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What is “core stability”?

Core stability refers to the ability of the trunk to provide a foundation for movement of the limbs without inducing strain or injury.

Improving core stability is one of a number of ways of economising movement, enhancing sporting performance and reducing the risk of injury.  Current research shows that low back pain and pelvic girdle pain are often associated with diminished activity in trunk stabilising muscles.

It does appear, however, that trunk stabilising exercises alone are not enough to enhance sporting performance or to prevent or heal an injury, particularly low back pain.  The research shows that we need more than strong trunk muscles; we need more training in the coordination and sequencing of limb and trunk movement to gain functional stability and efficiency of movement.

Pilates (particularly studio pilates and rehab pilates), exercise physiology, osteopathy and physiotherapy can all help in this area.

Why do we need it?

Combining trunk stability exercises with functional stability training has been shown to:

• improve sporting performance;
• reduce the risk of injury; and
• lead to more efficient movement and therefore enhance endurance.

How do I improve my core stability?

The first thing you need to do is become better aware of exactly what your trunk muscles are! Consider the trunk as a cylinder with a roof, a floor, a front wall and a back wall.

How do I improve my core stability?

Boosting your awareness and enhancing the function of these composite muscles should lead to you seeing a significant improvement in your core stability.

To really get a feel for what these muscles are and how they work, try the following low intensity exercises.

Please be mindful that in order to enhance overall sporting performance, trunk stabilising exercises are only part of the equation.  If you would like more information on functional exercise programming for cycling or any other sport, you should look into studio / rehabilitation pilates, exercise physiology or physiotherapy.

Breathing

I can hear you saying, “I already know how to breathe!”  But are you breathing well?

Spare a little time to think about how you breathe and challenge yourself to improve your control.  After all, it is an important component of trunk stability.

• Try placing your hands on your waist then move them upwards until they touch your lower ribs.
• Now position your hands so that your thumbs are around the back of the rib cage, and your fingers at the front.
• As you inhale, visualise the air you breathe in moving into the lower parts of your lungs – into your belly is a good
  starter.  Once you have the hang of this, try to feel each breath expanding into the back and sides of your rib cage
  (where your hands are placed).
• Perform 10 -20 breaths but be sure to breathe easy and avoid deep breaths or you will soon find yourself becoming
  faint.

Pelvic floor muscles – yes, we all have them!

The pelvic floor muscles are an important component of trunk stability. These muscles support all the pelvic organs, bowel, bladder, uterus (women) and prostate (men) and assist in the transfer of weight from the trunk to the limbs.

Studies show that in most people pelvic floor contraction causes simultaneous co contraction of the deep abdominal muscles as well as the diaphragm and deep back stabilising muscles.

• Lie on your back with knees bent and feet on the floor.
• Think of squeezing closed your anus and urethra, and lifting the muscle towards your head.
• Lifting your tailbone forwards and upwards may assist the muscle to engage.
• Keep you bottom and thighs as relaxed as possible.
• Aim to contract the muscle only 30-50% of your maximum contraction.
• Hold the contraction for as long as you can.

It is easiest to turn on your pelvic floor muscles lying on your back with your knees bent and feet on the floor.  Place your hands on your pelvis (below your belly button) with your finger-tips pointing towards the pubis.

Think of squeezing closed the anus and urethra (where your wee and wind passes out).  Combine the squeezing with lifting the muscle towards the head.

There must be a sensation of gently squeezing and lifting of this small set of muscles.  You may also like to try bringing the tail-bone forwards and upwards towards the navel to assist in engaging this muscle.

The pelvic floor muscles are smaller and deeper than most people think, so it is really important to keep your bottom and thighs relaxed as you perform each contraction.

Aim initially to contract this muscle 30 – 50% of your maximum contraction.
Hold the contraction for as long as you can, initially this may only be a few seconds.  With time you should be able to hold this for longer periods.

As you engage your pelvic floor, you may also be aware of the lower abdominal muscles also engaging – a great sign!  This can be felt below the navel where your finger-tips are placed.

Once you have the hang of this, it is possible (and beneficial) to practice turning on your pelvic floor in different situations (sitting, standing, walking, cycling etc).

Deep Abdominals (Transversus Abdominus)

This muscle is like a corset.  As it contracts, it gently draws the trunk inwards.

Consider engaging this muscle by gently drawing the area below your navel inwards, upwards and wide while you lie on your back.  Think of your deep abdominals as an airline seatbelt and tighten them like you would the seat belt.  This contraction should be felt low along the belt line and below it.

Aim to contract this muscle 50% of your maximum contraction and for as long as possible.

Some of you may also notice the pelvic floor contract as your deep abdominals engage – another great sign!

Single leg lift

This is a great exercise to challenge and strengthen the trunk muscles.

• Lie on your back with your knees bent and your feet on the floor.
• As you exhale:
  • engage your pelvic floor and deep abdominals;
  • slowly lift one leg off the floor, hinging from the hip joint and keeping your knee still and thighs relaxed (imagine
    your leg is being lifted by your trunk muscles).
• Inhale, and hold the position.
• As you exhale, slowly return the leg to the starting position, remembering to hinge down from the hip joint.

To progress this exercise, you may lift the second leg up to meet the first leg.  Be sure to maintain the trunk in its position as you do this.  It is common for the body to lurch as you lift the second leg so focus on keeping your trunk and pelvis steady.

Chest lift

This is another great exercise to challenge and strengthen the trunk muscles.

Note: keep your pelvic floor and deep abdominals engaged for the duration of this exercise. If you find this exercise hurts your neck, support your head in your hands as you do it.

• Lie on your back with your knees bent and your feet on the floor.
• As you exhale:
  • engage your pelvic floor and deep abdominals;
  • slowly reach the hands towards your feet, lifting the head and shoulder girdle off the floor, keeping your pelvis in
    the same position, still and quiet;
  • keep your bottom and thighs relaxed.
• Inhale, and hold the position.
• As you exhale, slowly return your upper body to the starting position.

Bridging

This is a great exercise to strengthen the muscles in your trunk, bottom and thighs.

• Lie on your back with your knees bent and your feet on the floor.
• As you exhale:
  • engage your pelvic floor and deep abdominals, allowing your waist to flatten into the mat (the pelvis will rock
    backwards in order to do this);
  • continue to slowly lift the pelvis and lower back off the mat – focus on lifting each vertebrae off the mat one at a
    time until you reach a bridge position.
• Inhale, and hold the position.
• As you exhale, slowly roll down back to the start position, sequentially softening each vertebrae into the mat as you roll down.

To progress this exercise, you may lift one leg once you are at the height of the bridge.  Exhale to lift the leg; inhale to lower it.   Alternate sides and repeat up to 5 times per side before lowering your pelvis back to the floor.

If you having difficulty with any of these exercises, ask your health care practitioner for further advice.

For those who want more information regarding sport specific exercise programming, call your pilates instructor, exercise physiologist, osteopath or physiotherapist.

ABOUT DR AINSLEY LORYCH

Dr Ainsley Lorych is the founder of West End Osteopathy and Pilates in Melbourne’s CBD.  She is a fully qualified and registered osteopath with a background in dance and pilates.

West End Osteopathy and Pilates offers an integrated approach to osteopathy and pilates.  In particular, our pilates instructors can design and lead you through pilates programs tailored to your individual needs.

West End Osteopathy and Pilates also provides myotherapy / remedial massage and yoga classes.

West End Osteopathy and Pilates
Level 3
546 Collins Street
Melbourne VIC 3000

(03) 9939 1289
Web: www.westendosteopilates.com.au

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Bo, Kari, Pelvic floor muscle training is effective in treatment of female stress urinary incontinence, but how does it work?,  International Urogynecology Journal 15 (2004) 76-84, doi:10.1007/s00192-004-1125-0.

Cusi, M.F., Paradigm for assessment and treatment of SIK mechanical dysfunction, Journal of Bodywork & Movement Therapies (2010), doi:10.1016/j.jbmt.2009.12.004.

Elphinston, J., Stability, Sport, and Performance Movement: Great Technique Without Injuryˆ, 2008.

Hodges, P.W., et al., Postural and respiratory functions of the pelvic floor muscles, Neurology and Urodynamics 26 (2007) 362-371, doi:10.1002/nau.20232.

Jansen, J., et al., Resting thickness of transversus abdominis is decreased in athletes with longstanding adduction-related groin pain, Manual Therapy (2009), doi:10.1016/j.math.2009.11.001.

Lee, D.G., et al., Stability, continence and breathing: The role of fascia following pregnancy and delivery, Journal of Bodywork & Movement Therapies (2008) 12, 333-348, doi: 10.1016/j.jbmt.2008.05.003.

Mills, Jonathan D., et al., Original research: The effect of a 10-week training regimen on lumbo-pelvic stability and athletic performance in female athletes: A randomized-controlled trial, Physical Therapy in Sport 6 (2005) 60-66, doi:10.1016/j.ptsp.2005.02.006.

Sapsford, Ruth, Masterclass: Rehabilitation of pelvic floor muscles utilizing trunk stabilization, Manual Therapy 9 (2004) 3-12, doi:10.1016/S1356-689X(03)00131-0.