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Assessing ‘Core Control’ and It’s Relationship to Musculoskeletal Pain.

 

Last month I talked about the fitness industry’s misunderstanding of ’Core Control’ and how many people over use these muscles, teaching them to work incorrectly. 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 hypolordotic 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 or 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.


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 it only gets involved fully when lifting heavy weights and usually needs to be assessed separately. The TVA test is pretty simple:
Have the client lay prone on a matted floor and slide a Sphygmomanometer (blood pressure cuff 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. Ask the client to lift their tummy button off the BP so dropping the pressure on the gauge. For a positive test the client either can’t move the gauge or can but does so by pushing their shoulders and knees into the ground to lift their body up. Either way this is evidence that the client doesn’t know how to use TVA so exercises to address this should be used.


Sagittal Plane 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:


Client lays supine with the legs out straight and the BP under their lower back so the middle of the pillow is at navel level. Pump the BP up to 40 mmHg then have the client tilt their pelvis posteriorly until the gauge reads 60. The client is asked to hold this pressure evenly while they raise and lower one leg at a time. If the gauge drops by more than 10 mmHg the test is a positive. In Pilates there is no feedback gauge used so the clients pin their backs against the floor. 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 clients 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 descended exercise program and build them up from there.


Conclusion.


With a couple of simple assessments we can quickly see where the client is failing in their core control. Once acute rehab strategies are complete, whether that is spinal, knee or shoulder treatment, a course of core strengthening can be the answer to reducing recurrence of the injury. These simple tests give you the tools to rule core control in or out of the rehab protocol and allow the client to gain a full and complete service that keeps them on the road to full recovery.

 

 

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