|Definition of core stability
Core stability is the ability to control the position and movement of the central portion of the body.1
Core stability training has become a popular fitness trend that has begun to be applied in rehabilitation programs and in sports medicine2
Many studies3,4,5 have shown that core stability exercise is an important component of rehabilitation for LBP.
|The model of the spine stability system consists of three subsystems, proposed by Panjabi6
Passive subsystem (which includes bone, ligament and joint capsule)
Active subsystem (which includes muscle and tendons)
Neural subsystem (which consists of the central nervous system and peripheral nervous system)
According to this model, these three subsystems work together to provide stabilization by controlling spinal movement. Thus, an effective core stability exercise should consider the motor and sensory components of the exercise and how they relate to these systems to promote optimal spinal stability.7
Core stability training includes the exercise associated with the prior activation of the local trunk muscles and should be advanced to include more intricate static, dynamic, and functional exercises that involve the coordinated contraction of local and superficial spinal muscles.
|Core stability versus general therapy
core stability exercise is better than general exercise for pain relief and improving back-specific functional status in the short term. However, no significant differences in pain relief were observed in the intermediate- and long-term follow-up periods (MD=-5.1points, 95% CI=-8.7 to 1.4).10
Two other studies show that specific stabilization exercise was better than ordinary medical care and treatment by a general practitioner for reducing pain over the short term and intermediate term.8,9
|How to perform core stability exercises
A core stability training program could be described as the reinforcement of the ability to insure stability of the neutral spine position.11 Core stability exercises are usually performed on labile devices, such as an air-filled disc, a low density mat, a wobble board, or a Swiss ball.12
- Stability-Themultifidusandiliolumbalisrun like abandaroundthe facet joint, and this gives compression.
- Stability-transversusabdominusconsists of 3 parts: the upper parthelpstheribshold togetherand supportsthebreathing. The middle sectiongoes all the wayto the back(back muscles). The lower part attachesto the ilium.Men havea higherpelvisthan women, menthemselveshavemuch more variation inpelvicheights(palpation isalways required). Therib-crest distanceis much smallerin menthanin women. Since the rib-crest distanceis greaterin women, the muscle tension inthisregionpresenta waist.
- Thefasciaconnects all thestructurestogether. The structuresthemselvesarestuck togetherbyloose connective tissue. The absandthe back musclesare connected bythe fascia-If youcuttheabdominals you lose40%ofyourpower in your back. Throughthe positionof the pelvis you canmakemovement inthe fascia.
- transversusandthe mobliqueexternus pull theTLF,making itshorterand give compression. Ifthe transversusgivespainin the backduring training, there is probablystill amyofascial triggerpointin the back(If so,alwaystreat this triggerpoint first, chronicpatientsareoftensensitized). Sometimes amanipulation can be very effective-it gives aselectivedecreaseof pain(= same astheswallowingof 4paracetamols). It maybe a good startof the therapy.
- PosteriorObliqueSystem: consists oflattissimusdorsi, quadratus lumborum, m.gluteus, m. tractus iliotibialis –together, this active systemprovidescompressionandthusforceclosureofthe sacro-iliacal joint.
|How to start?
Start on the inside(core): When training core stability it’s important that you start restoring the balance on the inside area(intrinsic). Do not use big levers in the beginning, before all the tissue is restored/healed. By using a lever you give tension to the bonds and muscle, this gives more compression in the joint – force closure. If the tissue has not recovered (for example didn’t pass the proliferation phase) it’s likely that you overload the tissue and compensation patterns are maintained or created. First start by building up proprioception and coordination. (within the desirable ROM / mobility) At a later stage you can start using more strength exercises but don’t be too quick. (Strength after 6 weeks)
- Omkar SN, Vishwas S, Tech B (2009) Yoga techniques as a means of core stability training. J Bodyw Mov Ther 13: 98–103.
- Review Core stability exercise principles. Akuthota V, Ferreiro A, Moore T, Fredericson M Curr Sports Med Rep. 2008 Feb; 7(1):39-44.
- Desai I, Marshall PW (2010) Acute effect of labile surfaces during core stability exercises in people with and without low back pain. J Electromyogr Kinesiol 20: 1155-62.
- Baerga-Varela L, Abréu Ramos AM (2006) Core strengthening exercises for low back pain. Bol Asoc Med P R 98: 56–61.
- Sung PS, Yoon B, Lee DC (2010) Lumbar spine stability for subjects with and without low back pain during one-leg standing test. Spine (Phila Pa 1976) 35: E753-60.
- Panjabi MM (1992) The stabilizing system of the spine. Part II. Neutral zone and instability hypothesis. J Spinal Disord 5: 390-6.
- Hodges PW (2003) Core stability exercise in chronic low back pain. Orthop Clin North Am 34: 245-54.
- Ferreira PH, Ferreira ML, Maher CG, Herbert RD, Refshauge K (2006) Specific stabilisation exercise for spinal and pelvic pain: a systematic review. Aust J Physiother 52: 79–88.
- Rackwitz B, de Bie R, Limm H, von Garnier K, Ewert T, Stucki G (2006) Segmental stabilizing exercises and low back pain. What is the evidence? A systematic review of randomized controlled trials. Clin Rehabil 20: 553–67.
- Review Motor control exercise for persistent, nonspecific low back pain: a systematic review. Macedo LG, Maher CG, Latimer J, McAuley JH Phys Ther. 2009 Jan; 89(1):9-25.
- Akuthota V, Ferreiro A, Moore T, Fredericson M (2008) Core Stability Exercise Principles. Curr Sports Med Rep 7: 39-44.
- Willardson JM (2004) The effectiveness of resistance exercises performed on unstable equipment. Strength and Conditioning Journal 26: 70-74.