FUNCTION TRANSVERSUS FUNCTION TRANSVERSUS ABDOMINUSABDOMINUS

SUPPORT OF ABDOMINAL CONTENTS VIA CIRCUMFERENTIAL ARRANGEMENT

BILATERAL CONTRACTION CAUSES DRAWING IN OF ABDOMINAL WALL

CAN WORK WITH MULTIFIDUS VIA TENSION OF THORACOLUMBAR FASCIA

CONTRIBUTES TO BOTH SUPPORTING AND TORQUE ROLES

MULTIFIDUSMULTIFIDUS

MultifidusMultifidus

FUNCTION (MULTIFIDUS)FUNCTION (MULTIFIDUS)

Provides control of shearing forces of intervertebral motion segments

Unique segmental arrangement of multifidus suggests capacity for fine control of movement

Control anterior rotation translation in trunk flexion Continuously active in upright posture compared with

recumbency Provides anti gravity support Active in both ipsilateral and controlateral trunk rotation Stabiliser rather than prime mover

Gluteal StabilizersGluteal Stabilizers

Hip MusculatureHip Musculature Psoas Closed chain vs. open chain

functioning

Works with erector spinae, multifidus & deep abdominal wall

Works to balance anterior shear forces of lumbar spine

Can reciprocally inhibit gluteus maximus, multifidus, deep erector spinae, internal oblique & transverse abdominus when tight

Extensor mechanism dysfunction

Synergistic dominance during hip extension

Hamstrings & superficial erector spinae

May alter gluteus maximus function, altering hip rotation, gait cycle

•Gluteus medius: provides frontal plane stabilization, decelerate femoral adduction , assist in deceleration femoral internal rotation (during closed chain activity)

Gluteus MediusGluteus Medius Provides frontal plane stabilisation in walking

cycle Prevents downward rotation of the pelvis

(Trendelenburg) Allows unsupported leg to swing clear of the

ground Decelerates femoral adduction and internal

rotation Anterior fibres assist the iliotibial tract to flex hip

and stabilise the extended knee

Hip MusculatureHip Musculature Gluteus medius Frontal plane stabilizer

Weakness increases frontal & transverse plane stresses (patellofemoral stress)

Controls femoral adduction & internal rotation

Weakness results in synergistic dominance of TFL & quadratus lumborum

Gluteus maximus Hip extension & external rotation

during OKC, concentrically Eccentrically hip flexion &

internal rotation Decelerates tibial internal

rotation with TFL Stabilizes SI joint Faulty firing results in decreased

pelvic stability & neuromuscular control

Hamstrings Concentrically flex the knee, extend the hip & rotate the

tibia Eccentrically decelerate knee extension, hip flexion &

tibial rotation Work synergistically with the ACL to stabilize tibial

translation

All muscles produce & control forces in multiple planes

Neuromuscular efficiency Ability of CNS to allow agonists, antagonists, synergists,

stabilizers & neutralizers to work efficiently & interdependently

Established by combination of postural alignment & stability strength

Optimizes body’s ability to generate & adapt to forces Dynamic stabilization is critical for optimal neuromuscular

efficiency Rehab generally focuses on isolated single plane strength gains in single

muscles Functional activities are multi-planar requiring acceleration & stabilization

Inefficiency results in body’s inability to respond to demands Can result in repetitive microtrauma, faulty biomechanics & injury Compensatory actions result

Functions & operates as an integrated unit Entire kinetic chain operates synergistically to produce force,

reduce force & dynamically stabilize against abnormal force In an efficient state, the CORE enables each of the

structural components to operate optimally through: Distribution of weight Absorption of force Transfer of ground reaction forces

Requires training for optimal functioning! Train entire kinetic chain on all levels in all planes

The COREThe CORE

Core Stabilization ConceptsCore Stabilization Concepts A specific core strengthening program can:

IMPROVE dynamic postural control Ensure appropriate muscular balance & joint arthrokinematics in

the lumbo-pelvic-hip complex Allow for expression of dynamic functional performance

throughout the entire kinetic chain Increase neuromuscular efficiency throughout the entire body

Spinal stabilization Must effectively utilize strength, power, neuromuscular control &

endurance of the “prime movers” Weak core = decreased force production & efficiency

Protective mechanism for the spine Facilitates balanced muscular functioning of the entire kinetic chain Enhances neuromuscular control to provide a more efficient body

positioning

Postural ConsiderationsPostural Considerations Core functions to maintain postural alignment &

dynamic postural equilibrium Optimal alignment = optimal functional training and

rehabilitation

Segmental deficit results in predictable dysfunction Serial distortion patterns

Structural integrity of body is compromised due to malalignment Abnormal forces are distributed above and below misaligned segment

Neuromuscular ConsiderationsNeuromuscular Considerations Enhance dynamic postural control with strong stable

core Kinetic chain imbalances = deficient neuromuscular

control– Impact of low back pain on neuromuscular control– Joint/ligament injury neuromuscular deficits

Arthrokinetic reflex – Reflexes mediated by joint receptor activity– Altered arthrokinetic reflex can result in arthrogenic muscle

inhibition Disrupted muscle function due to altered joint functioning

Optimum Dynamic FunctionOptimum Dynamic Function

Integrated proprioceptively enriched multi-directional movement controlled by

an efficient neuromuscular system

PROPRIOCEPTIONPROPRIOCEPTION

“Nerve impulses originating from the joints, muscles, tendons and associated deep tissues which are then processed in the central nervous system to provide information about joint position, motion, vibration and pressure”. (Bruckner & Khan 1999)

WHY IS PROPRIOCEPTION WHY IS PROPRIOCEPTION IMPORTANT?IMPORTANT?

–Sub-cortical systems are not under conscious control

–Stabilization response needs to be second nature.

–Sub-cortical systems act faster - rapid muscle reaction times.

–More rapid reaction times can be learnt which may lead to increased stability of the lumbar spine.

•To improve the proprioceptive system in dynamic joint stability it must be challenged.

•Pain-free does not mean cured.

•If the proprioceptive deficit has not been addressed a complete rehabilitation has not been accomplished.

•Mechanically stable joints are not necessarily functionally stable ( eg. ACL reconstruction)

WHAT HAPPENS WHEN THE WHAT HAPPENS WHEN THE SYSTEM GOES WRONG?SYSTEM GOES WRONG?

The Theories

“MUSCLE PAIN SYNDROMES ARE SELDOM CAUSED BY ISOLATED

PRECITATING FACTORS AND EVENTS BUT ARE THE

CONSEQUENCES OF HABITUAL IMBALANCES IN THE MOVEMENT

SYSTEM” (Sahrmann 1993)

REPEATED MOVEMENTSREPEATED MOVEMENTSSUSTAINED POSTURESSUSTAINED POSTURES

ALTERS MUSCLE LENGTH ALTERS STRENGTH ALTERS STIFFNESS ALTERS FLEXIBILITY ALTERS CARTILAGE AND BONE

STRUCTURE – BY OVERLOADING AT COMPENSATORY SITES OF MOVEMENT

POSTURAL DYSFUNCTION

MUSCULAR DYSFUNCTION

STRUCTURAL/SEGMENTAL DYSFUNCTION

PAINPAIN

POSTURE AND PAINPOSTURE AND PAINPoor posture can lead to increased stress on the

stabilising system of the joints (Chek P 1999)Multifidus dysfunction occurs after first

episode acute unilateral LBP (Hides et al 1994)

Multifidus dysfunction does not spontaneously restore following resolution of pain and disability (Hides et al 1996)

Specific retraining does restore dysfunction (Hides et al 1996)

TrA contraction is delayed during normal movements in subjects with low back pain (Richardson et al 1999)

Mulifidus function can be affected by spinal surgery

Atrophy of multifidus has been shown to be more prevalent in post operative patients (Jull, et al 1999)

Sherington’s Law of Reciprocal Inhibition:

Tight Muscles inhibit the functional antagonist.

Leads to Positive Cross Syndromes of the lower or upper limb

Gluteus Maximus and minimus are inhibited in most athletes due to tight psoas (Summer, 1988).

Poor recruitment in the local stabilisers can lead to over-

activity of the global stabilisers to compensate.