Training the core – what is it and what isn’t it?
The modern concept of core retraining emerged following Hodges research which showed delayed activity of the deep ‘core muscles’ in people with back pain. With this came the boom of the Pilates era and core retraining programs in gyms and elsewhere. Some of these are performed well, but too often the emphasis is on drawing in or pulling up resulting in breath holding and excess muscle activity. A concern that has led to the more recent arguments in the physiotherapy and research world saying “just keep people moving and forget about ‘core retraining'”. But, failing to address the core and change the way it functions leaves patients repeating the patterns of movement that have led to their current problems. Read more about this in a recent blog: the importance of retraining functional movement.
So lets get smart about core retraining!
The function of the core is to coordinate the dual roles of postural support and breathing.
I recommend retraining to start in a supine position to help eliminate the poor postural habits already at play for the client. Ensure the head is supported where necessary so the anterior ribcage can relax.
CORE RETRAINING STEPS
1. Establish healthy diaphragmatic breathing.
To determine if someone is breathing diaphragmatically:
- Position client comfortably in supine, with a neutral spine, knees bent
- Place one hand on the lower abdomen and the other on the chest
- The diaphragm descends with the in-breath, resulting in slight expansion of the abdominal wall and an out-flaring of the lower pole of the thorax. The ribs should move laterally like a bucket handle. There should be minimal expansion of the upper chest.
- The rib cage should not lift!
- The breath should be low and slow, it should feel effortless
2. Generate intra-abdominal pressure (IAP)
- IAP is the generation of pressure in the lower abdomen
- It is generated through the diaphragmatic breath and simultaneous engagement of the innermost layer of the lower abdominal wall and pelvic floor muscles. You should see the umbilicus move slightly southward, without gripping in the upper abdominal wall
- You should notice a slight firming in the lower abdominal wall at the iliac fossa just inferio-medial to the ASIS
- In everyday movement IAP should not exceed 10-15%, but varies according to load.
3. Sustain IAP during normal breathing
- Ensure the breath remains low and slow and there is no lifting of the upper chest
4. Expand the centre or laterally expand the rib-cage
- The expansion of the lower pole of the thorax, laterally and posteriorly across the rib-cage is achieved through increased IAP
- Your client should feel further firming of the lower abdomen when attempting this
- The expansion of the lower pole of the thorax helps prevents gripping of the upper abdominals and bracing the thoraco-lumbar extensors of the spine
- Holding the centre body open helps align the thorax with the pelvis
5. Add limb load challenge and progress to other movements
- When all the steps above can be maintained effortlessly, you can commence carefully adding limb load challenge, such as a knee fold or lifting one leg off the ground
- This movement requires stability of the pelvis and thorax, the pelvis should remain still while the leg is lifted
- This challenge is progressively increased so long as the steps 1-4 can be maintained without additional ‘effort’
- The amount of IAP generated will adjust, but breathing should remain slow and low and the centre should stay expanded. When you see a central cinch, or bracing around the centre you know the movement challenge exceeds the clients ability to control the spine using the deep internal mechanisms
The problem with core retaining is our obsession with the slogan “no pain – no gain”. Instead of establishing a healthy pattern and building on this, practitioners and clients push for more challenge, for abdominal fatigue, the sensation of being worked. In setting the bar too high the client fails to obtain the basic fundamental patterns which results in increased muscle activity and bracing of the spine, rather than improved spinal mobility and coordination.