I’ve been spending quite a bit of time the last few weeks learning about exercise and biomechanics of the body. One of the things I’ve recognized once again is how important it is to have a strong core. Yes, I know. Everyone is talking about core strength these days, but not every fitness guru actually develops core strength efficiently.
Just today I had a patient ask me if there was anything she could do to improve the stability of her spine and I assured her that there was. I always tell patients at the beginning of their care with me that exercise is important but I’ve never suggested any particular regimen, as everyone has different interests and desires. However, core strengthening needs to be the primary task. After the core is strong, other activities can be added. If other activities are engaged in without proper core strengthening, the results can be damaging.
So, what are the core muscles?
- Multifidus (small stabilizer muscles in the back)
- Pelvic floor muscles
- Transversus abdominis (inner layers of your abs, not the outer layers that are strengthened with crunches)
These muscles form walls around the abdominal cavity and they act as a dynamic team. Strengthening one group of muscles will affect the others and they all need to be considered.
NUCCA is an important first step to make sure that the structure is where it needs to be so that the exercises are most effective and do not injure us. After that, the muscles need to be strengthened slowly so that they do not pull the bones out of place.
One of my patients has been trying out Bikram yoga and she has noticed a profound improvement in overall health, strength, as well as stability of her joints. I’ve seen other patients whose low back pain went away after they added exercises with the exercise ball. I’ve felt so much better after I started using the exercise ball as a chair in my office. There is not necessarily one way to strengthen the core. However, the best options are either the use of a very knowledgeable personal trainer or physical therapist, or for most of us it is yoga, Pilates, or Foundation training.
For some information on strengthening each of the core muscles:
Multifidus is strengthened with back extension exercises and exercises on an unstable surface, such as an exercise ball or wobble board.
Pelvic floor muscles are strengthened very carefully and slowly by first becoming aware of where they are and how they move. Once one is aware of how to engage them, subtle movements will begin to strengthen them. Please see my pelvic floor blog post.
Transversus abdominis is strengthened by activating it first above the pubic symphisis and doing plank and push up exercises while pushing the feet into the floor, and by sitting in a “V” position while activating the abs. Because the fibers are transverse instead of vertical like the more superficial abdominals, crunches will do nothing for your core.
Diaphragm is strengthened while breathing properly and deeply. Breathing is to be done through the belly. Breathing is defaulted to the chest during pregnancy and when seated a lot, such as during school or while working at a desk. With poor posture, breathing is re-learned improperly. This needs to be carefully and slowly remedied.