One of the biggest problems I see in physical therapy today is how we discuss, describe and ultimately treat spine issues through core stabilization. Often, core stability is oversimplified down to strength, overly tightened muscles and/or being out of shape. Unfortunately, those explanations do not encompass the complexity of what it means to have a stable core or spine. Without the foundational understanding, treatment plans are often targeting the wrong concepts or are missing critical points to truly achieve better spine wellness.
First, it is important to understand the definition of general stability. Stability refers to the ability of a system, structure, or substance to maintain its properties and function over time without changing or breaking down. In other contexts, stability can also refer to the ability to resist change or disruption, or to remain balanced and upright. In the context of engineering and physics, stability can refer to the resistance of a structure or system to external forces or changes in its environment. For example, a bridge may be designed to be stable in order to withstand strong winds and earthquakes. When the above definition is applied to the spine and core, we should already be generating a more complete picture.
The correct definition of core stability: Core or spinal stability refers to the ability of the core muscles of the body, especially those of the abdomen and back, to maintain proper alignment and control of the spine and pelvis during movement. These muscles help to support the spine and transfer force between the upper and lower body, and are essential for maintaining balance, stability, and proper posture.
Good core stability is important for overall physical health and performance, as it helps to protect the spine from injury and strain, and can also improve athletic performance by increasing power, speed, and endurance. Improved sensitivity and responsiveness of muscle control will reduce the overreliance on structures as a means of controlling movement, such as ligaments, intervertebral discs and joint surfaces. Core stability can be improved through a variety of exercises that target the muscles of the abdomen, back, and pelvis.
Note that in the correct definition words such as control, sensitivity and responsiveness are the emphasis. This means that core stability is not just the output of the muscle, but the ability to know where the body is in space, creating a plan in the brain, sending back the correct muscle commands, having the strength to make the correction and then having the muscular endurance to make it useful over time for activity completion. Let’s take a look at the pieces of core stability more closely.
There are several key elements that contribute to spinal stability, including:
Proprioception: Proprioception refers to the body's ability to sense and interpret information about its position, movement, and balance. It is an important aspect of motor control and helps the body to maintain stability and coordinate movement. This information is pulled from peripheral nerves in the muscles, joints as well as from our eyes and vestibular system.
Motor Control: Muscle motor control is the process by which the nervous system regulates and coordinates the contraction of muscles in the body. It is an essential part of human movement and allows us to perform a wide range of tasks, from simple actions like lifting a finger to more complex movements like running or playing a musical instrument. Motor control is a complex process that involves the integration of sensory information from the environment and the body, the processing of that information in the brain, and the activation of specific muscles in response. The nervous system sends signals to the muscles through motor neurons, which stimulate the contraction of muscle fibers.
Adequate Range of Motion: Stiff joints or inflexible muscles can contribute to poor spinal alignment and stability. Adequate flexibility of the muscles and connective tissues of the spine and surrounding areas is important for maintaining proper movement patterns and reducing the risk of injury. Both joints and muscles act as sensors to give the brain more information about the body’s position in space. Dysfunction of joints in the spine may weaken muscles though segmental inhibition and produce further instability. In the peripheral joints, a dysfunctional joint may contribute to reflex inhibition and cause decreased proprioception leading to increased destabilization.
Muscle Strength: Muscle strength is the ability of a muscle or group of muscles to generate force against a resistance. It is an important factor in physical performance to withstand external forces that are moving the spine away from its optimal positioning.
Muscle endurance: Muscle endurance is the ability of a muscle or group of muscles to sustain repeated contractions or to maintain a steady level of force over an extended period of time. Because the majority of human movement is movement over time, improved endurance will allow the core muscles to work more efficiently and protect joints for longer periods of time.
How to Achieve Better Core Stability
In order to start building better core stability, we first need to start with assessing flexibility and joint mobility. Without having a sufficient range of motion at the spine and hips, there will be less input from the periphery. Also, having less joint mobility in the periphery will cause the spine to work harder as a compensatory mechanism. For example, lack of hip mobility will cause the spine to increase its contribution to maining alignment. Furthermore, hypomobile joints will be less responsive when the brain issues corrections. This should be assessed by a skilled physical therapist to understand what parts of the body are lacking mobility and what the restricting barrier(s) are present.
Once proper mobility is achieved, you have to learn to be aware of body position and learn to control it! Therefore, proprioception and motor control are next. When I test patients’ stability I often find these are the most lagging components. Decreased sensitivity of these elements is due to prolonged sitting which “detunes” our responsiveness through decreased use coupled by people's typical deference to more satisfying activities that emphasize strength and endurance. Proprioception can be improved through a variety of exercises that challenge balance and coordination, such as balance boards, wobble boards, or single-leg exercises. These types of exercises can help to strengthen the proprioceptors in the muscles and connective tissues, which can improve overall stability and coordination.
For foundational spinal stability, I use a BOSU extensively with patients. BOSU stands for "Both Sides Up," and it is a fitness training device that is shaped like a half-dome. One side is flat and the other is rounded, and it can be used in a variety of different exercises.
Using a BOSU ball can help improve balance, stability, coordination, core endurance strength. It can also be used to increase the difficulty of various exercises, as the unstable surface of the BOSU ball requires the muscles to work harder to maintain balance and control. It is important to start slowly and gradually increase the difficulty of your BOSU ball exercises as you become more comfortable and proficient. It is also a good idea to have a trained instructor or physical therapist present when starting a new exercise program to ensure proper technique and to reduce the risk of injury.
You can find some great BOSU stability exercises here.
It is also important to challenge the spinal muscles based on their most common role: the endurance to hold the body up against gravity as we move over the world. The spinal stabilizers have multiple muscle fiber types. The predominant muscle fiber type of the spinal stabilizer muscles can vary depending on the specific muscles and their specific roles. In general, however, the spinal stabilizer muscles are composed of a mix of muscle fiber types, including both slow-twitch and fast-twitch fibers.
Slow-twitch fibers, also known as type I fibers, are characterized by their high endurance and ability to sustain contractions over long periods of time. Remember, as a species, we evolved to walk around looking for food under low loads and long durations. Slow-twitch fibers are generally thought to be the predominant fiber type in the spinal stabilizer muscles for this reason. These muscles will help you maintain stability over prolonged periods of time which is their main function. The slow twitch fibers are also the ones that are most affected by prolonged disuse with sedentary jobs. Because people generally sit from 8-10 hours a day, these fibers aren’t being used. In addition, since our exercise routines are generally planned on a schedule of 1-2 hours, we often do not offset our endurance losses.
Fast-twitch fibers, also known as type II fibers, are characterized by their ability to produce quick, powerful contractions. Fast-twitch fibers are generally thought to be less prevalent in the spinal stabilizer muscles, but may still be present in smaller amounts. These fibers will help with momentary activities such as lifting, squating etc. Most patients I assess have adequate strength at the spinal level. Many are already doing exercises that challenge the power fibers. These activities should be incorporated as a part of reloading the spine after control has been established.
To summarize the idea of training to fiber type, I use running as an example. Completing a 40 yard dash or a 26.2 marathon are both forms of running, but their training is vastly different. Sprinting requires short term power to generate speed/power utilizing fast twitch muscle fibers. Sprinters will train for explosiveness and all out strength. On the other hand, marathon running requires lower load, long duration training to achieve distance by challenging the slow twitch fibers with prolonged activities. Sprinting will not make you a vastly better marathon runner and vice versa.
In conclusion, it is important to be aware of all the different components of core stability. By understanding all the elements involved, patients can make better use of their time, effort and money through comprehensive remediation of the most faulty areas. We need to have adequate control of the spine before we can load it. While lifting and loading are parts of activities we tend to enjoy and produce desirable cosmetic results, they often do not address the control element that protects the spine from injury.
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