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Core Training: Evidence

Translating to Better
Performance and Injury
Prevention
Stuart McGill, PhD
Spine Biomechanics, Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo,
Waterloo, Ontario, Canada

SUMMARY progressions for their clients. The core bending of the spinal discs is a potent
is composed of the lumbar spine, the injury mechanism (10,61). Another
THIS REVIEW ARTICLE RECOG-
muscles of the abdominal wall, the example of misdirected practice com-
NIZES THE UNIQUE FUNCTION OF
back extensors, and quadratus lumbo- monly occurs when some trainers have
THE CORE MUSCULATURE. IN their clients pull in their abdominals to
rum. Also included are the multijoint
MANY REAL LIFE ACTIVITIES, muscles, namely, latissimus dorsi and ‘‘activate their transverse abdominis’’ to
THESE MUSCLES ACT TO STIFFEN psoas that pass through the core, enhance stability. First, this does not
THE TORSO AND FUNCTION linking it to the pelvis, legs, shoulders, target the major stabilizers of the spine
PRIMARILY TO PREVENT MOTION. and arms. Given the anatomic and because studies that measure stability
THIS IS A FUNDAMENTALLY DIF- biomechanical synergy with the pelvis, show that the most important stabil-
FERENT FUNCTION FROM THOSE the gluteal muscles may also be con- izers are task specific.
MUSCLES OF THE LIMBS, WHICH sidered to be essential components as For example, sometimes the quadratus
CREATE MOTION. BY STIFFENING primary power generators (the synergy lumborum is most important, yet many
THE TORSO, POWER GENERATED of these components is outlined else- trainers neglect this muscle (19). Sec-
AT THE HIPS IS TRANSMITTED where (36)). ond, drawing the abdominals inward
MORE EFFECTIVELY BY THE CORE. The core musculature functions differ- reduces stability (57). Third, evidence
RECOGNIZING THIS UNIQUENESS, ently than the limb musculature in that on transverse abdominis shows that
IMPLICATIONS FOR EXERCISE core muscles often cocontract, stiffening activation disturbances may occur in
PROGRAM DESIGN ARE DIS- the torso such that all muscles become some people with specific types of back
CUSSED USING PROGRESSIONS synergists—examples in a wide variety of disorders, but that these same distur-
BEGINNING WITH CORRECTIVE training and athletic activities are pro- bances are not unique to transverse
AND THERAPEUTIC EXERCISES vided in Refs. (2,3,5,13,14,15,19,20,53,55). abdominis because they occur in many
THROUGH STABILITY/MOBILITY, Thus, training the core effectively means muscles (11,59). People are unable to
ENDURANCE, STRENGTH AND training it differently than the limb activate this muscle in isolation beyond
POWER STAGES, TO ASSIST THE muscles. very low levels of contraction because
PERSONAL TRAINER WITH A Evidence and common practice are not it is designed to activate with internal
BROAD SPECTRUM OF CLIENTS. always consistent in the training com- oblique muscle for athletic tasks (18). It
munity. For example, some believe that would appear that trainers who focus
repeated spine flexion is a good method on this muscle are misdirected.
INTRODUCTION to train the flexors (the rectus abdom- Other evidence shows how the core
he well-trained core is essential inis and the abdominal wall). Interest- makes the rest of the body more

T for optimal performance and
injury prevention. This article
introduces several elements related to
ingly, these muscles are rarely used in
this way because they are more often
used to brace while stopping motion.
capable. For example, in our work

KEY WORDS:
the core to assist personal trainers in Thus, they more often act as stabilizers core; exercise; back pain
designing the most appropriate than flexors. Furthermore, repeated

Copyright Ó National Strength and Conditioning Association Strength and Conditioning Journal | www.nsca-lift.org 33
Core Training for Better Performance

quantifying the tasks of strongman Thoughts are provided here for exer- swollen from the osmotic superhydra-
training, we documented how the core cise professionals who deal with issues tion of the disc that occurs with bed
assisted hip function to allow the related to the assessment and design of rest, has been proven very effective
competitors to accomplish tasks that therapeutic exercise for the core. Core with this type of client (60). Further-
they did not have the hip strength to training is of interest given the preva- more, typically, when this client bends
perform (53). Specifically, the quad- lence of back pain among clients. Core to pick up a weight, they flex the spine
ratus lumborum assisted in pelvis training is associated with spine stabil- adding to the cumulative trauma. This
elevation to allow the swing leg to ity and instability that results from back often continues without correction
make a step. This was the first evidence disorders. Evidence from the back from the trainer. This is a missed oppor-
suggesting that a strong core allows disorders’ literature shows that poor tunity. Realize that the spine discs only
strength to radiate out peripherally to movement patterns can lead to back have so many numbers of bends before
more distant regions of the body. disorders. In this way, trainers should they damage (10). Keep the bends for
Similarly, in training, our recent work consider the quality of movement essential tasks such as tying shoes
(58) demonstrated how an individual patterns in all clients and by default rather than using them up in training.
can only bench press half of their body should consider beginning any exercise Many lifestyle and occupational exam-
weight when standing—otherwise they program with corrective exercises. ples have been provided elsewhere (28)
would push themselves over. While Many trainers follow a ‘‘recipe’’ for to guide the elimination of the cause of
laying, bench press performance was assessment, corrective exercise, or per- a client’s back troubles; the trainer will
primarily governed by the chest and formance training. Using this generic find that half of their initial effective-
shoulder musculature, whereas stand- approach ensures ‘‘average’’ results— ness will be because of preventing the
ing press performance was governed some clients will improve and get cause (i.e., a flawed movement pattern).
by core strength, particularly one-arm better, but many will fail simply This need not be so complicated. Con-
presses. Thus, the limiting factor in because the approach was above or sider the client who stands slouched
standing press ability was core strength. below the optimum level necessary to where the back muscles are chronically
address the deficit. The program and contracted to the point of chronic
The core, more often than not, func-
approach principles introduced here muscle pain. The family doctor typically
tions to prevent motion rather than
are based on principles intended to prescribes muscle relaxants, which fail to
initiating it, which is contrary to the
assist development of elite corrective relax the muscle. The trainer addresses
approaches that many trainers employ
exercise and training specialists. the postural cause and corrects standing
in designing exercise for their clients.
to effectively silence the muscles and
Good technique in most sporting, and
remove the associated crushing load
daily living tasks demands that power CONSIDER THE CAUSES OF from the spine (Figure 1) (32).
be generated at the hips and trans- BACK DISORDERS
mitted through a stiffened core (37). Here is a disturbing fact: many of the
BUILDING THE SCIENTIFIC
Pushing, pulling, lifting, carrying, and back pain patients I see have been FOUNDATION
torsional exertions are enhanced using exacerbated by poor training programs Myths and controversies regarding
this basic technique of hip power because the mechanism of injury was spine function and injury mechanisms
generation but are compromised when unknowingly incorporated. The first are common. Consider ‘‘the cause’’ of
the spine bends causing what is often step in any exercise progression is to back troubles, specifically the common
referred to as ‘‘energy leaks.’’ Interest- remove the cause of pain or potential perception regarding common injury
ingly, these task classifications greatly pain, namely, the perturbed motion pathways in which the back is injured
assist the organization of program and motor patterns. For example, the from an ‘‘event.’’ Generally, statistics
design (think of building exercises to flexion intolerant back is very common are compiled from epidemiological
fulfill a push, pull, lift, carry, and a in today’s society (i.e., pain is produced approaches, which ignore the large
torsional buttressing task rather than after repeated or prolonged back flex- role of cumulative trauma. Compensa-
specific isolationist exercises for the ion). Giving this type of client stretches tion board data are often used, how-
abdominals, back extensors, latissimus such as pulling the knees to the chest ever, and they ask clinicians to fill out
dorsi, and the like). may give the perception of relief reports and name the ‘‘event’’ that
As a contribution to this special issue, (through the stimulation of erector caused the ‘‘injury.’’ For example, ‘‘Mr
I thought about how best to assist spinae muscle stretch receptors), but X lifted and twisted at the time that the
increasing the competency of trainers. this approach only guarantees more injury occurred.’’ Kinesiologists and
But after writing 2 textbooks (25,35) pain and stiffness the following day trainers know that twisting is different
based on our hundreds of scientific because the underlying tissues sustain from generating twisting torque, but
publications, I feel as though I have more cumulative damage. very few of the individuals filling out
already said what is necessary and Eliminating spine flexion, particularly the reports will know. So, was it
important in a cohesive story. in the morning when the discs are twisting torque that caused the injury?

34 VOLUME 32 | NUMBER 3 | JUNE 2010
Figure 1. (a) Poor standing posture causes constant spine load and chronic contracture of the erector spinae muscles causing
muscular pain. (b) One approach for correction is to externally rotate the arms about the shoulders (steering the thumbs
out). (c) Correcting the posture with chin and shoulder retraction reduces the chronic muscle contraction reducing pain
and building training capacity.

Or, was it being twisted that caused the treatment. Avoiding this specific direc- mechanics that increase back loads.
injury? Furthermore, despite the injury/ tional cause will lead to optimal thera- Many of them have stronger backs
incident reporting system geared to the peutic exercise design together with but are less endurable than matched
reporting of the ‘‘event’’ associated elimination of activities in the patient’s asymptomatic controls (47). They tend
with the ‘‘injury,’’ very few back injuries daily routine identified as replicating to have more motion in their backs and
occur this way. the cause. less motion and load in their hips. A
Evidence of the process of disc herni- common aberrant motor pattern is
Many training programs have the
ation provides a proof of principle. For known as ‘‘gluteal amnesia’’ (27), which
objectives of strengthening muscle
example, the damaging mechanism may be both a common consequence
and increasing spine range of motion.
leading to herniation, or prolapse, is of back troubles and possibly a cause of
This is problematic for some because
repeated lumbar flexion requiring only them as well. The general principle
those who have more motion in their
very modest concomitant compressive that joint pain causes inhibition of the
backs have a greater risk of having
loads (10). This trauma accumulates extensors and chronic facilitation of the
future back troubles (56). Strength flexors to the point of ‘‘tightness’’
with little indication to the future may, or may not, help a particular
patient. With repeated flexion cycles, appears to be true with hip or back
individual because strength without pain. Obviously, for this category of
the annulus breaches layer by layer control and endurance to repeatedly
with progressive delamination of the client, exercises to enhance the in-
execute perfect form increases risk. tegration of the gluteal muscles will
layers (61). This allows gradual accu- Interestingly, the differences between
mulation of nucleus material between enhance back function while also
many ‘‘troubled backs’’ (the chronic sparing knees. Hip flexor mobility is
the delaminated layers. The location of
back with recurrent episodes) and also needed (but special technique is
the annulus breaches can be predicted
matched asymptomatic controls per- needed to separately target psoas from
by the direction of the bend. Specifi-
forming the same jobs have been iliacus) (Figure 2) (38). Optimal back
cally, a left posterior lateral disc bulge
shown to be variables other than back exercise therapy results from the
will more likely result if the spine is
strength or mobility. Rather deficits in identification of these clients with
flexed with some additional right
motion and motor patterns have been perturbed patterns followed by specific
lateral bend (1). Subsequent twisting
documented as being more critical and corrective exercise—this precedes all
leads circumferential rents in the
annulus that tends to make McKenzie thus should be targets for therapeutic other exercise progressions.
extension approaches for these clients exercise.
useless or even exacerbating (23). This For example, people with troubled THE SCIENCE OF CORE STABILITY
is critical information for the trainer, backs use their backs more. Generally, Effective core/spine stabilization
both in terms of prevention and in they walk, sit, stand, and lift using approaches must begin with a solid

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Core Training for Better Performance

techniques are described (38). Finally,
some provocative tests, such as a shear
test, will help reveal which classifica-
tion of client is best suited for a stabi-
lization approach (17).
It is also interesting to consider the
studies that have quantified training
devices, which claim to enhance
spine/core stability. For example,
Moreside et al. (54) quantified stability
when using the ‘‘Bodyblade’’ (Mad
Dogg Athletics, Venice, CA), which is a
flexible foil that is shaken at a resonant
frequency. As with virtually all other
tools, the technique determines the
actual stability achieved. Poor body
blade technique can actually reduce
stability, whereas good technique,
where the core is locked into an
isometric contraction to control mo-
tion, enhances core stability. The role
of the trainer is to be aware of this
science, its implication on technique,
and devote their attention to exercise
form in the client.
Figure 2. Lunging with the arm directed overhead helps to differentiate and target
psoas from iliacus during hip flexor stretching. Hip extensor patterns are TOLERANCE AND CAPACITY
simultaneously trained on the opposite side of the body. When this exercise
Suppose a trainer wants to include
is performed as walking steps, holding the posture for 2 seconds and
a lifting pattern to challenge the
pulsing the arm upward through the core, then taking a step and
repeating, it becomes a facilitator and a good ‘‘warm-up’’ exercise. posterior components of the core.
They are wondering if a squat with
a weighted bar would be better than
understanding of what stability is. a single muscle generally does not the birddog exercise. The choice is
From a spine perspective, it has little enhance stability but creates patterns assisted by determining the tolerance
to do with the ability to balance on that when quantified result in less and capacity of the individual to ensure
a gym ball. This is simply the ability stability (20). It is impossible to train that a given exercise dosage is matched
to maintain the body in balance, which muscles such as transverse abdominis to the client. Each individual has
is important but does not address the or multifidus in isolation—people can- a loading tolerance which, when ex-
unstable spine. In fact, in many in- not activate just these muscles. Do not ceeded, will cause pain and ultimately
stances, the unstable spine is also perform abdominal hollowing techni- tissue damage. For example, a client
flexion intolerant and with associated ques because it reduces the potential may tolerate a ‘‘birddog’’ extension
intolerance to compression. Sitting on energy of the column causing it to fail posture but not a ‘‘superman’’ exten-
an exercise ball and performing move- at lower applied loads (39). Interest- sion over a gym ball, which imposes
ment exercises increases spine com- ingly, a recent clinical trial (22) com- twice the compressive load on the
pression to a flexed spine (52). This pared the efficacy of many of the lumbar spine. For a more highly
retards progress—it is generally a poor exercises quantified and published in trained person with a higher tolerance
choice of back exercise until quite late Physical Therapy (24), with the same may find ‘‘supermans’’ very appropri-
in a therapeutic progression. True exercises combined with specific trans- ate. A person’s capacity is the cumula-
spine stability is achieved with ‘‘bal- verse abdominis isolation (hollowing tive work that he or she can perform
anced’’ stiffening from the entire and the like). Adding the specific before pain or troubles begin.
musculature, including the rectus ab- transverse abdominis training reduced For example, someone who can only
dominis and the abdominal wall; efficacy. Instead, the abdominal brace walk 20 m before pain sets in has a low
quadratus lumborum; latissimus dorsi; (contracting all abdominal muscles) capacity. This kind of person will not
and the back extensors of longissimus, enhances stability. Target contraction benefit from therapeutic exercise that is
iliocostalis, and multifidus. Focusing on levels for bracing and training performed 3 times per week; instead,

36 VOLUME 32 | NUMBER 3 | JUNE 2010
he or she has a better chance with 3 motions, postures, and loads. All in- 4. Perform movement screens and
short sessions per day. Corrected formation is used to formulate the tests—Are there perturbed postural,
walking in 3 short sessions per day, exercise progression plan starting with motion, and motor patterns? Do
never exceeding the current tolerance corrective exercise and the starting they move well in daily activities
and capacity, is an alternate approach dosage of tolerable therapeutic exer- such as getting out of a chair or up
to building capacity. Typically, clients cise. This process concludes with off the floor? If not, the trainer
will progress to 1 session per day as functional screens and tests that were should recognize corrective squat,
their pain-free capacity grows and then chosen based on information obtained and lunge training is needed before
be tolerant of a session with their in the preceding process—the assess- any loaded resistance progressions.
trainers. ment process is well documented (29). 5. If the clinical picture is complex and
These results are used to substantiate beyond your comfort zone, develop
INTERPRETING CLIENT
some speculation as to the existence of a referral relationship with a compe-
PRESENTATION
perturbed motion and motor patterns tent corrective exercise specialist.
Our approach to client assessment
and for considering exercise choice and This is reciprocal and will serve you
incorporates a strong biomechanical
rates of subsequent exercise progression. well with more clients in the future.
foundation and blends expertise from
various disciplines. First, an impression Interpreting client presentation AN EXAMPLE OF A PROVOCATIVE
Specific exercise programs for a client TEST THAT IS HELPFUL
is formed from the first meeting of the
client, their sitting posture, how they with back pain are derived from the Provocative testing is a potent tool in
rise from the chair, their initial gait following process (it is assumed that the assessment of back problems and
pattern, and so on. Then, a history is appropriate medical screening has is easily performed. A wide variety of
taken looking for possible candidate transpired): provocation tests together with some
injury mechanisms and perceived pain 1. Observe everything, starting with corrective techniques are in a DVD
exacerbators and relievers. Observation the client rising from a chair. (see Ref. (34)) because the expertise
continues during some basic motion 2. History—link injury mechanisms, gained by viewing the technique can-
patterns as the evaluation process pain mechanisms with specific ac- not be obtained from written text.
proceeds delving further into the tivities, and past exercise regimens. Figure 3 (31) illustrates an example of
mechanics and nature of the symp- Of course, if ‘‘red flags’’ appear, provocative testing for compressive load
toms. Then, provocative tests are make the appropriate referral. tolerance. This posture-modulated tol-
performed to identify motion and 3. Perform provocative tests—what erance test provides powerful informa-
motor patterns that are tolerated. loads, postures, and motions exac- tion and can serve as a guide to avoid
Specifically, we include a range of erbate, what relieve? damaging/exacerbating activity, and it
also helps to design appropriate therapy.
More practical information can be
gleaned from simply asking whether
a client has better and worse days in
relation to pain. Even though it seems
straightforward, it cannot be stressed
enough that if there are indeed better
and worse days, it means that some
activities help and others hurt. Find
out what they are and eliminate the
exacerbating elements. For example, if
prolonged sitting is not tolerated,
avoidance of flexion by using a lumbar
support will help, together with orga-
nizing tasks to eliminate prolonged
sitting. This is known as ‘‘spine hy-
giene’’ and will build more capacity for
Figure 3. An example of provocative testing. The patient compresses the spine by the client to work with you. Specific
grabbing the side edges of the seat and pulling up. When doing this with exercises designed to combat the
an upright back (a), the torso is stiffened with muscle activity. The test is cumulative stresses of sitting should
then repeated in a slouched posture (b); discomfort in this position as then be prescribed.
compared with an upright back shows a lower tolerance when the spine is
flexed (and a flexion intolerant patient). This reveals where the spine REDUCING THE RISK OF INJURY
tolerance is highest, and therefore, a posture to begin therapeutic exercise No exercise professional can be
(i.e., no spine flexion). fully successful without removing the

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Core Training for Better Performance

Figure 4. (a) Curl-up over a gym ball motions stresses the discs, mimics a potent disc injury mechanism, and unwisely uses pain-free
training capacity. (b) The ‘‘stir the pot’’ exercise spares the painful discs of motion and builds abdominal athleticism.

movement flaws that are the cause of LINKING ANATOMY WITH common training approach of curling
back troubles in clients throughout the FUNCTION the torso over a gym ball that replicates
day. Recommendations such as ‘‘when Consider the usual and popular ap- the injury mechanics while not creat-
lifting, bend the knees and keep the proach to train the abdominal wall ing the athleticism that enhances
back straight’’ rarely address the real muscles by performing sit-ups or curl- performance. This is a rather poor
issue, despite their popularity. Few ups over a gym ball for example. But choice of exercise for most situations.
patients are able to use this strategy consider the rectus abdominis where Yet many clients will expect that a gym
in their jobs; furthermore, this is often the contractile components are inter- ball be used. Disguise your intentions
not the best strategy. For example, the rupted with transverse tendons giving with these clients and retain the gym
‘‘golfers lift’’ is much more joint con- the ‘‘6 pack’’ look. The muscle is not ball, but change the exercise from a
serving for repeated lifting of light loads designed for optimal length change but spine compromising curl-up to a plank
from the floor. Here, one leg is raised rather to function as a spring. Why where the elbows are placed on the ball.
behind, the torso tilts forward about a have these transverse tendons in rectus Now, perform a ‘‘stir the pot’’ motion
flexed hip of the stance leg forming a abdominis? The reason is that when to enhance the torso/abdominal spring
fulcrum. No spine or knee bending the abdominals contract, ‘‘hoop and spare the spine—this is often a much
occurs. Another example illustrates the stresses’’ are formed by the oblique superior exercise for most people (see
poor choice of movement strategies for muscles that would split the rectus Figure 4) (41).
a particular task. For example, observe apart (26). In addition to the spring-like
the client who transitions to laying on architecture of the muscle, consider DESIGNING STAGED CORE
the floor by using a deep squat—this how it is used. People rarely flex the rib EXERCISE—BIOMECHANICS AND
CLINICAL PRACTICE
overloads their back. Squatting may be cage to the pelvis shortening the rectus
in sport or everyday activity. Rather Exercise progression is a staged pro-
appropriate for getting off a toilet or
they stiffen the wall and load the hips cess. Several sources are available
chair but not necessarily for dropping
or shoulders—if this is performed (30,40) that expand on the many
to the floor. Instead a lunge that does
rapidly such as in a throw or move- considerations and techniques to hone
not bend the spinal discs may be a
ment direction change, the rectus clinical skills at each stage some of
much more appropriate choice. Again,
functions as an elastic storage and which are listed below.:
this builds capacity for them to ac-
complish more in their training session recovery device. When lifting weights, Stages of progressive exercise design:
with you (see Ref. (30) for full explana- it stiffens to efficiently transmit the 1. Corrective and therapeutic exercise
tion and evidence for spine sparing power generated at the hips through 2. Groove appropriate and perfect
guidelines). Although it is not the the torso. Those individuals who do motion and motor patterns
expertise of this author, ‘‘core stability’’ actively flex the torso (think of cricket 3. Build whole-body and joint stability
training has been shown to be effective bowlers and gymnasts) are the ones (mobility at some joints such as the
for both preventing and rehabilitating who suffer with high rates of spine hips and stability through the lum-
shoulders (21) and knees (16,55). joint damage and pain. Now, revisit the bar/core region)

38 VOLUME 32 | NUMBER 3 | JUNE 2010
4. Increase endurance muscle reintegration helps to unload relatively low levels of contraction.
For occupational/athletic clients: the back. Another critical concept for This is an endurance and motor
5. Build strength this stage of exercise design is that control challenge—not a strength chal-
6. Develop speed, power, and agility technique ‘‘details’’ are important. It is lenge. For many clients wanting to
The first stage of designing the appro- not a matter of client performing an accomplish tasks of daily living pain
priate corrective exercise emanates exercise, but it is a matter of the client free, this is sufficient. In the preceding
from the identification of any per- performing the exercise with perfec- progressions, of course, strength is
turbed motion and motor patterns. tion. Exercise form, subtle maneuvers enhanced as are specific patterns, such
Every exercise is considered within to eliminate pain, pacing, duration, and as the ability to squat, push/pull, lunge,
the working diagnostic hypothesis other coconsiderations are all ex- and so on. But strength is not specif-
such that the first time the exercise is tremely important (51). The next stage ically trained because this requires
performed, it is considered a provoca- in the progressive algorithm is to overload and elevated risk—this is
tion test. If it is tolerated, the client encode movement and motor patterns reserved for performance training.
proceeds. If it is not tolerated, the to ensure stability. Stability is consid- Many people, whether they have
technique is reexamined and adjusted ered at 2 levels—both joint stability (in athletic objectives (such as wanting to
and/or a more tolerable variation is this case spine/core stability) and play golf ) or have demanding occupa-
tried—see Ref. (51) for some examples whole-body stability. Quantification tions will fall into this category.
where technique adjustments with of stability proves that these 2 objec- On the other hand, many clients
stabilization exercise make them toler- tives are fundamentally different and confuse health objectives (minimizing
ate much more challenge but without need 2 different exercise approaches. pain, developing joint sparing strate-
pain. Examples of corrective exercise Our observation is that the 2 types of gies) with performance objectives
are introduced here, although many stability are often confused in the (which require risk) and compromise
are provided in Ref. (33). clinic/gym. Variations of our ‘‘Big 3’’ their progress with specific strength
For example, gluteal muscle activation stabilization exercises (modified curl- training too early in the progression.
retraining based primarily on the up, side bridge, and quadruped bird- Many exercises typically prescribed to
original work of Janda has been honed dog) have been quantified and selected patients with low back pain are done so
in our laboratory (Figure 5). This for their ability to ensure sufficient without the trainer having knowledge
cannot be accomplished with tradi- spine stability and optimal motor of the spine load and associated muscle
tional squat training (37). Chronic back patterns; they spare the spine of many activation levels. For this reason, we
pain tends to inhibit the gluteal injury mechanisms and pain exacerba- have quantified exercises in this way
muscles as hip extensors, and as a result, tors and are designed to build muscle (see Ref. (2,9,19,20)) to allow evidence-
clients create hip extension using the endurance (see Figures 6–9) (49). based decisions when planning optimal
hamstrings as a substituting pattern. Then, specific muscle group endurance exercise progressions. Consider devel-
Subsequent back extension overacti- is enhanced. Spine stability requires oping progressions with some exer-
vating the spine extensors creates un- that the musculature be cocontracted cises shown in Figures 10 and 11
necessary crushing loads. Gluteal for substantial durations but at (14,43).

Figure 5. Chronic back pain tends to cause people to use their hamstring muscles, instead of their gluteals to extend the hip. This
changes patterns that increase spine load when squatting. Performing the back bridge, squeezing the gluteal muscles,
and eliminating hamstrings helps to establish gluteal dominance during hip extension. Clinical cues are presented in
McGill (37)—one is shown here as the trainer palpates the hamstrings, and if they are active, the client is cued to push the
feet with knee extension and externally rotate the hips to ensure gluteal dominance.

Strength and Conditioning Journal | www.nsca-lift.org 39
Core Training for Better Performance

Figure 6. The ‘‘Big 3’’ stabilization exercises selected to create muscle patterns that ensure stability in a spine sparing way include the
curl-up (poor form with too much spine flexion resulting in disc stress is shown in (a)) (better form shown in (b)). Although
we have quantified many variations and progressions, there are several cues for correct form. For example, during the
curl-up, try and remove any motion from the lumbar spine and the cervical spine. Progression included prebracing of the
abdominal wall, elevating the elbows off the floor, and breathing, to name a few.

CAVEATS FOR THERAPEUTIC/ bigger initial gains in progress to- For example Durall et al. (12) docu-
CORRECTIVE EXERCISE ward a pain-free back (see Ref. (42)). mented how training the flexors, lateral
1. Keep the duration of isometric 3. Maintain impeccable form to en- musculature, and extensors of the core
exercises under 10 seconds and hance available strength and main- with the Big 3 in the preseason for
build endurance with repetitions tain the spine in its strongest (most 10 weeks prevented any new back pain
(reps), not by increasing the dura- tolerable) posture. incidents and controlled the pain in
tion of the holds. Near infrared those with a history of pain in a
spectroscopy of the muscles showed CORE EXERCISE AS AN INJURY population of competitive collegiate
that this was the way to build PREVENTION PROGRAM gymnasts. Gymnasts form a high-risk
endurance without the muscles The exercises that form the ‘‘Big 3’’ group for back pain/disorders. In-
cramping from oxygen starvation noted in the previous section have terestingly, similar exercises have
and acid buildup (48). been used by many occupational and been shown to prevent knee injuries
2. Use the Russian descending pyra- sporting groups as part of an injury in female intercollegiate basketball
mid to design sets and reps to make prevention program. players (16).

Figure 7. The beginner’s side bridge (a) is held for sets of 10-second contractions before more challenging progressions are
attempted (b–d). Challenge is added by bridging from the feet and adding more mass to the bridge with arm placement.

40 VOLUME 32 | NUMBER 3 | JUNE 2010
An interesting example is provided
with speed training. Many train speed
by using resistance exercise for
strength gain. But speed technique,
when measured, also usually requires
superior rates of relaxation. This ap-
parent paradox can be exemplified this
way. Consider the golf swing. The
initiation of the downswing involves
some muscle contraction but too much
actually slows the swing. Speed comes
from compliance and relaxation. At
the instant just before ball contact, the
farthest ball hitters in the world then
undergo a full-body contraction that
creates superstiffness throughout the
Figure 8. The superman is a common extensor exercise but imposes double the
entire linkage (45). Then, just as
compressive load on a spine, which is hyperextended compared with the
much more tolerable birddog exercise. The capacity to train the superman quickly the stiffening contraction is
exercise is greatly compromised because pain is usually developed before released to allow compliance, speed in
high levels of training can be achieved. Thus, it is rarely a good choice of the swing follow through. This same
exercise. cyclic interplay between relaxation for
speed and contraction for stiffness is
TRAINING FOR PERFORMANCE (force 3 velocity) development in the measured in the best sprinters in the
Training the back for performance (for spine is usually very risky. Instead, world, the best strikers and kickers in
either athletic or occupational applica- power is developed about the should- mixed martial arts, the best lifters,
tion) requires different approaches and ers and hips to both increase perfor- and so on. Thus, the rate of muscle
objectives than training to fulfill re- mance and to minimize risk to the contraction is only important when
habilitation objectives. Some of the spine and related tissues. Specifically, if the muscle can be released just as
techniques developed in our work with the force in the spine/core is high (e.g., quickly—only a few in the world are
world-class athletes are beyond the deadlifting), then the spine velocity able to do this.
scope of this article and have been (i.e., bending to create muscle length These examples show why traditional
detailed extensively elsewhere (35). change) must be low. If the spine strength training is usually a detriment
These include the progressions from velocity is high (e.g., golf ), then the to performance. Techniques of ‘‘super-
establishing motor control patterns muscle force must be low (particularly stiffness’’ used by strength athletes are
once the appropriate corrective exer- when the spine is deviated). This is important to understand when being
cise was performed, through stability, why the great golfers ‘‘pulse’’ when the mindful of the lower functioning client
endurance, strength, speed, power, and spine is traveling through the neutral who may be able to grasp some of
agility. A note is needed here: power range just before ball contact. these concepts and, for the first time,

Figure 9. During the birddog exercise, making a fist and cocontracting the arm and shoulder is a progression that enhances the
contraction levels in the upper erector spinae (a). This is a better exercise than the superman because the spine loads are
lower; the muscle contraction level can be similar using the ‘‘squares’’ technique (b), and the spine is neutral, not
hyperextended that lowers the load tolerance.

Strength and Conditioning Journal | www.nsca-lift.org 41
Core Training for Better Performance

Figure 10. There are many progressions of exercises to stiffen and balance the anterior chain in a spine sparing way such as
a staggered hand push-up (a) and the rollout (b).

perhaps be able to rise from the toilet Eight essential components of the abdominal wall formed by the
unassisted. In my consulting, I am often superstiffness internal and external obliques and
asked ‘‘How do you design a training 1. Use rapid contraction, then relaxation transverse abdominis, highlighting
program for a gymnast or wrester’’ of muscle. Speed results from relaxa- the need to contract them together
who must produce high force with tion for speed but also stiffness in in a bracing pattern (15).
a deviated spine posture? There are some body regions (e.g., core) to but- 4. Direct neuronal overflow. Strength
several potential strategies, and the tress the limb joints to initiate motion is enhanced at one joint by con-
choice depends on the body type, or enhance impact (of a golf club, tractions at other joints—martial
injury history, current fitness level, hockey stick, fist, and the like) (50). artists call this ‘‘eliminating the soft
and fitness goals of the athlete (to 2. Tune the muscles. Storage and re- spots.’’ Professional strongmen use
name a few). Sometimes, it is necessary covery of elastic energy in the mus- this to buttress weaker joints using
to avoid the injury mechanism (de- cles require optimal stiffness, which core strength (53).
viated spine posture) in training and is tuned by the activation level. 5. Eliminate energy leaks. Leaks are
save the ‘‘bending’’ for the competition. In the core, this is about 25% of caused when weaker joints are
In this way, rigorous training can reach maximum voluntary contraction forced into eccentric contraction
higher levels without injury. An exam- for many activities (4,8,5). by stronger joints. For example,
ple of this approach can be found with 3. Enhance muscular binding and when jumping or changing running
cricket bowlers in Australia who have weaving. When several muscles direction, the spine bending when
reduced injury rates and maintained contract together, they form a com- the hip musculature rapidly con-
performance by limiting the number of posite structure where the total tracts forms a loss of propulsion.
bowling reps but still train other stiffness is higher than the sum of The analogy ‘‘you can push a stone
activities. These newest concepts are the individual contributing muscles but you cannot push a rope’’ exem-
compiled (40). (6). This is particularly important in plifies this principle.

Figure 11. Posterior chain progressions usually begin with pull-ups with the body stiffened.

42 VOLUME 32 | NUMBER 3 | JUNE 2010
Figure 12. The asymmetric kettlebell carry uniquely challenges the lateral musculature (quadratus lumborum and oblique
abdominal wall) in a way never possible with a squat. Yet this creates necessary ability for any person who runs and cuts,
carries a load, and so on. The suitcase carry is another variation suitable for many advanced clients.

6. Get through the sticking points. The passive stretching. Turn your ath- pulse with each stride. However, do
technique of ‘‘spreading the bar’’ letes into Kangaroos. For example, consider stretching to correct left/
during the sticking point in the reconsider if a runner should be right asymmetries shown to be pre-
bench press is an example of stretched outside of their running dictive of future injury.
stiffening weaker joints. range of motion. Many of the great 8. Create shock waves. Make the
7. Optimize the passive tissue connec- runners use elasticity to spare their impossible lifts possible by initiating
tive system. Stop inappropriate muscles or to potentiate them to a shock wave with the hips that is
transmitted through a stiff core to
enhance lifts, throws, strikes, and the
like.

ORGANIZING THE LATE-STAGE
PROGRAM
Finally, consider exercises such as the
squat. Interestingly, when we measure
world-class strongmen carrying weight
or National Football League players
running planting the foot and cutting—-
neither of these are exclusively trained
by the squat (see Ref. (44)). This is
because these exercises do not train the
quadratus lumborum and abdominal
obliques, which are so necessary for
these tasks (53).
In contrast, spending less time under
a bar squatting and redirecting some of
Figure 13. The lateral cable hold begins first with the hands close to the core and then this activity with asymmetric carries
placed further increases the twisting torque challenge (note no twist is such as the farmers’ walk (or bottoms-
allowed). Different levels and distance of the handles to the body modifies up kettlebell carry—see Figure 12) (53)
the challenge. builds the athleticism needed for

Strength and Conditioning Journal | www.nsca-lift.org 43
Core Training for Better Performance

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