Core Rehabiliation
By John J. Brannan, MD
We hear frequently about strengthening our “core” in order to get in shape. The question is what exactly is the “core?” Is it the abdominal muscle group we sometime call our “washboard,” or is it something else. In fact, the “core” is far more than the muscles we strengthen when we do sit-ups.
The core of our body consists of the muscles from the diaphragm above to the gluteal and hamstring muscles below, but also includes the floor of the pelvis, which is important especially in women., and is bordered on the sides by the abdominal muscles in the front, the oblique muscles on the sides, and the paraspinal muscles in the back. So, to strengthen the core, isolated strengthening of the abdominal muscles is inadequate to fully strengthen our core muscles.
So why do we need a strong core? Every human activity involves getting our bodies into position to complete a task. This can be something simple like sitting and typing on a computer, or walking to the bathroom, to complex activities like hitting a golf ball, running, or pitching a baseball. The core of our body positions the limbs in the correct location to complete all of these tasks. It positions the spine and head, which house the neurologic system, to control all of the motions. To complete these tasks faster, more efficiently or more accurately than most, in the case of athletics, the core muscles are even more important. In the case overhead athlete, or one using a racket of golf club, the core muscles are responsible for delivering the forces from the ground to accelerate the arm toward its object. In the case of the running athlete, the core muscles transfer the forces from one leg to the other in order to propel the body quickly and forcefully. A stable core allows the optimal transfer and control of force and motion to the limbs in kinetic chain activities (Kibler.)
There are many different exercise philosophies that strengthen the core muscles. Programs designed by Pilates, McKenzie, McGill, Williams and others all address strengthening the core and other muscle groups. The minimal goal of strengthening the core is to maintain a margin of safety. But for the athlete, or for the patient recovering from a spinal injury, more advanced and aggressive strengthening is necessary. Regardless of he exercise program used, some of the goals of a sound core strengthening are to improve deep, interspinal paraspinal muscles activity and endurance, control the deep abdominal muscles, restore mobility and coordination of the core muscles, and to train motor and postural control mechanisms specific to the exercise or activity of choice.