess. When it works correctly it encourages activation from both the Pelvic Floor and Multifidus muscles. These three sets of muscles are the primary stabilisers known as the Inner Unit. Capping the Inner Unit off (literally) is the Diaphragm but this only gets involved fully when lifting heavy weights and usually needs to be assessed separately. The TVA test is pretty simple: Lay face down on your tummy on a matted floor and slide a Sphygmomanometer (old fashioned blood pressure cuff with a gauge or BP as I’ll refer to it), under their abdomen so the middle of the BP is at their navel level. Pump the BP up to 20 mmHg while the client relaxes. Now lift your tummy button off the BP by hollowing your abdomen thus dropping the pressure on the gauge. You failed the test if you either can’t move the gauge or can but do so by pushing your shoulders and knees into the ground to lift your body up. Either way this is evidence that you don’t know how to use your TVA so exercises to address this should be used.
Pelvic Control.
This is the area that goes so horribly wrong in Pilates resulting in the flat back. However, when a lack of control is evident then shear forces in the spine can cause all manner of problems. Control is key to allowing a neutral pelvis tilt to remain stabilised with only enough muscular input being used to counteract the forces generated by movement. Here’s how it works:
Lay on your back with the legs out straight and the BP under your lower back so the middle of the pillow is at navel level. Pump the BP up to 40 mmHg then tilt your pelvis backwards until the gauge reads 60 mmHg. Now hold this pressure evenly while you raise and lower one leg at a time. If the gauge drops by more than 10 mmHg the test is a positive. In Pilates where there is no feedback gauge used the person pins their back against the floor through abdominal contraction. If the gauge was present and you read it, it would shoot up to 90 – 120 mmHg as they used their legs. This is the over recruitment that leads to a flat back posture. Getting these people to ease off is a hard pattern to break but education and practice usually suffice. For those that drop in pressure, well the future is bright. Learning this control is quick and easy because the nervous system learns so quickly and is usually crying out for some interesting stimulus. We just start them on a basic exercise program and build them up from there.
Conclusion.
With a couple of simple assessments we can quickly see where core control is failing and a course of core strengthening can be the answer to reducing the recurrence of injury. These simple tests give you the tools to understand how subtle the core really is. If you can’t pass the tests then maybe it’s time to get working on it. This is so often the answer to some simple injuries that cost you a fortune at the Chiropractor’s office.
Article Source: http://EzineArticles.com/expert/Chris_D_Newton/1432397
Video: https://www.youtube.com/user/sanfranciscocrossfit
