M.A.P. To Your Core

by Anna DiMarco, Senior Physiotherapist

Over the last two decades, core training/core stability has been a major area of focus within the realms of rehabilitation and performance training. We have come to appreciate the importance of a well functioning core for general movement, strength and stability. Core stability is often defined as the body's ability to control the spine in response to various loads. From this solid, balanced centre, limbs can be moved and weight can be transferred without detrimental effect to the body. Much like the foundation of your home is seen as the central focus of its architectural stability, the core is recognized as the centre of our body's stability. When the core is weak or inhibited, we are more likely to experience either an overuse /repetitive strain injury or an "overload" injury (even when the loads are not technically heavy, like bending down to pick up a fallen potato off the kitchen floor......disc herniation !)

Complexities of the Core There has been much discussion and debate about which muscles constitute the core, how these muscles rank in order of significance, and even some disagreement about the importance and the actual role of the core muscles. For our purposes in this discussion, we will simplify the matter and include in our definition of the core: the abdominal muscles, the diaphragm, the pelvic floor muscles and the spinal muscles. Functionally we could include the muscles of the hip and shoulder girdle as well, but we will leave that for a different discussion. Imagine the trunk to be a pressurized cylinder. The diaphragm is the "lid" of the cylinder; the pelvic floor is the base of the cylinder; the abdominals are the front and the spinal muscles are the backside of the cylinder. These muscles are intimately connected via our motor patterns ( ie they are normally recruited to work together by our brain, unconsciously) and through our fascial connections (the web-like structure beneath the muscle fibres that holds us together). When we inhale, the diaphragm contracts and pushes down into the abdominal cavity. This puts pressure on the abdominal organs which in turn push down into the pelvic floor. The pelvic floor has to descend a little bit in order to receive this pressure, and the abdominal wall has to stretch outwards somewhat. The inhale has created an increase in intra abdominal pressure (IAP) . This increased IAP stiffens and stabilizes the spine. Consider the response of a fully inflated balloon vs. a partially inflated balloon. Which balloon will be much stiffer and resistant to the pressure of your squeezing hands? When the IAP is high, the spine is much more resistant to displacements that may arise from loads ( like reaching, pushing, pulling, or lifting ).When we exhale, these muscles recoil - the pelvic floor rises back up and the abdominal wall flattens. The diaphragm is clearly a key component in spinal stabilization. It has to contract first and then the abdominal wall, the spinal muscles and the pelvic floor follow. The spine is a mechanically complex and architecturally unstable structure to stabillize. It is virtually 24 vertebrae stacked vertically with a bowling ball at the top. As a result, even simple every day movements can cause displacement through shearing or buckling forces unless the core muscles take action to protect the spine. Thankfully, there is a large set of "hard-wired" motor/muscle activation patterns (M.A.P.S.) to meet the stability requirements. These motor activation patterns occur without our conscious effort, much like relaxed breathing, and they occur in anticipation of movement. In other words, our brain is sending out the message to stabilize the spine as soon as we think about moving a limb. However, we have come to recognize that motor activation patterns (M.A.P.S.) which would normally help to stabilize the trunk may become impaired or inhibited altogether in individuals who have a history of low back pain and in those individuals who have dysfunctional breathing patterns. I often refer to these impaired activation patterns as "detours" that the body takes, apparently either to protect itself from pain or because the natural, optimal pattern is not available to it. What is not yet known for certain is whether the detours cause the pain or whether they are a result of the pain. It is, once again, the chicken and the egg dilemma. What we do know for certain is that restoring proper activation patterns is of key importance. This often requires a significant amount of focus and conscious awareness. Some practitioners have labelled this rehab strategy towards spinal stabilization as "grooving" the motor patterns. The idea is that in order for the motor activation patterns to become restored, to become "hardwired" again, they must be practiced repeatedly through pain-free, conscious recruitment via a foundation of basic movements. Once the muscles have "woken up" from their sleepy state, specific skills and movements that are appropriate to the individual's specific situation and physical demands may be pursued with a progressively more difficult exercise prescription. Waking Up a Sleepy Core It is best to seek the guidance of a health care specialist for guidance with particular core deficiencies. However, it is always wise to start with good quality breathing (diaphragmatic or belly breathing....see previous post for further details) some gentle belly bracing, and a dose of pelvic floor activation to wake up the stabilizing system. Lie yourself on a firm surface, knees bent, feet flat to the floor, spine in neutral (pillow under head, natural curve of lower spine present) 1) Inhale through the nose for a 4-5 second count, feeling the belly rise and the ribs expand outwards. Hold for 2 seconds. Exhale for 6 seconds. Repeat 3x. 2) Imagine a line that connects the two front hip bones. Imagine drawing the hip bones towards eachother, as if closing two book covers. Or, imagine gently bracing the belly to prepare for a punch. This is a subtle action. Hold for 3 seconds while you continue to inhale and exhale naturally. Repeat 3x. 3) Females....imagine the pelvic floor as a sheath or hammock that runs front to back and side to side. See it as being suspended from the pubic bone in the front of your pelvis to the "sits bones " in the back, and between the sits bones left to right. Imagine drawing the front of the sheath towards the back, and the back towards the front, left towards right and right towards left . Imagine pulling the sheath up to create a "tent" towards your belly button. Hold 5 seconds. Relax completely. Repeat 3x Males....visualize gently drawing your testicles up and forward into your abdomen ("bring the boys home" as physiotherapist Diane Lee says). Hold for 5 seconds. Relax. Repeat 3x Remember, this is simply a starting point to reconnect to these long lost muscles. The relationship needs to deepen with an appropriately designed exercise program to meet your specific needs. Please seek the guidance of a healthcare professional who can help you to progress appropriately with your core stabilization goals. Stay Strong and Live Well ! Anna