Balanced Body Movement Principles. How the Body Works and How to Train It Module 2: Trunk Integration. Copyright 2017, Balanced Body Education LLC.

Transcription

1 Balanced Body Movement Principles How the Body Works and How to Train It Module 2: Trunk Integration

2 Trunk Integration Module 2: Key Principles Breathing Core work Transverse Abdominis, Multifidi, Pelvic Floor, Diaphragm Outer unit or lumbopelvic stability Anterior Oblique Sling, Posterior Oblique Sling, Deep Longitudinal System, Lateral System Spinal mobility

3 Trunk Integration The Evolution of Core Training Core Training Panjabi, Richardson, Jull, Hodges et al Functional Movement Gray, Chek, Cook et al Myofascial Slings Anatomy Trains Myers, Schleip, Lee, Vleeming et al Trunk Integration Manual page 20

4 Trunk Integration - Breathing The Importance of Breath The Purpose of Breathing Respiration Enhancing the mind body connection. Creating a rhythm for movement. Manual page 21

5 Trunk Integration - Breathing Anatomy The Anatomy of Breathing The diaphragm is the primary muscle of respiration. Additional respiratory muscles include: intercostals, scalenes, serratus posterior inferior and superior, levator costarum, quadratus lumborum and more.

6 Diaphragm Copyright 2017, Balanced Body Education LLC.

7 Trunk Integration - Breathing How Breathing Works On the Inhale The diaphragm contracts. The dome moves down. The volume of the lungs increases and draws air in. Abdominal pressure increases. Pelvic floor responds. On the Exhale The diaphragm relaxes. The dome moves up. The volume of the lungs decreases and air flows out. Abdominal pressure decreases. Transversus abdominis contracts. Pelvic floor responds.

8 Trunk Integration - Breathing How Breathing Works

9 Trunk Integration - Breathing Breathing Exercises Diaphragmatic Breathing Belly expands, relaxing, calming breath Posterolateral Breathing Expands lung capacity, allows breathing with abdominal stability One Lung Breathing Improves lateral flexion, corrects imbalances Sniffing Breath (PPT Extra) Stimulating, rhythmic breath Manual pages 22-23

10 Trunk Integration The Core The Core or Powerhouse The core, powerhouse or inner unit provides support to the lower spine during dynamic movement. The elements of the core include: Diaphragm Transversus abdominis Multifidi Pelvic floor The core stabilizes the spine through a complex series of interconnections between the fascia, the muscles and the bones. Manual pages 24-34

11 Trunk Integration Lumbopelvic Stability Lumbopelvic Placement -Neutral Position The placement of the pelvis is neutral when the anterior superior iliac spines and the pubic bone are in a plane perpendicular to the ground in standing and parallel to the ground when supine. According to current research in biomechanics, the core or inner unit works best as a spinal stabilizer when the pelvis is in a neutral position.

12 Trunk Integration Lumbopelvic Stability Lumbopelvic Placement In Standing When standing or sitting with a neutral lumbopelvic position, the action of gravity on the core musculature leads to a balanced engagement of the muscles on the front and back of the spine. This decreases the stress on the spine and helps to prevent low back pain and injury. A neutral position should be used in any exercise designed to train clients for upright, functional movement.

13 Trunk Integration Lumbopelvic Stability Lumbopelvic Placement in Supine Neutral placement Imprinted spine flexed lumbar spine with a posterior pelvic tilt Exaggerated lumbar curve with an anterior pelvic tilt

14 Trunk Integration Lumbopelvic Stability Lumbopelvic Placement In Supine Find a neutral position in supine by balancing the muscle engagement on the front and back of the body while maintaining a bony position that is as close to neutral as possible. When lying supine, the pressure of the ground on the back of the pelvis can tilt the pelvis slightly posterior so use muscle engagement rather than just the bony position to optimize the position.

15 Trunk Integration Lumbopelvic Stability Lumbopelvic Placement - Modifications Supported neutral Use a rolled up sticky mat or towel to support the lower back in neutral for: Beginners Who need both support and increased proprioception to learn where neutral is. Clients with unstable lumbar spines To keep the back neutral during challenging exercises. Clients with an increased or decreased lumbar lordosis To support and help relax the low back muscles. PowerPoint Extra!

16 Trunk Integration Lumbopelvic Stability Lumbopelvic Placement Exceptions to neutral The following conditions MAY prefer an imprinted spine and a slightly posteriorly tilted pelvis: Spondylolisthesis (anterolisthesis only) Spinal stenosis Spinal arthritis Some sacroiliac joint dysfunctions Some disc injuries An imprinted spine should only be used to allow clients to perform exercises comfortably and should be discontinued when the client can comfortably maintain a neutral spine position. PowerPoint Extra!

17 Trunk Integration Lumbopelvic Stability Lumbopelvic Placement Imprinted Spine For clients that need to use a slightly imprinted position for comfort: Clients can maintain the position themselves by posteriorly tilting the pelvis. Clients can use a sticky mat, towel or small wedge under the sacrum to passively tilt the pelvis posteriorly. PowerPoint Extra!

18 Trunk Integration Lumbopelvic Stability Lumbopelvic Placement Exercises Pelvic Clock Move the pelvis from 12 to 6 From 3 to 9 Then in circles The goal is to feel the center point where the pelvis is balanced PowerPoint Extra!

19 Trunk Integration The Core Transversus Abdominis The first link in the chain, the transversus abdominis acts like a corset to draw in the abdominal muscles and decrease the diameter of the waist. The fibers of the transversus abdominis wrap horizontally around the abdomen creating the deepest abdominal layer.

20 Trunk Integration The Core Transversus Abdominis Origin: Interior surfaces and costal cartilage of ribs 7-12, lineaalba, lumbodorsal fascia Insertion: Interior surface of iliac crest, lateral third of inguinal ligament Action: Compresses the contents of the abdomen, stabilizes the lumbar spine

21 Trunk Integration The Core Inner Unit Activation Exercises -TA Supine Fingertip Abdominals Place the fingers just inside the ASIS Draw the abdominals toward the spine. All Fours Abdominals Lift the abdominals up toward the spine while maintaining a neutral lumbopelvic position. Manual pages 30-32

22 Trunk Integration The Core The Multifidi and Erector Spinae The next link in the chain is the multifidi. They can be felt as the relatively thin and taut band of muscle just on either side of the midline of the spine. The multifidi connect the transverse processes of each vertebra to the spinous process of the vertebra 3 to 4 levels above. The multifidi and the rotatores fill in the space between the spinous processes and the transverse processes.

23 Trunk Integration The Core Rotatores and Multifidi Origin: Sacrum and transverse processes of lumbar through cervical vertebrae. Rotatores, thoracic vertebrae only. Insertion: Spinous processes of lumbar through 2 nd cervical vertebrae. Rotatoresspan 1 2, multifidi span 2 4. Action: Torso extension, contralateral torso rotation, spinal segmental stabilization

24 Trunk Integration The Core Thoracolumbar Fascia When the transversus abdominis contracts, it creates tension on the thoracolumbar fascia which surrounds the following muscles: Multifidi Erector spinae Psoas Quadratus lumborum

25 Trunk Integration The Core Thoracolumbar Fascia Rectus abdominis External oblique abdominal Psoas major Internal oblique abdominal Quadratus lumborum Transverse abdominis Fascial connections Multifidi Body of L3 Erector spinae Cross section of the torso at L3

26 Trunk Integration The Core Transverse Abdominis & Thoracolumbar Fascia As the TA contracts and tightens the thoracolumbar fascia, the multifidi expand into the fascia creating a stabilizing support around the lumbar vertebrae. The fascia acts like a corset around the multifidi forcing the muscles to elongate vertically as it contracts. This creates axial elongation or decompression of the vertebrae.

27 Muscles of the Spine and Thorax

28 Trunk Integration The Core Inner Unit Activation Exercises -Multifidi Flat Back Bridging Keep the spine relatively neutral as the hips rise to activate the multifidi. Manual pages 30-32

29 Trunk Integration The Core Inner Unit Activation Exercises -Multifidi Standing Multifidi Engagement Do both sides of the spinal muscles fire at the same time? Lunge with Weight Shift The muscles on the back leg side should (maybe) fire more easily.

30 Trunk Integration The Core Pelvic Floor The pelvic floor acts in conjunction with the diaphragm to create the top and bottom of the cylinder formed by the transversus abdominis, the spine and the spinal muscles. The purpose of the pelvic floor is to: Support the contents of the abdomen against the force of gravity. Control urination and defecation. Assist with sexual function. Facilitate childbirth.

31 Trunk Integration The Core The Pelvic Floor

32 Trunk Integration The Core Pelvic Floor Awareness Exercises Standing Anterior and Posterior Pelvic Floor Engagement Notice how different the pelvic floor feels when the pelvis is in a different position. Supine Engagement Add a ball between the knees to increase the activation PowerPoint Extra!

33 Trunk Integration The Core Inner Unit Activation Exercises Pelvic Floor There are currently many conflicting ideas about pelvic floor training. Using verbal cues Using movements that naturally activate the pelvic floor Movements of the hips and legs such as walking, squats, lunges, bridging, side leg lifts and clam shells may be more effective than verbally cueing activation. PowerPoint Extra!

34 Trunk Integration The Core Inner Unit Activation in Standing Squats Use the inner unit to support a neutral lumbopelvic position Knee bends Use the inner unit to support a neutral lumbopelvic position

35 Trunk Integration The Core Core Activation Transversus abdominis and multifidi cocontract to support the spine. Diaphragm organizes the ribcage over the pelvis. All 4 elements work together to create stability of the lumbar spine Pelvic floor stabilizes the pelvis by drawing the bones together from the inside.

36 Trunk Integration The Core Quadratus lumborum and Psoas major In addition to the inner unit muscles, the psoas major and quadratus lumborum play an accessory role in stabilizing or destabilizing the lumbar spine. The psoas major runs along the front of the spine and has many different functions depending on the structure of the individual and the movement being performed. The quadratus lumborumconnects the ribs, spine and iliac crest and is critical in maintaining the balance of the torso in walking and running. PowerPoint Extra!

37 Trunk Integration The Core Psoas Major Origin: Bodies, transverse processes and intervertebral discs of vertebrae T12 and L1-4. Insertion: With the iliacus tendon on the lesser trochanter of the femur. Psoas major Action: Hip flexion, adduction and external rotation. Lumbar extension (maybe flexion) lateral torso flexion, stabilization of the lumbar vertebrae (select fibers) PowerPoint Extra!

38 Trunk Integration The Core Quadratus Lumborum Origin: 12 th rib, transverse processes of lumbar vertebrae Insertion: Posterior iliac crest Quadratus lumborum Action: Spinal lateral flexion, extension, stabilization of the pelvis, ribcage and spine. PowerPoint Extra!

39 Trunk Integration Lumbopelvic Stability Lumbopelvic Stability Lumbopelvicstability is the ability of the neuromuscular system to maintain balance between the rib cage, lumbar spine and pelvis. Good core activation combined with the action of the 4 outer units is required for lumbopelvic stabilization. Maintaining balance and strength in the four outer units is essential for preventing low back pain and for creating efficient and graceful movement patterns. This model is based loosely on the work of Diane Lee, PT, FCAMT, CGIMS.and Andry Vleeming, PhD, PT Manual pages 36-39

40 Trunk Integration Lumbopelvic Stability Lumbopelvic Stability The 4 Outer Units All four muscular systems work together to create harmonious movement of the torso, pelvis and legs. Lateral System Deep Longitudinal System Anterior Oblique Sling Posterior Oblique Sling

41 Trunk Integration Lumbopelvic Stability Deep Longitudinal System Anatomy: The deep longitudinal system includes the erector spinae, quadratus lumborum, thoracodorsal fascia, sacrotuberousligament and the biceps femoris. In the Anatomy Trains system, it also includes the medial hamstrings, gastrocnemius, plantar fascia and toe flexors. Function: This system creates spinal extension and holds us upright against gravity.

42 Trunk Integration Deep Longitudinal System in Action

43 Trunk Integration Lumbopelvic Stability Anterior Oblique Sling Anatomy: Includes the serratus anterior, external oblique abdominal, opposite internal oblique abdominal and opposite adductor muscles. Function: Creates torso flexion and torso rotation as in the Crisscross exercise. Instrumental in creating pelvic stability in exercises like walking.

44 Trunk Integration Lumbopelvic Stability Anterior Oblique Sling in Action

45 Trunk Integration Lumbopelvic Stability Posterior Oblique Sling Anatomy: The posterior oblique sling includes, along one line, the latissimus dorsi, opposite gluteus maximus and opposite external hip rotators. Function: The posterior oblique sling creates torso extension and rotation as well as pelvic stability as in the many Swan exercises.

46 Trunk Integration Lumbopelvic Stability Posterior Oblique Sling in Action

47 Trunk Integration Lumbopelvic Stability Anterior and Posterior Oblique Sling in Action Anterior oblique sling Posterior oblique sling

48 Trunk Integration Lumbopelvic Stability Anterior & Posterior Oblique Slings in Action

49 Trunk Integration Lumbopelvic Stability Lateral System Anatomy: The Lateral System includes the hip abductors, hip adductors and the quadratus lumborum. Function: Responsible for keeping the pelvis balanced over the femurs when walking, running or balancing on one leg. Imbalances lead to an unlevel pelvis when standing on both legs.

50 Trunk Integration Lumbopelvic Stability Adductors Origin: Superior pubic ramus, inferior pubic and ischial ramus. Insertion: Linea asperaon the posterior thigh, medial tibia (gracilis only) Action: Hip adduction, flexion, extension, rotation.

51 Trunk Integration Lumbopelvic Stability Abductors Origin: Ilium and sacrum Insertion: Greater trochanter, posterior thigh and ITB (gluteus maximus only) Action: Hip abduction, extension, flexion rotation.

52 Trunk Integration Lumbopelvic Stability Quadratus Lumborum Origin: 12 th rib, transverse processes of lumbar vertebrae Insertion: Posterior iliac crest Action: Spinal lateral flexion, extension, stabilization of the pelvis, ribcage and spine.

53 Trunk Integration Lumbopelvic Stability Lateral System Imbalances High hip (pelvic upslip) Abductor is long Adductor is short Quadratus lumborum is short Low hip (pelvic downslip) Abductor is short Adductor is long Quadratus lumborum is long

54 Trunk Integration Lumbopelvic Stability Lateral System in Action

55 Trunk Integration Lumbopelvic Stability Lumbopelvic Stability Exercises Marching Place the hands under the sides of the hips to see if the pelvis stays level Toe Taps Marching and Toe Taps Introduce the idea of lumbopelvic stability stability Manual page 41

56 Trunk Integration Lumbopelvic Stability Lumbopelvic Stability Exercises Diagonal Press Hand to opposite inner thigh for Anterior Oblique Sling Press hand and foot into the floor for Posterior Oblique Sling Dead Bug Teaches coordination of the upper and lower body in contralateral patterns Manual page 42

57 Trunk Integration Lumbopelvic Stability Lumbopelvic Stability Exercises Bridging Focus on articulating the spine Keep the pelvis level Spine can be flexed or neutral Bridge with Marching The goal is to keep the pelvis level Manual page 43

58 Trunk Integration Lumbopelvic Stability Lumbopelvic Stability Exercises Swimming One arm Alternating arms One leg Alternating legs Opposite arm and leg Manual pages 44-45

59 Trunk Integration Lumbopelvic Stability Lumbopelvic Stability Exercises Opposite Arm and Leg Reach Provides a quick assessment of all 4 outer units. Deep longitudinal system Line from head to tail Anterior and posterior oblique slings stability of shoulders and pelvis Lateral system note lateral sway of hips Manual page 46-47

60 Trunk Integration Lumbopelvic Stability Lumbopelvic Stability Exercises Standing Diagonal Press Keep the pelvis level. Takes the supine work into a functional position. Standing Marching Keep the pelvis level. Takes the supine work into a functional position Manual page 48

61 Trunk Integration Lumbopelvic Stability Lumbopelvic Stability Exercises Walking Keep the pelvis level. Observe the counter rotation of the torso and pelvis. Running Observe what happens with speed Manual page 49

62 Trunk Integration Spinal Mobility The Purpose of the Spine The purpose of the spine Creating efficient force transfer between the ground, lower body and upper body. Protecting and organizing the spinal cord and nerve roots Maintaining good posture. Creating spinal mobility for efficient, effective and graceful movement patterns Manual pages 50-58

63 Trunk Integration Spinal Mobility Movements of the Spine Flexion Extension Spinal Mobility Lateral Flexion Rotation Copyright 2017, Balanced Body Education LLC

64 Trunk Integration Spinal Mobility Spinal Anatomy The spine is composed of 5 interconnected segments Cervical Spine Thoracic Spine Lumbar Spine Sacrum Coccyx or tailbone 7 small vertebrae connecting the head to the spine 12 vertebrae attached through the ribs to the sternum to form the rib cage 5 larger vertebrae to support the weight of the body 5 fused vertebrae to connect the spine and the pelvis 3 or 4 fused vertebrae that used to be a tail

65 Trunk Integration Spinal Mobility Anatomy of a Vertebra Spinous process Inferior facet Vertebral foramen Lamina Superior facet Pedicle Transverse process Vertebral body

66 Trunk Integration Spinal Mobility Anatomy of an Intervertebral Disc The disc acts as a cushion and allows movement between the vertebrae. It is a common source of injury in lower back problems

67 Bony Landmarks

68 Lumbar Vertebra Primary actions: Flexion, lateral flexion, extension. Rotation is extremely limited.

69 Thoracic Vertebra Primary actions: Flexion, lateral flexion, rotation. Extension is somewhat limited.

70 Cervical Vertebra Primary actions: Flexion, extension, lateral flexion, rotation

71 Axis (C-2) Primary action: Rotation!

72 Atlas (C-1) The atlas is the first cervical vertebra. In classical Greek mythology Atlas held up the world. In our spine the Atlas holds up our head! Sort of the same thing, really. Primary action: Flexion, extension, slight lateral flexion

73 Trunk Integration Spinal Mobility Ranges of Motion in the Spine Copyright 2017, Balanced Body Education LLC

74 Trunk Integration Spinal Mobility Muscles of the Spine Deep spinal muscles Rotatores Multifidi Erector spinae Spinalis Longissimus Iliocostalis Iliocostalis Spinalis Longissimus Copyright 2017, Balanced Body Education LLC

75 Trunk Integration Spinal Mobility Muscles that Move the Spine In addition to the spinal muscles, all of the following muscles are attached to the spine and integrate its motion with other areas of the body. Diaphragm Connects spine to the inside of the ribcage. Abdominals Connect rib cage, spine (through fascial connections of TA and Internal Oblique) and pelvis Psoas major Connects spine to femurs Latissimus dorsi Connects humerus, scapula, spine and pelvis Trapezius Connects head, spine, scapula and clavicle Quadratus lumborum Connects rib cage, spine and pelvis PowerPoint Extra! Copyright 2017, Balanced Body Education LLC

76 Trunk Integration Spinal Mobility Muscles that Move the Pelvis and affect the Spine Hip Extensors Hip Flexors Hip Abductors Hip Adductors Hip Lateral Rotators PowerPoint Extra! Copyright 2017, Balanced Body Education LLC

77 Trunk Integration Spinal Mobility Spinal Mobility Exercises All Fours Cat/Cow Observe thoracic flexion Lumbar extension Integration of pelvis and lumbar Integration of the head and cervical spine Tail Wag Observe lateral flexion Integration of spine, pelvis and hips in lateral flexion Integration of the head and cervical spine Range of motion of the hips in rotation. Manual pages Copyright 2017, Balanced Body Education LLC

78 Trunk Integration Lumbopelvic Stability Abdominal Strengthening Abdominal strength is important for: Creating a strong, stable and balanced torso. Generating power in athletic activities such as golf, tennis, swimming and dancing. Abdominal strength starts with the core or inner unit but the inner unit does not move the torso. In order to create movement the remaining abdominals must be engaged. These are: Internal oblique abdominal External oblique abdominal Rectus abdominis Manual Page 35

79 Trunk Integration Lumbopelvic Stability Internal oblique Origin: Cartilage of ribs 10-12, lineaalba, lumbodorsal fascia Insertion: Iliac crest, lateral third of inguinal ligament Action: Torso flexion, ipsilateral torso rotation

80 Trunk Integration Lumbopelvic Stability External oblique Origin: Outer ribs 5-12 interdigitating with Serratus anterior, linea alba Insertion: Iliac crest, lateral third of inguinal ligament Action: Torso flexion, contralateral torso rotation

81 Trunk Integration Lumbopelvic Stability Rectus abdominis Origin: External surfaces of ribs 5-7, xiphoid process, lineaalba Insertion: Superior surface of pubic symphysis Action: Trunk flexion

82 Trunk Integration Lumbopelvic Stability Spinal Mobility Exercises Abdominal Curls Lift the head from the torso. Observe the difference between keeping the pelvis neutral and allowing a posterior tilt. Oblique Abdominal Curls Focus on rotation around the midline rather than lateral flexion. Manual page 63

83 Trunk Integration Spinal Mobility Spinal Mobility Exercises Rockets Focus on the upper back Maintain abdominal support Mini Swan Focus on the upper back. Lift the chest, press into the pinky side of the hand and slide the shoulder blades down the back. Swan Spread the extension out over the whole spine. Observe mobility in all segments. Manual page 64 Copyright 2017, Balanced Body Education LLC

84 Trunk Integration Spinal Mobility Spinal Mobility Exercises Seated Side Stretch Observe strategy in lateral flexion Position of ribs Apex of lateral flexion Seated Twist Observe strategy in rotation Position of ribs Range of motion to each side. Manual pages 65 Copyright 2017, Balanced Body Education LLC

85 Trunk Integration Spinal Mobility Spinal Mobility Exercises Standing Roll Down Segmental articulation of the spine Bend the knees if necessary Standing Flexion Where does the flexion come from? Does the pelvis participate Manual page 66 Copyright 2017, Balanced Body Education LLC

86 Trunk Integration Spinal Mobility Spinal Mobility Exercises Standing Extension Standing Lateral Flexion Standing Rotation Manual page 67 Copyright 2017, Balanced Body Education LLC

87 Trunk Integration Module 2: Key Principles Breathing Core work Transverse Abdominis, Multifidi, Pelvic Floor, Diaphragm Outer unit or lumbopelvic stability Anterior Oblique Sling, Posterior Oblique Sling, Deep Longitudinal System, Lateral System Spinal mobility Spinal rotation, lateral flexion, flexion and extension

88 Balanced Body Movement Principles Whole Body Movement ( ) Trunk Integration ( ) Lower Body Strength and Power Upper Body Strength and Balance Dynamic Flexibility

89 Balanced Body Movement Principles Moving on to Lower Body Strength and Power!