Core Stability Exercises

Transcription

1 Core Stability Exercises Static Floor Exercises The plank Hold a straight body position, supported on elbows and toes. Brace the abdominals and set the low back in the neutral position. Hold this position for an increasing length of time up to a maximum of one minute. Perform two to three sets. Side Plank Lie on one side, ensuring the top hip is above the bottom hip. Push up until there is a straight bodyline through feet, hips and head. Keep the elbow under the shoulder. Lower under control and repeat on opposite side. Hold this position for an increasing length of time up to a maximum of one minute. Perform two to three sets. The Gluteus Bridge Lie on the floor with your knees bent. Squeeze your gluteus and then push your hips up until there is a straight line through knee and hip to upper body. Shoulders remain on the floor. Beware of rising too high or of flaring the ribs, which pushes the back into hyperextension. Hold this position for an increasing length of time up to a maximum of one minute. Perform two to three sets. Birddog or Superman Start with hands below shoulders and knees below hips. Set your low back into neutral and brace your abdominals slightly. Slowly slide back one leg and slide forward the opposite arm. Ensure that the back does not slip into extension, and that the shoulders and pelvis do not tilt sideways. Hold for up to a maximum of 20 seconds. Slowly bring your leg and arm back and swap sides. Perform 5 to 10 sets.

2 Dynamic Floor Exercises Straight leg raise Lie on your back with knees bent. Set your lumbar spine in neutral and brace the abdominals. Lift one leg up straight in the air and ensure your back does not move. Lift the other leg up keeping your back in place. Keeping one leg in the air, slowly lower the other down to the floor. Only go as far as you can until you feel the lumbar spine start to move. Placing your fingers under your back will help you to gauge when this happens. Keep bracing the abdominals and then lift the leg slowly back up. Repeat with the other leg. Perform 2 to 3 sets of 5 to 10 repetitions, alternating legs Oblique Crunch Lie on your back with right ankle resting on left knee. Right arm is placed on the floor out to the side. Keeping the right shoulder down, curl the left shoulder up to the right knee, Crunch at the top and return slowly, under control; avoid 'head nodding' during the movement: keep head off the floor and look forward throughout. Perform 2 to 3 sets of 15 to 30 repetitions on each side in turn. Side lying hip abduction Lie on your side and set pelvis so your top hip is stacked above lower hip. Roll shoulders forward a little and brace the abdominals to control pelvic position. Lift the top leg slowly up and down, without hitching at the hip. Perform 2 to 3 sets of 20 to 30 repetitions on each side in turn Lying windscreen wipers Lie on your back with arms out to the sides. Lift legs straight up in the air until the hip is at 90 degrees. Set the lumbar spine in neutral and aim to keep it set throughout. Keeping legs straight and maintaining hip angle, move the legs to one side, controlling any movement in the trunk. Go as far as you can in control, keeping your upper back and shoulders on the floor. Bring the legs to a halt, pull them back up to the start position and then over to the other side, under control. The slow side-to-side movement is like a 'windscreen wiper' arc. Perform 2 to 3 sets of 5 to 10 repetitions

3 Static Swiss Ball Exercises Sit and leg lift Sit on a Swiss ball with hips on the top of the ball and feet hip-width apart. Ensure the size of ball is correct, so that knees are level with hips and at 90 degrees in sitting. Relax and find a neutral lumbar spine position. Set this position by lightly bracing your abdominal muscles. Think about good upper back and shoulder posture as you sit (stomach in, chest lifted, shoulders low and relaxed). It is important to hold an upright sitting position - not leaning forward or back. Once you are set, carefully lift one foot a few centimeters off the floor. Maintain your balance, lumbar and pelvic alignments as you hold the position on one leg. Hold for a count of 5 to 10. Perform 5 repetitions each side Supine Bridge Lie on your back with heels on the top of the Swiss ball, hip-width apart to aid stability. Suck in the abdominals and squeeze up from your gluteus, lifting your hips until there is a straight line from heels to upper back. Shoulders and head stay firmly on the floor. Take care not to lift the hips too high or flare the ribs so that your back hyper extends. Hold for 30 seconds and lower. Perform 2 to 3 sets. Gluteus Bridge Lie on your back with your shoulders and head on the top of a Swiss ball; feet on the ground, hip- width apart for stability. Squeezing up from the gluteus, lift hips until there is a straight line running through the knees, hips and shoulders. Do not lift the hips too high or flare the ribs so that your back hyper extends. Hold for 30 seconds and lower. Perform 2 to 3 sets Plank Kneel in front of the Swiss ball and place elbows on the top of the ball in the centre. Slowly roll the ball away from your body until there is a straight line through knees, hips and head and your weight is being supported through your elbows down on to the ball. Once in this position it may be necessary to tilt the pelvis so that it

4 is held in neutral with correct lumbar spine alignment. Be careful not to round off the shoulders: aim for a 'long spine'. Hold at the far point for 30 to 60 seconds. Perform 2 to 3 sets. Back Kneel over a Swiss ball with thighs and stomach in contact with the ball and head and shoulders dipping over the front of the ball. With your back straight and parallel to the floor, position the lumbar spine in neutral and then set your hips so they do not move. Allow the chest to drop and fall over the ball, flexing the upper back. Place your hands at the sides of the head, elbows bent. From this position, lift your chest up, extending your upper back until it is higher than at the starting position. Maintain abdominal contraction throughout to fix the hips and limit hyperextension of the lumbar spine. Perform 2 to 3 sets of 10 to 20 repetitions. Overhead Pulls Start in the press-up position with your shins on the ball and hands shoulder width apart under shoulders. Place knees apart slightly for stability. Set lumbar spine in neutral and ensure that the shoulders are stable with shoulder blades down and chest out. Roll backwards until your hands are above your head, maintaining straight body position and neutral low back. Brace your abdominals and pull yourself forwards to return to the start position. Perform 2 to 3 sets of 5 to 10 repetitions. Squat Thrust Start in the press-up position with shins on the ball, hands shoulder-width apart under the shoulders. Place knees slightly apart for stability. Set lumbar spine in neutral and ensure shoulders are stable with shoulder blades down and chest out. Pull knees to your chest and crunch the abdominals to get an extra flex of the hips and back. Slowly extend knees back, using your abdominals to prevent the hips dropping down. Perform 2 to 3 sets of 10 to 20 repetitions. Dynamic Swiss Ball Exercises Side Crunch

5 Position yourself sideways on the ball, balanced on lower hip with top hip stacked vertically. Brace feet against a wall, one slightly in front of the other for stability. Ensure a straight line through legs, hips and shoulders. Place your hands, elbows bent, by your head. Lift upper body up away from the ball, crunching sideways towards your feet and focusing upon your oblique muscles. Slowly return, under control. Perform 2 to 3 sets of 10 to 20 repetitions. Chop Rotation Kneel, facing forwards, by the side of the pulley column. Handle attachment is set at (standing) head height. Fix the hips square to the front and set your lumbar spine in neutral. Twisting through the waist, turn shoulders towards the pulley column and grasp the handle with both hands. Pull down on the handle, rotating your shoulders away from the column and crunching down. Finish with hands by your hips and shoulders facing away. Hips remain square to the front throughout the movement Perform 2 to 3 sets of 8 to 10 repetitions. Lift Rotation Technique: Kneel, facing forward by the side of the pulley column. Handle attachment is set just below (kneeling) hip height. Fix hips square to the front and set your lumbar spine in neutral. Twisting through the waist, turn shoulders towards the pulley column and grasp the handle with both hands. Pull up on the handle, rotating the shoulders away. Finish with hands above your head and shoulders facing away from the column. Hips remain square to the front throughout

6 Perform 2 to 3 sets of 8 to 10 repetitions. Pulley Crunch Technique. Kneel with your back to the pulley column holding a rope attachment with each hand around your neck. Start with the hips fully extended (i.e. kneeling fully upright) and pelvis set in neutral. Shoulders, hips and knees should all be in line and upright. Focusing on the abdominals, crunch down, pulling the weight and flexing your trunk forward. The arms simply hold on - avoid using them to assist in pulling the weight. Ensure the pelvis remains set and stable throughout: all the movement comes from the spine flexion, so there should be no hip flexion, forward lean or anterior pelvic tilt Perform 2 to 3 sets of 5 to 10 repetitions. Rear Sling Stand on one leg to the side of the pulley column. Handle is attached at below-hip height. Grasp the handle with the hand on the opposite side (opposite to standing as leg). Set perfect posture and pelvic alignment. Brace the core and then pull the weight up and around the body, keeping the elbow straight, so that the arm rotates up and out. Finish with hand above your head and out to the side slightly. The aim is to maintain perfect balance and pelvic alignment as you raise and lower the arm diagonally. Reposition to repeat exercise for opposite leg/arm. Perform 2 to 3 sets of 10 to 20 repetitions. Front Sling Stand on one leg to the side of the pulley column. Handle is attached at above-shoulder height.

7 Grasp the handle with the arm nearest the column (opposite side to standing leg). Set perfect posture and pelvic alignment. Brace your core; pull the weight down and around the body, keeping the elbow straight so that the arm rotates down and round. Finish with hand next to your hip across your body. The aim is to maintain perfect balance and pelvic alignment as you lower and raise the arm. Reposition to repeat with opposite leg/arm. Perform 2 to 3 sets of 10 to 20 repetitions. One-leg one-arm rowing Stand on one leg, facing the pulley column. Handle is attached at waist height. Grasp the handle with the opposite arm (same side as lifted leg). Your hand will be out directly in front of you in the start position. Set perfect posture and pelvic alignment, standing tall with shoulders back. Brace your core; pull on the cable, leading with the elbow in a rowing movement. Finish with hand by your side and elbow behind you. The aim is to maintain perfect balance and pelvic alignment as you perform the rowing movement. Reposition to repeat with opposite leg/arm. Perform 2 to 3 sets of 10 repetitions. Sit-up and throw The athlete either needs a partner to receive and pass the ball, or should perform the exercise in front of a wall and use a medicine ball that will bounce back. Start in the sit-up position (knees bent) with hands up ready to receive the ball. Catch the ball and begin to lower back down. Do not collapse back down, control it with the abdominals and keep hands above the head as you lower down.

8 Once shoulders are touching the floor (keeping head up and eyes forward), reverse the movement. Throw the ball forward and crunch up at the same time. Follow the throwing action and complete the sit-up as fast as possible. Make sure you crunch as you throw so that the abdominals contribute to the force of the throw and help you sit up faster. Men should start with a 5kg ball; women with a 3kg ball. Perform 2 to 3 sets of 10 to 20 repetitions. 45-degree sit, catch and pass Sit up with knees bent and lean back at 45 degrees, as shown in the picture right. Aim to hold a 'lengthened' spine, with lumbar spine in neutral, shoulders' back and neck long and relaxed. It takes a fair amount of control and strength endurance simply to hold this posture perfectly. Aim to get this right before progressing on to the catch and pass. Raise hands in front of your face and receive a pass from a partner, around this height. As you catch the ball you must hold the long spine position. Do not flex the low back or become round shouldered. Gently throw the ball back Men should start with a 3kg ball; women with a 2kg ball. Complete a few passes, holding the position for 30 seconds. Perform 2 to 3 sets Sit and twist pass Sit up as shown in the picture above right. Your feet, knees and hips should remain reasonably still throughout this exercise, the rotation coming from your waist and not your hips. Hold hands to one side ready to receive the ball. Catch the ball to one side and absorb the catch by turning your shoulders further to that side. Reverse the rotation turning back to the middle and release the ball. Continue

9 rotating to the other side; receive the ball the other side and continue. Ensure you can hold good posture throughout the movement, with a long spine and wide shoulders. Men should start with a 4-5kg ball; women with a 2-3kg ball. Perform 10 to 20 repetitions. Kneeling twist pass Kneel upright with good posture (lumbar spine in neutral, chest out, shoulders low). Start with the ball in your hands, twist the shoulders and head round as far as you can. Then, under control, twist around to the other side as far as possible and hand the ball to partner. Turn back to the start position, receive the ball again and continue. The aim of the movement is to rotate through the biggest shoulder turn you have. You can allow the hips to rotate a little with the shoulders, but not too much. You should feel a stretch in the side at the end of each twist. As you gain greater flexibility and stability, you will be able to fix your pelvis square to the front and rotate through an increasingly full range of motion. Men should start with a 5-6kg ball; women with a 3-4kg ball Perform 10 reps then take the ball to the opposite side and repeat One leg twist pass Stand on one leg with hips facing square to the front. Hold medicine ball in one hand slightly out in front. Slowly twist from side to side. The rotation comes from the waist only, head turning with the shoulders.

10 Keep pelvis fixed square and knee in line with second toe throughout. Men should start with a 5-6kg ball; women with a 3-4kg ball. Perform 2 to 3 sets of 10 slow repetitions. Repeat on other leg One-leg dead lifts with rotation Stand on one leg. Flex the free leg a little at the knee to lift it off the floor, but do not flex or extend the hip of the free leg throughout the movement, in order to keep pelvis in control. Hold the ball in front of you. Bend down, flexing at the knee and the hip. Lower down until the ball touches the floor by your foot, all the time keeping your arms straight and without reaching excessively with your upper back (i.e. maintain a reasonably flat back). Stand back up, pushing down through the foot to use your gluteus correctly to extend the hips. Alternate between touching the ball down on the inside and then the outside of the standing foot. This means you are internally or externally rotating the hip on alternate repetitions, challenging control of hip rotation. Keep the knee in line with second toe as much as possible throughout. Men should use a 5kg ball; women use a 3kg ball. Perform 2 to 3 sets of 5 slow controlled repetitions, build up to 10 repetitions. Repeat on the opposite leg One-leg catch and pass Stand on one leg with good posture (lumbar spine neutral, chest out and shoulders wide) and with hips square to the front. Hold hands up ready to catch. Receive catches anywhere within arms' reach. Make sure the passes are varied in their placement. Aim to move arms and/or turn your shoulders only, keeping the pelvis and lower limb stable. Use a 2-3kg ball that is not too big, so it is easy to catch. Start with 30-second bouts of catch and pass on each leg. Perform 2 to 3 sets.

11 The Muscles The deep trunk muscles, Transverses Abdominis (TA), multifidus (MF), Internal Oblique (IO), Para spinal, pelvic floor, are keys to the active support of the lumbar spine. The co-contraction of these muscles produce forces via the "the racolumbar fascia" (TLF) and the "intra-abdominal pressure" (IAP) mechanism which stabilize the lumbar spine, and the Para spinal and MF muscles act directly to resist the forces acting on the lumbar spine. It is not just the recruitment of these deep-trunk muscles, but how they are recruited that is important. Hodges and Richardson (1996) showed that the co-contraction of the TA and MF muscles occurred prior to any movement of the limbs. This suggests that these muscles anticipate dynamic forces that may act on the lumbar spine and stabilize the area prior to any movement. Hodges and Richardson showed that the timing of co-ordination of these muscles was very significant. Training Having identified the key muscles and how they act, the next step is to establish how best to train these muscles. As with any type of strength and conditioning training, the training protocol for improving the function of the deeptrunk muscles must be specific to the task required. This specificity of training must take into account the type of contraction, the muscle fiber type and the anatomical position required. By definition, the deep-trunk muscles act as "stabilizers" and are not involved in producing movements, but instead involve static, or isometric, contractions. Furthermore, they must act as stabilizers continuously throughout everyday activities as well as fitness and sport activities, and so require very good endurance of low-level forces. These muscles do not need to be very strong, but they must be correctly coordinated and capable of working continuously. In addition, we want these stabilizer muscles to act by holding the lumbar spine in the neutral position, which is the correct alignment of the pelvis that allows for the natural 'S' curve of the spine. These characteristics underpin the following deep-trunk muscle training program.

12 The basics Core-stability training begins with learning to co-contract the TA and MF muscles effectively as this has been identified as key to the lumbar-support mechanism. To perform the TA and MF co-contraction, you must perform the "abdominal hollowing" technique with the spine in the neutral position. To do this, use the following guidelines: Start by lying on your back with knees bent Your lumbar spine should be neither arched up nor flattened against the floor, but aligned normally with a small gap between the floor and your back. This is the "neutral" lumbar position you should learn to achieve Breathe in deeply and relax all your stomach muscles Breathe out and, as you do so, draw your lower abdomen inwards as if your belly button is going back towards the floor. Pilates teachers describe this as "zipping up", as if you are fastening up a tight pair of jeans Hold the contraction for 10 seconds and stay relaxed, allowing yourself to breathe in and out as you hold the tension in your lower stomach area Repeat 5-10 times It is vital that you perform this abdominal hollowing exercise correctly otherwise you will not recruit the TA and MF effectively. Bear in mind the following points: Do not let the whole stomach tense up or your upper abdominals bulge outwards, as this means you have cheated by using the large rectus abdominus muscle (the six-pack) instead of TA Do not brace your TA muscle too hard; just a gentle contraction is enough. Remember it's endurance not max strength your are trying to improve Do not tilt your pelvis nor flatten your back, as this means you have lost the neutral position you are trying to learn to stabilize Do not hold your breath, as this means you are not relaxed. You must learn to breathe normally and maintain the co-contraction of TA and MF Use your fingers for biofeedback on either side of your lower abdomen to feel the tension in the TA muscle.

13 Once you have mastered the abdominal hollowing lying on your back, practice it lying on your front, four-point kneeling, sitting and standing. In each position, get your lumbar spine into neutral before you perform the hollowing movement. The next step Having learned to recruit the TA and MF muscles correctly in various positions, which can take anything from one session to one month or more, it is time to move onto simple core stability exercises. These exercises may also involve the oblique muscles, other lumbar muscles and gluteus to assist the TA and MF in maintaining the lumbar spine in a stable neutral position. Lying leg lift stabilization Lying on your back with your knees bent Ensure your back is in neutral Place your hands on your hips for biofeedback Breathe in and relax Breathe out and, as you do so, perform the abdominal hollowing or zipping-up action Once you have established some TA tension, slowly slide your left leg out along the floor until it is straight and then slide it back Your back should not have moved, and your pelvis should not have tilted as you performed this action If your back or pelvis moved, you did not achieve the correct stability Repeat for the other side 10 times each leg Variations include the same exercise with knee lifts up and knee drops out to the side. Again, the aim is to retain a stable lumbar spine in the neutral position as the legs move. The waiter's bow Stand up with good posture, knees soft, lumbar spine in neutral, head up and shoulders back and relaxed Breathe in and relax Breathe out and as you do so perform the abdominal hollowing action

14 Keeping the tension, slowly lean forward from the hips 20 and stop, like a waiter's bow, keeping your back completely straight and long as you lean Hold the lean position for 10 seconds - you will feel your TA and MF supporting you if you hold the correct position Keeping the tension and the alignment, slowly return to your start position Repeat 10 times These exercises are two examples of learning how to keep the spine in neutral, using slow and controlled static contractions of the trunk stabilizer muscles. Notice how technique is vital and the aim is to build up the time you are able to maintain good stability. Getting functional The ultimate aim of core stability training is to ensure the deep trunk muscles are working correctly to control the lumbar spine during dynamic movements, e.g. lifting a heavy box or running. Therefore, it is important that once you have achieved proficiency of the simple core exercises, you must progress on to achieving stability during more functional movements. Try the following two exercises. The lunge Stand with feet hip width apart in front of a mirror Ensure your lumbar spine is in neutral and your back is tall with your shoulders back and head up Lunge forward and bend your knee only halfway down Ensure that your front knee is in line with your toes and your back has remained upright with your lumbar spine in neutral and your hips level Push back up, initiating the movement by pushing down into the floor with your front foot The force from your legs should bring you back up quickly and easily to your start position Your back should have remained totally still and your hips level as you performed the push back Many people wrongly initiate the up movement by pulling their heads and shoulders back first. This extends the lumbar spine, losing the neutral position. Others have

15 problems keeping their pelvis level while performing the lunge. You must learn to use your deep trunk and gluteus muscles to hold your lumbar spine in neutral and pelvis level as you perform the movement up and down. The movement should only come from the leg muscles. The Press up Start from your knees, even if this means it is easy for your upper body, to learn the correct technique Your hands should be slightly wider than your shoulders and your head must be in front of your hands Lift your hips so that there is a straight line from your knees through your pelvis and lower back, through your shoulders and all the way to your head Ensure your lumbar spine is in neutral, using a mirror or a partner/trainer to help you To maintain a neutral spine and a straight back during the exercise, the trunk muscles must provide active support Slowly lower down, bending your arms all the way to the floor. Keep your head still with your neck straight relative to your back Push up, initiating the movement by pressing down into the floor with your hands Your back should remain straight and your lumbar spine in neutral throughout the exercise. These two exercises enable you to learn core stability while performing dynamic movements. By reducing the resistance i.e. doing only half lunges and knee press ups, your are able to focus on the trunk stabilizers and achieving perfect technique rather than working the major muscle groups. The whole essence of core stability training is quality of movement and relaxation. The more you practice, the easier it becomes until you can control your lumbar stability at all times and during complex movements.