EXERCISE TECHNIQUES

Core Training
I. Core Fundamentals
II. Core Assessment
1. Prone
2. Supine
III. Core Stability Program Design
1. Progressions
2. Sets, Reps & Duration
V. Core Fitness Program Design
1. Progressions
2. Sets, Reps & Duration
 CORE FUNDAMENTALS
What is the core?
 Can be divided into 2 units
 Outer Unit (mobilizing role)
 Oblique system
 Deep longitudinal system
 Lateral system
 Latissimus dorsi
 Glutes

✰Inner Unit (stabilizing role)

 Transverse abdominus
 Multifidus
 Diaphragm
 Pelvic floor muscles

Functional Soft Tissue Examination and Treatment by Manual Methods – Hammer Pg 443
CORE FUNDAMENTALS
The Inner Unit
Co-contraction of these
muscles stabilize the spine
through the following
mechanisms:
1) Thoracolumbar fascial gain
2) Intra-abdominal pressure
CORE FUNDAMENTALS

Why is the CORE so important?

1. It is the foundation through which the lower &

upper extremities exert their force.
2. Directly linked to predisposition of lumbar and
pelvic pathologies
3. Has significant consequences for energy
consumption during gait and other activities.
 CORE FUNDAMENTALS
Research on Core Training:

 TA (Transverse Abdominals)
contracted before shoulder muscles
in healthy subjects, increasing the
stiffness of the lumbar spine in
anticipation of limb movement.
 Low back pain sufferers showed a
delayed onset of TA contraction. -
Hodges et al, Spine 1996, O’Sullivan P JOSPT 1998

 Multifidus contraction increases

stiffness around the L4/5 segment
more than 66%.
- Wilke et.al,
Spine 20: 192–198, 1995

 Capable of reducing compression of

the lower lumbar discs by as much
as 40 percent.
- Wirhed, R. Athletic Ability &
the Anatomy of Motion. 1984
CORE ASSESSMENT

1. SUPINE
2 . P RO N E
WAYS TO TEST CORE AND INTERNAL

1-Or 10 pound weight

or 2 large Textbooks
2-Elastic band around
belly
CORE ASSESSMENT WITH STABILIZER

1. Prone Activation
 With patient lying prone and cuff centered under navel,
increase pressure to 20 mmHg

 Have patient take a deep diaphragmatic breath and on

exhalation, instruct him/her to draw their belly button toward
their spine. Try to hold the contraction for 100 seconds..

 What happened to the pressure?

DECREASE 10 mmHg
 CORE ASSESSMENT

•Normal TA function = decrease in cuff pressure by 10 mmHg

without any movement of your spine, without flexing your
hips, or pressing your shoulders into the floor.
•You can safely consider that for each 1 mmHg less than 10
mmHg the patient de-pressurizes the cuff, you have a 10%
loss of function. For example, if the patient could only
reduce the cuff pressure 5 mmHg, he/she is probably about
50% deficient in TA function.
CORE ASSESSMENT

Ways to Spot a Cheater

Watch for pelvic tilting

Pressure on hands and feet
Thoracic hollowing
 CORE ASSESSMENT

2. Supine Activation – Part 1

 Start the patient in supine position with knees flexed, and
feet in line with the ischial tuberosities
 Place the cuff under L3-4 and inflate to 40-70 mmHg
(depending on the patient’s lordosis)
 Instruct the patient to take a deep breath in, and without
tilting the pelvis, draw the belly button in toward the spine and
hold the contraction
 What happened to the pressure reading?
NO CHANGE

Watch for posterior pelvic tilt

Check pressure on heels
CORE STABILITY
PROGRAM DESIGN

1. Readiness Position
2. Stability
Progressions
3. Sets, Reps &
Duration
CORE STABILITY PROGRAM DESIGN
Priorities of Core Training
1. Retrain activation of the inner unit (TA &
multifidus).
2. Coordinate activation with outer unit muscles.
3. Maintain stability with an applied load.
4. Maintain stability with slow limb and trunk
movements.
5. Maintain stability with fast limb and trunk
movements.
 CORE STABILITY PROGRAM DESIGN

STOP ALL SIT-UPS & CRUNCHES

Core training begins with learning to
maintain ‘abdominal hollowing’ in various positions.

1. Prone Activation with Arm/Leg Opposition

 With the patient in a prone position, instruct him/her lift to drawn-in and hold.

 Have him/her lift up one arm, then one leg, then opposite arm and leg .
 Repeat 10 times on each side while alternating lifts.
ART OF STABILITY WITH POSTURE
ACTIVATION
CORE STABILITY PROGRAM DESIGN
2. Supine Alternating Leg Lowering
 Place patient in a supine L-position and inflate to 70mmHg
 Have patient lower heel to ground while alternating legs.
 Pressure should stay between 60-80 mmHg
 Lower one leg 10x, switch and then the other.10x. Repeat
for 3 sets. When you can complete all repetitions without
allowing the pressure to drop, move to the following
progressions:
 Alternating straight legs
 Simultaneous bent legs
 Simultaneous straight legs
CORE STABILITY PROGRAM DESIGN
Tips:

 Don’t let the whole stomach tense up or bulge outwards. This

indicates the RA is taking over.

 Don’t brace your TA too hard, remember it’s endurance not max
strength you’re trying to improve.

 Don’t tilt your pelvis or flatten your back. This means you’ve lost
the neutral position.
CORE STABILITY PROGRAM DESIGN
Tips:

 Don’t hold your breath. You must learn to breathe normally

and maintain the contraction.

 Use your fingers of BP cuff for biofeedback.

CORE FITNESS
PROGRAM DESIGN

1. Fitness Progressions
2. Sets, Reps & Duration
REACTIVATION OF CORE

READINESS 6
CORE FITNESS PROGRAM DESIGN
1. Plank
 Start holding for 30s and work up to 1min 30s. Perform 3 sets.
 Progressions: knees, toes, single-legged, on ball
FUNCTIONAL CORE
POSTURE FITNESS