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Q&A with Australian Health Practitioners
Is a strong core essential for injury prevention?
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I keep on getting injured playing sport and everyone says I need to improve my core stability? How is core stability and how can I improve it? -
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Dr Peter Dun
Chiropractor
Rehab - Sports - X-Ray - Standing MRI - Second Opinions. We provide strategies for chronic and more complex function problems to help restore active … View Profile
Before offering a potentially helpful answer, we need to clarify what we mean by the ‘core’. Core (or corset and shunt) muscles are those whose main role is to maintain skeletal joints in their ideal position with various postures and when guiding the joints through their range of motion when we move – so the joint movements are smooth with no jolting. In order for them to do this job properly, these muscles need to have the maximum mechanical advantage when they contract. This typically means they are quite close to the joints so that when the more superficial muscles do the grunt work of moving us in all sorts of ways, the deeper core muscles can provide control and stability for the joints.
For example, when it comes to the core muscles that provide stability to the lumbar spine – important for protecting both joints and discs from excessive movement – current understanding is that short spinal, pelvic floor, diaphragm and abdominal muscles need to be able to work as a coordinated team. Like many things that the amazing human body does, this is indeed a complex task. While there is a requirement for a minimum degree of muscle strength, research is increasingly showing that timing, order and degree of muscle contraction are the vital ingredients.
So, for a range of injuries that can be classified as overuse or repetitive – such as types of neck/lower back pain, groin/hamstring/shoulder rotator cuff problems among others – it is important that assessment of the integrated stabilising system of the body frame is included in overall injury management. This means that the various ingredients – including muscle contraction timing, order, degree and strength – need to be evaluated by the sports care practitioner. For key faults identified in each case, customised strategies should then be provided that aim to address the faults. This would ideally involve the patient being taught a range of specific exercises where the focus is particularly on performing them with the best quality. The sports practitioner may also need to provide certain manual clinical procedures that aid this process so that the patient is able to achieve better quality postures and movements during their sport.Report this post
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Stewart Hayes
Podiatrist (General)
Stewart Hayes has experience as a podiatrist specialising in the area of “Sports Podiatry” since 1994 (the specialty dealing with biomechanical, sporting & overuse complaints … View Profile
I believe a strong core is the key to a lot of sporting performance. If it is broken down into very simplistic terms, it can be easier to understand.
Watch how Roger Federer hits a tennis ball - it starts from the foot, up through the leg and then the strong, stable core kicks in.
Watch how Julio Cesar Chavez, Jr throws a roundhouse punch - watch his torso contract.
Watch how Usain Bolt runs down the track - he runs with his core and buttocks which throw his legs forward, he then strides over the top of the grounded leg.
The core should never be undervalued in any sporting endeavourReport this post
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Brad McGregor
Exercise Physiologist
Brad is an exercise physiologist specialising in musculoskeletal rehabilitation. Clients include Workcover Qld, Commonwealth Rehabilitation Services and other private insurers. He has worked with athletes … View Profile
Core stability is a term that we hear often these days, however I often wonder how many individuals have a true appreciation for the relevant anatomy, physiology & indeed pathophysiology in conditions such as low back pain.
Many experts (including Professor Paul Hodges) define the ‘inner unit’ as the pelvic floor, diaphragm, multifidus & transversus abdominus. These muscles provide the essential intersegmental stability that provides the stable base from which we can execute our movements. By contrast, the ‘outer unit’ consists of the rectus abdominus, erector spinae, internal obliques & external obliques. These muscles perform a different role in assisting with the production of force.
Where patients often encounter problems is when the ‘inner unit’ doesn't function properly, or doesn't function early enough (in a feed forward manner). In these cases the ‘outer core’ needs to pick up the slack & perform this segmental stabilising role as well as its core (pardon the pun) role of force production. This altered recruitment pattern is at the heart of many issues & it takes some time to recorrect the motor system & the relevant musculature.Report this post
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Ian Montgomery
Exercise Physiologist
Experienced exercise physiologist specialising in musculoskeletal rehabilitation. With over 10 years experience working with clients returning to work after injuries I offer specialised physical conditioning … View Profile
The problem with any questions regarding the importance of “core” stabilisers and their role in injury prevention is in determining what they are and how to test for them. My initial understanding is that original research into delayed onset of activation into core muscles with clients with low back pain was based on slow controlled movements - almost never seen in a functional or sports context. As the body is a dynamic entity and muscles are required to be trained specifically for their purpose (ie. a sprinter doesnt get maximum benefit from slow, controlled strength training), most core training and research requires further clarification and investigation to provide some scientific evidence.
Of interest in understanding the role of various muscles in the stabilising process I have found the research by Dr Stuart McGill to be very informative and evidence based.Report this post
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Dr Peter Dun
Chiropractor
Rehab - Sports - X-Ray - Standing MRI - Second Opinions. We provide strategies for chronic and more complex function problems to help restore active … View Profile
G'Day Ian,
Also important is that we remind ourselves periodically that good research seeks to answer specific questions about a particular topic or field of knowledge and that there are typically many specific questions that need to be answered in order to gain an accurate picture of any topic of interest.
Our understanding of ‘core’ stability, muscle stabilisers and motor control in injury prevention is still incomplete because there are knowledge gaps regarding a range of specific questions awaiting research answers.
Dr Stuart McGill, a spine biomechanics researcher, has expressed concern that widespread misinterpretation of early research on the role of particular muscles in back pain seems to have led to the notion that core health is “all about transversus abdominus”.
As you mention, Ian, muscles are used in the context of humans performing functional / dynamic activities – in sport, work, study, leisure. This is indeed a complex process of muscles acting in a coordinated way as they pull bones and connective tissue (fascia) to gain mechanical advantage in order to position and move the human frame against the force of gravity. So, it is not surprising that clinical interest and research momentum about injury prevention and optimising function is moving in the direction of gaining more understanding about the coordination, relationships and resistance to fatigue of various groups of muscles (rather than just particular individual muscles) during activities involving different levels of skill.
Regards, Peter
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