Does increasing Core Strength aid in speed of Recovery?

Team 2 Robyn, Vikki and Susan

Core StrengtheningThe Core is like a box Abdominals in the front Paraspinals and gluteals in back Diaphragm roof Pelvic Floor and hip girdle bottom

Lumbar StabilityPassive and Active Stiffness PASSIVE-ligaments and osseous structures (facet joints, pedicle, lamina, pars interarticularis, intervertebral disk, fascia) ACTIVE-muscles (paraspinals, quadratus lumborum, abdominal muscles, hip girdle muscles, diaphragm, pelvic floor)

INSTABILITY HAPPENS WHEN PASSIVE OR ACTIVE STRUCTURES ARE DISRUPTED

Core Muscles PARASPINALS:erector spinae-group of 3 muscles; runs along neck to lower back. Multifidus-under erector spinae they extend & rotate spine. Multifidus-atrophy in people with low back pain QUADRATUS LUMBORUMusually works isometrically to stabilize spine HIP GIRDLE-transfers forces from lower extremity to pelvis and spine

Core Muscles-Abdominals Transverse Abdominis-located under the obliques,is the deepest, wraps around your spine for protection and stability. Activates before limb movement in healthy people and is delayed in people with back pain Internal Oblique-located under the external obliques-runs in the opposite direction and increases intra-abdominal pressure External Oblique-located on the side and front of the abdomen and checks anterior pelvic tilt Rectus Abdominis-located along front of abdomen -strap like muscle over anterior abdominal wall, causes lumbar flexion MOST EXERCISE PROGRAMS OVEREMPHASIZE RECTUS ABDOMINIS AND INTERNAL OBLIQUE WHICH CAUSES AN IMBALANCE WITH WEAKER EXTERNAL OBLIQUE

Core Muscle Strength & Stability Test Start in the plank position-elbows on ground hold for 60 seconds Lift right arm off the ground hold for 15 seconds Return right arm to ground and lift left arm hold for 15 seconds Return left arm to ground and lift right leg hold for 15 seconds Return right leg to ground and lift left leg hold for 15 seconds Lift left leg and right arm off ground hold for 15 seconds Return left leg and right arm to ground Lift right leg and left arm hold for 15 seconds. Return to plank position hold for 30 seconds. If you can complete the test fully you have good core strength If you can not complete the test fully your core strength needs improvement Practice routine 3-4X a week until you improve

START WITH CAT-CAMEL This exercise allows spinal segment motion before more aggressive exercise

STABILIZATION EXERCISE-THE BIG 3 CURL UP SIDE BRIDGE BIRD DOG

CURL UP Breathe in, and zip and hollow. (Breathing out): try to lift your chest off the ground. This is a subtle movement- only the spine at the lower end of your chest bends, and then only a little. Even with this small movement, your upper body has sufficient weight to really challenge those "abs."! Keep the length and width in front of the pelvis, and make sure that the tail bone stays down on the ground (pelvic neutral). (Breathing in): slowly curl back down. Repeat three to five times each side

STABILIZATION EXERCISESIDE BRIDGESide Bridge Lie on side, propped up on elbow, with top foot in front of bottom so both feet are on floor. Contract abs as you raise body, forming a straight line from toes to shoulders. Do all reps, then switch sides. Make it easier Lie with legs bent behind you and raise torso and legs resting on bottom knee. Make it harder From Main Move, rotate body to face floor, supporting yourself on forearms and toes, legs and torso in a straight line. Hold, then rotate back to Side Bridge.

STABILIZATION EXERCISEBIRD DOG1. 2. Assume quadruped position. Brace the abdominals, and at first, practice lifting one hand and the opposite knee just clear of the floor while balancing on the other hand and knee. When you're ready to do the complete exercise, point the arm out straight in front and extend the opposite leg to the rear Hold for 10 seconds then return to hands and knees on ground position.

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Shirley Sahrmann Core Building These moves focus on stabilizing the pelvis and strengthening the lower abdominal area, which is often weakened by pregnancy. These are progressive exercises, so you'll need to master each exercise (performing 20 reps without losing your abdominal contraction) before moving onto the next. Take as much time as you need to progress, even if you only do a few exercises during each workout

Basic BreathLie on your back, knees bent and arms at your sides. Inhale and exhale a few times and focus on keeping a neutral spine (don't flatten the back or arch the back, but find a comfortable place in the middle). Take a deep breath and while exhaling, tighten the abs and pull the navel towards the spine. Concentrate on contracting the muscles below the belly button without flattening the lower back against the floor. When you're able to do this without arching or flattening your back, you're able to stabilize the pelvis and move on to the next exercise.

Sahrmann Exercise #1Lie on the floor with the knees bent. Perform the Basic Breath Keeping one knee bent, slowly slide the other leg out until it's parallel and just a few inches off the floor. Bring the leg back and repeat on the other leg. Once you're able to complete 20 reps on each leg, without losing the abdominal contraction, move to the next exercise.

Sahrmann Exercise #2 Lie on the floor with the knees bent. Perform the Basic Breath and lift one knee towards the chest. Straighten the leg so that it is parallel and about 2-3 inches off the floor. Bring the leg back to start and repeat with the other leg for 5 or more reps. Once you're able to complete 20 reps on each leg, without losing the abdominal contraction, move to the next exercise.

Sahrmann Exercise #3 Perform the Basic Breath as you bring the knees up to a 90-degree angle. Keep one leg bent and lower the other leg towards the floor, tapping the floor with your toe. Complete 1-5 reps on the same leg and then switch sides. Once you're able to complete 20 reps on each leg, without losing the abdominal contraction, move to the next exercise

Sahrmann Exercise #4 Perform the Basic Breath as you bring the knees up to a 90-degree angle. Keep one leg bent and extend the other leg out until it's parallel, but not touching the floor. Repeat on the other leg, working up to 10 reps on each side. Once you're able to complete 20 reps on each leg, without losing the abdominal contraction, move to the next exercise.

Sahrmann Exercise #5

Perform the Basic Breath and bring the legs into the chest. Straighten both legs so that they're perpendicular to the floor. Slowly lower both legs towards the floor, going as far as you can without arching the back. Repeat for 5-10 reps, working up to 20 reps.

Additional core exercises Controlled Trunk Twistexternal oblique muscles are activated with control. Physioball ExercisesPelvic bridging Abdominal crunch Modified push up Prone Superman Balancing while seated Lunge- perform forward and sideways. Add labile surface for greater difficulty factor Patients should be given exercises in sitting, standing and walking\standing positions

Strengthening for treatment of other conditions in older adults Across the spectrum it has been generally agreed that exercise in older adulthood has a positive impact on morbidity, balance, mobility, posture and prevention of falls

In surveying the literature of evidence-based research, it is evident that further study and clinical trials are needed for conclusive treatment programs involving exercise for older adults The research in the study of exercise for older adults is primarily targeted to general strengthening utilizing aerobics, weight bearing and resistance. In surveying the literature there is little mention of specific core strengthening exercise but it appears that core strength is certainly included in the general discussion of improved function in this age group.

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Osteoporosis Osteoporosis is a disease characterized by a decline in bone mass and architectural deterioration of bone tissue. Although both men and women are at risk for osteoporotic changes, it is more common in women and thus more research has been directed at reducing the morbidity in women, particularly post-menopausal women. (1) It has long been recognized that changes in bone mass occur more rapidly with habitual inactivity and results in a downward spiral of physiological changes including bone mass deterioration. Older adults may find it increasingly difficult to continue the kinds of activities that provide adequate load-bearing to maintain bone density contributing to the decline. (3)

Osteoporosis Continued Studies indicate that exercise interventions with individuals with low bone mass density to reduce falls and fractures should include balance, muscle strengthening and weight bearing to improve bone strength and integrity. Balance related exercise and muscle strengthening to increase lower extremity and back extensor strength were found to have positive effects. (4)

No studies were found that addressed core strengthening in particular for the treatment of low bone mass density but the relationship of exercise intervention to the reduction in falls and fall related fractures appears implicitly clear

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Sources 1. Suominen H., Muscle training for bone strength. Aging Clin Exp Res. 2006 Apr; 18(2): 85-93. Abstract. 2. Kado, DM, The rehabilitation of hyperkyphotic posture in the elderly. Eur J Phys Rehabil Med. 2009 Dec: 45(4): 583-93. Abstract. 3. No authors listed. American College of Sports Medicine position stand. Osteoporosis and exercise. Med Sci Sports Exerc. 1995 Apr:27(4): i-vii. 4. D. de Kam, E Smulders, V Weerdesteyn, BCM Smits-Engelsman, Exercise interventions to reduce fall-related fractures and their risk factors in individuals with low bone density: a systematic review of randomized controlled trials.

Parkinsons Parkinsons disease is a progressive neurodegenerative disorder that affects function, movement abilities and quality of life. People with the disorder are twice as likely to have recurrent falls compared to other older people, and as many as 65% will experience an injury secondary to their falls, 33% will sustain a fracture. (1) Historically physical medicine and rehabilitation have not been really involved in Parkinsons disease and few articles have assessed the value of these programs. (2) Recent studies suggest that exercise improves some of the cardinal features of this disease that often resist pharmacologic intervention, including gait, posture and dysarthria. (3) Again no study was found that addressed the effect of specific core strengthening exercise on those with Parkinsons disease.

Parkinsons Continued Of four controlled studies with satisfactory methodology cited in a literature review, it was concluded that exercise would be effective more by reducing daily life disability than by improving Parkinson symptoms such as bradykinesia or tremor. It was noted however that some evidence suggests that exercise resulted in improvement in balance task performance and postural stability. (4) In a study protocol for an upcoming clinical trial it was noted that after a review of the literature it was concluded that there is an urgent need to identify cost-effective evidence based interventions for reducing falls and related injuries for people with Parkinsons disease. (1)

Sources 1. Canning, Colleen G., et al. Exercise therapy for prevention of falls in people with Parkinsons disease: A protocol for a randomized controlled trial and economic evaluation. Address to Clinical and Rehabililtation Sciences Research Group, The University of Sydney. 2009 Jan. Study Protocol. 2. Pelissier, J., Perennou D., Exercises program and rehabilitation of motor disorders in Parkinsons disease. Rev Neurol (Paris). 2000: 156 Suppl 2 Pt 2:190-200. 3. Hirsch, Mark A., et al. Exercise for Management and Treatment of Parkinson Disease. American Family Physician, 2009 June: Letter to the Editor. 4. Dibble, LE, et al. The effects of exercise on balance in persons with Parkinsons disease: a systematic review across the disability spectrum. J Neurol Phys Ther. 2009 Mar;33)1):14-26.

References Akuthota, Venu MD and Nadeler, Scott f< DO; Core Strengthening Arch Phys med Rehabail Vol 85, Supple 1, March 2004 http://exercise.about.com_library_postpartumabs1.htm Hodges PW, Richardson CA. Contraction of the abdominal muscles associated with movement of the lower limb. Physical Therapy, February 1997 Hodges PW, Richardson CA. Relationship between limb movement speed and associated contraction of the trunk muscles. Ergonomics, November, 1997 Arch Phys Med Rehabil Vol 85, Suppl 1, March 2004 http://sportsmedicine.about.com/od/bestabexercises/a/core_test.htm

Conclusion Core strengthening programs have not been well researched. Most studies are prospective, uncontrolled, case series. In 2002 Nadler attempted an evaluation. LBP in male athletes decreased 47%; female athletes LBP slightly increased, possibly due to unsafe exercises ie. Roman chair and did not include recommended exercises in transverse plane. Core strengthening does appear to be effective in the treatment of back pain (Cochrane), but no specific program showed a clear advantage. Core strengthening has a theoretical basis in treatment and prevention of various musculoskeletal conditions. Core strengthening programs appear to be the cusp of innovative new research.