Unit 1 - Anatomy and physiology for health and exercise - Postural and core stability

Question 1

The development of a strong and stable core is considered the key to what?

Answer 1

Is for many the key to improved/pain-free function and sporting excellence.

Question 2

What is the core of a body?

Answer 2

If the arms and legs are discounted, the core is what remains.

Question 3

Movements of the spine and extremities can be divided into what two categories?

Answer 3

physiological and accessory movements

Question 4

What are gross physiological movements responsible for?

Answer 4

Large motions of the body and allowing to perform many functional tasks, such as bending and lifting.

Question 5

What are accessory muscles responsible for?

Answer 5

For controlling movements that occur within a joint. Example → when bending to pick up an object from the floor the spine moves into a flexed position, but there is also accessory movement at each vertebral segment.

Question 6

What is included in the Middle layer muscles?

Answer 6

• the transversus abdominis (TVA)
• internal obliques
• lumbar multifidus
• diaphragm
• pelvic floor

Question 7

What happens when the middle layer muscles contract?

Answer 7

When these muscles contract they create a non-compressible cylinder where the spine is stabilised and forms the working foundation from which the arms and legs can function optimally.

Question 8

What muscles are included in the outer-layer muscles?

Answer 8

• rectus abdominis
• external obliques
• erector spinae
• latissimus dorsi
• the gluteals
• the abductors → form muscle slings

Question 9

The muscle slings of the outer-layer unit contribute to what?

Answer 9

These muscle slings contribute to the ability to maintain an optimal working relationship between joints and to integrate the various body segments for successful motion.

Question 10

What is the functional role of the core?

Answer 10

“The ability of your trunk to support the effort and forces from your arms and legs, so that muscles and joints can perform in their safest, strongest and most effective positions.” - Elphinstone and Pook (1998)

Question 11

What is the main focus of core training?

Answer 11

To address any functional deficit in trunk stabilisation and/or movement in order to provide the necessary spinal support and a strong and adaptable platform for the actions of our extremities.

Question 12

What risks is increased by failure to stabilise/control core movement?

Answer 12

The risk of acute (short term) and chronic (long term) injury to the vertebral column.

Question 13

What Postural deviations create muscular dysfunction around the core and reduce the ability to hold good form and maintain a neutral spine during exercise and activity?

Answer 13

Kyphosis or lordosis, for example.

Question 14

What happens when the exercise increases the forces placed through the joints and the core?

Answer 14

The muscles will shift into their ‘strongest’ positions, which inevitably falls in line with their dominant posture

Question 15

What can too much time in a seated position lead to?

Answer 15

Reductions in core muscle activation and a lack of neural drive, so that even relatively light loads placed upon the core muscles exceed their ability to cope

Question 16

Abdominal obesity shifts the centre of gravity forward which in turn leads to an increased chance of what?

Answer 16

Postural deviations like a lordotic lumbar curve or a swayback posture where the hips are translated forward.

Question 17

What is the core’s passive support?

Answer 17

Ligaments and discs

Spinal discs sit between each pair of vertebrae, providing both shock absorption and an element of support for the spine. Ligaments run the entire length of the vertebral bodies (e.g. the anterior and posterior longitudinal ligaments) and between spinous and transverse processes (interspinous and intertransverse ligaments) and also help guide and support the spinal movement.

However, despite, these passive structures, without its supporting musculature, the human spine is inherently unstable and can only withstand a load of 4-5 lb before it buckles into flexion.

Question 18

What is a basic principle of core stabilisation that during movement?

Answer 18

That a failure to activate local stabiliser muscles will result in excessive forces being placed on these passive structures.

Question 19

Define Intra-abdominal pressure (IAP).

Answer 19

To maintain stability and reduce pressure on the intervertebral discs in the lumbar spine some identifiable core muscles contract simultaneously causing an increase in pressure within the abdomen.

Question 20

If we consider the trunk of the body as a cylinder, and the diaphragm forms the lid, the pelvic floor the base, and the walls of the cylinder are created by the deep abdominals, what happens during contraction of the abdominals?

Answer 20

The walls are pulled in and up while if a deep breath is taken, the diaphragm is lowered, compressing the cylinder and the abdominal contents from the top.

Provided that the pelvic floor (the base of the cylinder) has sufficient integrity, it will resist the action of the diaphragm and the downward displacement of the internal organs (viscera).

In this way, a noncompressible cylinder is created. This gives the torso stiffness and a more rigid structure.

Question 21

When the torso has stiffness and a more rigid structure, it is better able to resist what?

Answer 21

Stresses placed on the lumbar spine, particularly during lifting movements.

The spine is stabilised and forms the working foundation from which the arms and legs can function optimally. As Twomey and Taylor (1987) state, making the trunk into a more rigid cylinder reduces axial compression and shear loads and transmits loads over a wider area.

Question 22

The thoracolumbar fascia (TLF)?

Answer 22

The TLF is a

• broad,
• flat fascial sheath

that stretches across the thorax and lumbar region and is involved in

• passive and
• active stabilisation of the spine.

It serves as an anchor for many muscle attachments, especially that of the TVA, and aids stability for the second to the fifth lumbar vertebrae.

Question 23

What can the function of the TLF be likened to?

Answer 23

The tightening of the strings on a girdle around the waist.

Stability is created by lateral tension or a pulling action from the TVA and internal obliques that is transferred to the fibres of TLF creating a hoop-like tension through the TLF.

This tension produces an extension force on the lumbar spine, which resists the natural pull of lifting movements into spinal flexion.

This phenomenon has been referred to as TLF gain

The TLF can be seen as

• adding to the tension and
• the ability to resist stress placed on the walls of the non-compressible cylinder created by IAP and therefore,
• enhancing our core stability

Question 24

What is a neutral spine?

Answer 24

A neutral position for the lumbar spine is midway between full flexion and full extension as determined by the position of the pelvis.

The greater the anterior tilt of the pelvis, the greater the spinal extension, while

the greater the posterior tilt of the pelvis, the greater will be the degree of spinal flexion.

Question 25

How is a neutral spine maintained?

Answer 25

Exclusively through muscular activity, thereby placing minimal stress on the passive structures of the spine (ligaments and discs).

This is also the best position from which the trunk muscles can work

Question 26

Which outer musculature have an effect to back stability?

Answer 26

The contraction of gluteus maximus muscles via their attachment to the TLF will have the effect of tightening this fascia.

Consequently, an efficient gluteal function is fundamental to back stability.

Question 27

What is abdominal bracing?

Answer 27

The act of tightening or stiffening ones abdominal muscles (as if bracing for a punch in the stomach) is believed (McGill, 2002) to be the most effective method of stabilising the core.

This bracing technique activates a simultaneous or co-contraction of the abdominal and lumbar extensor muscles.

Question 28

How do you teach abdominal bracing?

Answer 28

By stiffening a joint, like the elbow, to demonstrate. Actively stiffen the biceps and triceps and palpate the muscles on each side of the joint to get the idea. This can be practised at different percentages of maximum contractions e.g. 10, 20, 50%.

Once the basic idea has been grasped replicate this co-contraction on the torso. With abdominal bracing the abdominal wall is neither pushed out, nor pulled in.

Here is what you have to do:

• Begin on your back in a relaxed neutral spine position
• Gently contract your abdominal muscles. It is often helpful to imagine you are about to be hit in the stomach and you need to tense your abdominal muscles for protection
• Now try to hold the abdominal contraction as you breathe in and out

Note: It can be helpful in the initial stages to lightly squeeze or press into your abdominal muscles with your hands to feel the muscle contraction. The contraction / stiffness of the abdominal muscles should remain steady with each breath

Question 29

Describe some core equipment and what their function is.

Answer 29

Equipment such as stability balls, BOSU and wobble boards are commonly associated with training for core stability.

They all provide an unstable surface and thereby serve the purpose of amplifying the instability of the user. This enforced instability increases the activation of the core musculature which, has to work harder to provide the necessary stabilisation.

Question 30

When starting with a client in core exercises, what type of exercises would you include in the programme at the beginning, and how would you progress?

Answer 30

First utilising floor-based positions and unstable surface training to address any existing deficiencies in core function.

Clients would then be given more functional exercises in standing positions which seek to place demands on the core in all three planes of motion (sagittal, frontal and transverse).

Question 31

Name reasons for participant exclusion in core stability training.

Answer 31

There are some conditions which, may be aggravated by physical activity and are beyond the scope of their practice.

These would include a prolapsed/bulging intervertebral disc or facet joint syndrome.

Such conditions should be identified during a thorough consultation/screening process.