Core Training- Facts, Fallacies and Top

6/15/13
Nick Tumminello’s
Core Training: Facts, Fallacies & Top Techniques Workshop Objectives -­‐  Discover the Performance U approach to core-­‐training. -­‐  Demonstrate the technique and application of the top core training methods used in the Performance U approach. -­‐  Separate Facts from Fallacy about the TvA, Psoas, Posture, Performance and Low Back Pain. Who the heck is Nick Tumminello? §  Live in South Florida §  Owner of Performance University International §  Consultant to several training equipment and clothing manufactures §  Writer / Contributor for over 20 major fitness magazines §  Featured in 2 NY Times Best Sellers §  Featured in ACE PT Manual, 4th Edition §  Produced 12+ DVDs §  International Fitness Presenter §  Trained Pro / Amateur Bodybuilders, Pro / Amateur Figure Athletes, MMA Fighters, NFL Players, and lots of exercise enthusiasts! §  Teach professional mentorships 1
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The BIG Question… What is the “Core”? The “Core” Made Simple! §  The core is your entire torso! (w/o arms & legs) §  All the muscles that surround your spine: Neck, Glutes, Abs, Back, Scapular, Pecs, Obliques, etc. §  The term “The Core”was first published in 1982 by Gajda & Dominquez in their book Total Body Training What is Core Training? “The foundation of Total Body Training is the core, which compromises the muscles in the center of the body. These muscles stabilize the body while in upright, antigravity position or while using the arms and legs to throw or kick. These muscle maintain the body’s structure during vigorous exercises such as running, jumping, shoveling and lifting weights. These muscles also also control the head, neck, ribs, spine and pelvis” 2
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What does the Core do? 3 Primary functions of the Core §  Respiratory (during active expiration) §  To transfer force from the hips to the shoulders. The Core “X-­‐Factor.” Ex: Overhead Press §  To help produce force: Force summation (of all your levers) = Power. Ex: Swinging a Baseball Bat. How we train to enhance the Core’s function: §  We use the SAID principle to design exercises that require the core to do it’s job: Transfer force or Help in Force Summation. “An organism makes specific adaptations to imposed demands” (1) (Mathew & Fox, 1976) “The simplest and most straightforward way to implement the principle of
specificity is to select exercise similar to the target activity with regard to
the joints about which movement occur and the direction of the
movements.”(2)
Dr. Everett Harman, "Essentials of Strength & Conditioning.
§  We use the principle of overload to progress these exercises for continued strength. 3
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The Performance U Approach to… CORE POWER TRAINING The Summation of ALL Your Levers It our belief that the core has an active role, not ( just) a passive role in force production during swinging (a Bat , Racquet, Club, etc.) to throwing and striking. Sports Involve Speed!
“Fighters need to activate muscles
extremely quickly and then be able to
relax them to allow the middle section
(speed generation of the foot) of the
double pulse of activation to happen.”
Dr. Stuart McGill
“This is also applied when Dr. McGill
measured the muscle activities of
great distance hitters in golf. They
are not necessarily the strongest, but
long distance golf hitters have this
wonderful gift of creating a pulse at
the instant the club hits the golf
ball.”(3)
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Research: Tri-­‐Phasic EMG -­‐ Elbow extension movements at speeds ranging from ballistic (FAST) to very slow. -­‐ The results showed that triphasic EMG patterns developed systematically. -­‐ Slow elbow extension movements were produced by a single continuous activation of the agonist triceps brachii muscle. -­‐ Agonist activation became predominantly burst-­‐
like and other components of the triphasic EMG pattern [activation of the antagonist (Ant) and second agonist activation (Ag2)] began to appear. -­‐ At the fastest movement speeds, triphasic EMG patterns (Ag1-­‐Ant-­‐Ag2, Ag1 being first activation of agonist muscle) were always present. (4,5,6) The Take Away… §  Slow (heavy) exercises or isometrics don’t refine the tri-­‐phasic muscle-­‐firing pattern. §  Our “Specific” exercise applications for force summation involve fast speed and Momentum -­‐ Especially Rotary actions! Our Top Fast (MET) Exercises: THROW STUFF! §  MB OH Throw / Step (We don’t do Slams) §  MB Chest Throw w/ Step §  MB Rotary Throws (Punch, Front & Side Scoop) §  MB Reverse Scoop HIT SHI# -­‐  Punching, Elbows, Kicks, Knee Strikes -­‐  Gladiator Twist -­‐  Hammers 5
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Our Top Fast (MET) Exercises Cont.… §  Tight Rotations (MB,ABB, BW) §  Gladiator Twist (w/o bag) §  DB Punches §  KB Rotary swing §  Sprinting Quick review! We use the exercise applications just discussed to: §  Enhance to body’s ability to summate force using all of it’s levers: the Legs, Core and Arms. §  To match the force production patterns of fast, sporting-­‐type actions. “Direction-­‐specific properties of power and agility: Training should match the force production patterns of how athletes move in competition” (7) (Hoffman et al., 2007). §  To refine the tri-­‐phasic EMG firing pattern. Science! “Because sequential kinetic linking plays such a vital role in rotational power, fundamental exercises that enhance trunk and core strength are essential for success. Furthermore, ground reaction forces generated by the large muscles of the lower body provide a base of support to transfer kinetic energy through the core, resulting in a more powerful kinetic link.” (8) Frank J. Spaniol, EdD. Developing Power to Turn, “Core strength does
have a significant effect
on an athlete's ability to
create and transfer
forces to the
extremities” (9)
(Shinkle, Nesser, et al.
2012.)
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The Performance U Approach to… CORE STRENGTH
TRAINING We use 2 types of Core Strength Training: §  Integrated: Compound Core (CCT) & Core Limited (CLT) §  Targeted (focusing on specific muscles of the core) One of the MANY Common Fitness Training CONTRADICTIONS: -­‐ “I train movements, not muscles” -­‐ “Integrated (complex) exercises before isolated (simpler) exercises” -­‐ “We start each workout with specific “core” exercises because the core is the most important part of the body.” The Performance U training approach applies the SAME training logic to everything we do! 7
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Full Spectrum Core Strength Training: -  FSCT approach prioritizes Core Limited
Strength (CLT) and Compound Core exercise
applications.
- It does NOT “prioritize” the Bench Press (1 of
the 3 “big” lifts), but it is still used because it’s a
great pushing exercise. -­‐  Can your core control the force you can create? (the muscle imbalance no one talks about!) -­‐ The TRUTH About the Bench Press… The Truth About the Bench Press: -­‐  This study compared the standing cable press (SCP) and the traditional bench press (BP) to better understand the biomechanical limitations of pushing from a standing position together with the activation amplitudes of trunk and shoulder muscles. -­‐  In addition, the model predicted that pushing forces from a standing position under ideal mechanical conditions are limited to 40.8% of the subject's body weight. -­‐  For the 1RM BP, anterior deltoid and pectoralis major were more activated than most of the trunk muscles. In contrast, for the 1RM single-­‐arm SP, the left internal oblique and left latissimus dorsi activities were similar to those of the anterior deltoid and pectoralis major. -­‐  Our EMG findings show that SCP performance is limited by the activation and neuromuscular coordination of torso muscles, not maximal muscle activation of the chest and shoulder muscles. (10) Santana JC, Vera-­‐Garcia FJ, McGill SM. J Strength Cond Res. 2007. The Take Away! -  Unless you’re a powerlifter or
training for a Bench Press (combine)
test; the bench press is just another
compound exercise application – it’s
not magic - to strengthen your chest,
shoulders and triceps.
-  Squats & Deadlifts are awesome
because they are CLT!
-  We feel the best “core training” is
infused with pushing, pulling,
squatting, etc. movements. (The
SAID Principle)
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One-­‐Arm Push ups (Done Better than Rocky Displayed) Our Top CCT & CLT Exercises PUSHING
PULLING
§ - Push Ups
§ - BO rows
§ -1A Push Ups
§ -1A Free Standing Rows
§ -1A Cable Presses
§ -1A Cable Rows
§ -OH Presses (DB or BB)
§ -1A Compound Rows
§ -DB Uppercuts
§ -1A Motorcycle Rows
§ -Angled Barbell Presses
§ (Split Stances)
Our Top CCT & CLT Exercises § ROTATION
§ LOWER BODY (R&LCOM)
§ - Cable Chops
§ - BB Squats
§ -Plate Corkscrew
§ -1A Lunges
§ -DB Plank Row
§ -Deadlifts (DB,BB, Trap Bar)
§ -DB Uppercuts
§ -Front Squats
§ -1A Cable Press
§ -Zercher Squats & Lunges
§ -1A Farmers Walks (lateral)
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Our Top 3 Hybrid CCT Exercises: §  TGUs (partials) §  Cable Tight Chops (High, Mid, Low) §  Animal Patterns SCIENCE! “The activation of the abdominal and lumbar muscles was the greatest during the exercises that required deltoid and gluteal recruitment… An integrated routine that incorporates the activation of distal trunk musculature would be optimal.” (11) Gottschall JS et al. J Strength Cond Res. 2013 The Performance U approach to… TARGETED ABS EXERCISES 10
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We Use Targeted Abs Exercises to gives us what the other stuff didn’t! §  Build up the hardware! (To better Dissipate Force) §  CCT Work is mostly (anti) Rotary and Lateral. We integrate in some targeted work (mainly) for the anterior core (i.e. the Abs). TOO DAMN EASY! Here’s what we do instead: §  For Upper-­‐Abs: SB Plate Crunches (w/ stretch) §  For Lower-­‐Abs: Reverse Crunches Your abs work together as a unit, but the upper and lower abs are separately innervated and you can be maximally load from the bottom up, or from the top down. 11
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Your Abs don’t Flex your spine when standing? SCIENCE!!! “The Swiss ball roll-­‐out and Swiss ball pike were the most effective exercises in activating upper and lower rectus abdominis, external and internal obliques, and latissimus dorsi muscles, while minimizing lumbar paraspinals and rectus femoris activity.” (12) Escamilla et al. J Orthop Sports Phys Ther 2010. -­‐ Don’t forget about the research on core exercises that involve the hips and shoulders. Our Top 10 (Targeted) Abs moves: §  Medicine Ball Roll out §  Swiss Ball knee tuck (modify for disc issues) OR § 
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§ 
§ 
§ 
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Swiss Ball Pike (+ Roll Back) Stir the Pot Pallof Press (2.0,Linear, lateral) BB Rainbow Leg Lowering Posterior Reaches Ab Snails MB Side Lean MB Around the World 12
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Coaching Tips on using Abs Exercises §  For Increased Lordodic Individuals we use: Swiss Ball Pike, Leg lowering, Linear Pallor Press (Rev crunch; if using flexion) §  For Decreased Lordodic individuals, we use: Roll outs, Bodysaw, Posterior Reach (SB Sit up; if using flexion) REMEMBER! YOUR CORE IS YOUR ENTIRE TORSO! If you want a truly strong core -­‐ Don’t forget to… Strengthen Those Lats §  Works with the glutes to “squeeze” on the spine. (Porterfield & Serosa) §  Only muscle to connect shoulders and pelvis. §  Biggest/Strongest muscle in the upper-­‐ torso. §  Do your Chin ups, Lat pull downs, Rows, etc.: 13
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Strengthen Your Upper/
Mid-­‐back! §  Mid/Lower Traps, Rhomboids, Serratus §  Your shoulders work with your hips – ”The serape effect” Do your Horizontal rows (seated, BO, etc.) Y’s,T’s, etc. Strengthen Your Pecs and Serratus! §  Your Pecs and Serratus are linked (through facial connections) to your obliques. (Porterfield & DeRosa) §  Do your Pushing exercises! §  “Great abdominal exercises are the ones that involve some shoulder movement” Carl DeRosa Strengthen your Lower-­‐Back and Glutes! §  Do your Deadlifts, Hip Thrusts, Good-­‐Mornings, etc. §  Shout out to Bret Contreras! 14
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Strengthen Your Neck! §  Neck Supports Your Head (Brain talks to body through the neck) §  Injury Prevention/ (Concussion protection -­‐ Football, Rugby, etc.) §  Combat Sports (Boxing, MMA, wrestling, etc.) §  Pain Reduction: "Specific strength training exercises led to significant prolonged relief of neck muscle pain, while general fitness training resulted in only a small amount of pain reduction.” (13) Arthritis Care & Research, January 2008; 59:1; pp. 84-­‐91. §  Upper-­‐Traps, Focus on Neutral Neck/Head Position §  Do your shrugs and neck work (Athletes) Sample Neck Exercises -  Use band at neck for planks
-  Shoulder Shrugs
The TRUTH About the TvA! 15
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Slides Adapted from Mark Comerford! KineticControl.com PerformanceStability.com Transversus Abdominis Two General Types of Core Muscles
Classifications
Local Muscles
(Inner-Unit)
Global Muscles
(Outer-Unit)
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Global Mobility Muscles (Outer Core) Function §  generates force to produce range of movement §  concentric acceleration of movement ( sagittal plane: power) §  High load shock absorption and stability §  activity is especially phasic (on:off pattern) §  direction dependent (review: Comerford & Mottram 2001) (14)
© Primal
Pictures
Local (Inner Core) Stability Muscles Function §  muscle stiffness to control segmental translation §  no or minimal length change in function movements §  anticipatory recruitment in all directions prior to functional loading provides protective stiffness §  activity is continuous and independent of the direction of movement (review: Comerford & Mottram 2001) (14)
Lumbar Local Cylinder Local ‘Inner Core’ §  Transversus abdominis §  Segmental multifidus §  Posterior psoas §  Diaphragm §  Pelvic floor 17
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Core Cylinder – expanded concept Local (inner) Core
• 
• 
• 
• 
• 
• 
transversus abdominis
segmental multifidus
posterior psoas
pelvic floor
diaphragm
Global (outer) Shell
global stabilisers
•  oblique abdominals & anterior psoas
•  superficial multifidus & semispinalis
•  trapezius & serratus anterior
•  global mobilisers
Pelvis & Scapula (girdles)
link the limbs to the core
•  Gluteals, iliacus, stab adductors
•  G-H rotator cuff, deltoids
Local Muscle System
§ 
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§ 
§ 
§ 
§ 
§ 
§ 
Deepest, 1 joint Minimal force, stiffness No/min length change Does not produce or limit range of motion Controls translation Maintains control in all ranges, all directions, all functional activities Tonic recruitment with low load and high load activities No antagonists (NOT Inhibited) (adapted Rood)
Global Muscle System
§  Deep 1-­‐joint (stabilisers) or § 
§ 
§ 
§ 
§ 
superficial multi-­‐joint (mobilisers) Force efficient Concentric shortening to produce range (mobilisers) Eccentric lengthening or isometric holding to control range (stabilisers) No translation control Direction specific ∴ antagonist influenced (adapted Bergmark)
The TRUTH About Presetting the TVA in the gym “If movements are planned, slow and the CNS can predict potential displacement, there is no need to consciously pre-­‐contract TVA. Even in the presence of back pain when TVA is delayed, it automatically activates within 50-­‐90ms of starting to move the arm, leg or spine. There are almost no situations in the gym when load will be taken faster than this.” Comerford (2006) (15) 18
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The Take Away! TVA is NEVER “off” unless you are dead or paralyzed! Recruitment Threshold differences Local Muscles Low Threshold §  SMU dominant Slow / Static and Sustained (low load, non-­‐
fatiguing) Global Muscles High Threshold §  FMU dominant Fast or Fatiguing (high load) The Facts Don’t Lie! “1-­‐3% increase in muscle tension in the deep local muscles can significantly increase stiffness about a motion segment.” McGill & Cholewicki (1996) (16) “As little as 25% of the max voluntary contraction of the muscle around a joint is needed to provide optimal stiffness (and stability) around that joint.” Hoffer & Andreassen (1981) (17) 19
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Core Muscle Activation During Normal Activities “During standing and walking the trunk muscles are minimally activated [42]. In standing the deep erector spinal, psoas and quadratus lumborum are virtually silent! In some subjects there is no detectable EMG activity in these muscles. During walking rectus abdominis has a average activity of 2% maximal voluntary contraction (MVC) and external oblique 5% MVC [43]. During standing “active” stabilization is achieved by very low levels of co-­‐
contraction of trunk flexors and extensor, estimated at less than 1% MVC rising up to 3% MVC when a 32 Kg weight is added to the torso. With a back injury it is estimated to raise these values by only 2.5% MVC for the unloaded and loaded models [44]. During bending and lifting a weight of about 15 kg co-­‐contraction increases by only 1.5% MVC [45].” Dr. Eyal Lederman, The Myth of Core Stability (18) The Take Away!!! §  It is not possible to maintain a transversus dominant recruitment pattern and move! §  As soon as you move -­‐ (even if you maintain a hollowing contraction of the lower abdominal wall ) ... you have global (oblique abdominal) dominant recruitment pattern Mark Comerford Non-­‐functional specific recruitment – Motor control training §  (Hodges & Richardson 1996 1997, Hodges et al 1999, Hides et al 1996 2001,O’Sullivan 2000, Jull 2000, Hodges & Tsao 2007 – 2008) (19-­‐26) §  The above have all demonstrated : ú  that specific, non-­‐functional, cognitive low load, motor control training (low abdominal wall hollowing) can correct the timing delay in TrA that is consistently associated with LBP. ú  that functional strength movements do not improve the TrA timing delay in the short term ú  that core stability & core strengthening exercises do not improve the TrA timing delay in the short term 20
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Core Stability vs. Strength §  Stability = Prevent unwanted motion. §  Stability does NOT mean “don’t move.” §  Static holds just build “isometric strength.” (SAID principle) §  The way we teach joint stability during movement is by using movement. TvA Review
§  TvA is never off! §  TvA is never weak, it’s late! – Only w/LBP §  No need for NLBP to Draw in, ever! §  Posture does not change TvA function. §  It’s impossible to move (exercise) and stay TvA Dominant §  You cannot strengthen TvA – It’s timing issue. §  Use Abdominal Brace (or let your body handle it) in the gym, not a draw in! Is Changing Timing the LBP Solution? Rolling? “No study to date has shown that back pain is due to timing differences in specific muscle such as transversus abdominis. These control changes have been observed only in individuals who already have back pain. They probably represent the outcome rather than the cause of back pain .” (27) Lederman, Fall of the PSB Model “Measurement studies have demonstrated that cognitive, non-­‐
functional, low threshold motor control retraining, can more effectively recover the timing delay in the short term… Specific motor control retraining can reduce symptoms and recurrence of low back pain.” (28) Mark Comerford 21
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The TRUTH About the PSOAS Psoas Major Psoas major segmentally connects the lumbar spine, pelvis (sacro-­‐iliac joints) and femur (hip joint) Psoas Major: Myths & Misconceptions Function based on theory & assumption §  (very little direct measurement) §  Very few papers are of high quality §  Many have been misinterpreted §  Anatomy texts are 25yrs out or date Mark Comerford (29) 22
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Psoas -­‐ Fascial Relationships §  Psoas fascia is continuous with the diaphragm fascia §  Psoas fascia is continuous with the pelvic floor fascia Gibbons (1999) (30) Psoas is a part of the Inner-­‐Unit! Posterior Fascicles Psoas Major Local ‘Inner Core’ §  transversus abdominis §  segmental multifidus §  posterior psoas §  pelvic floor §  diaphragm Lumbar Local Cylinder Local ‘Inner Core’ §  transversus abdominis §  segmental multifidus §  posterior psoas §  pelvic floor §  diaphragm 23
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Psaos Myth vs. Reality §  MYTH Psoas can get short/tight and cause LBP or “Your Psoas is too strong/
overactive!” §  REALITY Psoas is a local, low load muscle (minimal length change and force, etc.) See chart for review of Local vs. global Local Muscle System
§ 
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§ 
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§ 
§ 
§ 
§ 
Deepest, 1 joint Minimal force, stiffness No/min length change Does not produce or limit range of motion Controls translation Maintains control in all ranges, all directions, all functional activities Tonic recruitment with low load and high load activities No antagonists (NOT Inhibited) (adapted Rood)
Global Muscle System
§  Deep 1-­‐joint (stabilisers) or § 
§ 
§ 
§ 
§ 
superficial multi-­‐joint (mobilisers) Force efficient Concentric shortening to produce range (mobilisers) Eccentric lengthening or isometric holding to control range (stabilisers) No translation control Direction specific ∴ antagonist influenced (adapted Bergmark)
The Take away!!! §  The Psoas works with your Inner-­‐Unit, not against it! §  The Psoas is a part of the inner-­‐unit! – It mirrors your Multifidus §  The Psaos is primarily a spinal stabilizer, not a mobilizer! §  Psoas does NOT get short or tight due to its design/role as a low load, local stability muscle! 24
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Lines of Action of Psoas Major Line of pull is too close to axis of rotation to contribute to flexion, extension or lateral flexion. (31) §  More suited for eccentric control of spinal movements §  EMG activity does not mean PSOAS
muscle provides movement (Adapted Bogduk, 1997)
  Nobody questions psoas as a hip flexor Psoas Major: Fiber Orientation Fascicle Length ú  10 -­‐ 15 cm ú  similar within individuals Fiber length:
ú  Anterior fascicles: 3-­‐8cm ú  Posterior fascicles: 3-­‐5cm §  Psoas can shorten between ú  1cm -­‐ 1.5cm (posterior) ú  1 -­‐ 2.25cm (anterior) §  Unable to produce sufficient L5
Anterior L3
range or force to be an effective hip flexor The TRUTH!!! Psoas is NOT a Hip Flexor! 25
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The proof is in the Bursa! Muscles that act like pulleys have a bursa (underneath) to deal with the pulley action/friction. Who has a bursa under it: illiacus or psoas? Relationship to Iliopectineal Bursa Relationship to Iliopectineal Bursa 26
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Psoas Major: Biomechanical Function -­‐ Research Support Lumbar Spine ú  Minimal movement function on the lumbar spine ú  Primary force on lumbar spine is axial compression –  (Bogduk et al, 1992) (32) SIJ ú  Resultant force of posterior rotation of the innominate ú  + axial compression
(Gibbons et al, 2001) (33) Hip •  Primary force on hip joint is axial acetabular compression
(Adapted: Bogduk et al, 1992) (32)
Psoas: Compression & Shear Forces §  It is claimed that Psoas produces too much anterior shear §  Compression & shear are consistent findings §  But: Compression is always > shear ú  3: 2 or > ú  3:1 or > with Internal Ab Pressure (IAP) estimates (Rab et al, 1977; Bogduk et al, 1992; Santaguida and McGill, 1995) (34,32,35) The Take Away… Psoas does NOT place anterior shear forces on the Lumbar spine! 27
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Psoas Conclusion §  Psoas is your friend! §  Psoas (along with Multifidus) is the only muscle in the body that mechanically stabilizes the disc because it attaches to the disc (anterior aspect). §  Anything that causes you to pull your femur up into the pelvis is psoas training. It’s a spine and Hip stabilizer! Core Strength & Stability as it Relates to Posture & Low Back Pain: Claims vs. Evidence Spinal Curvatures & LBP: A 2008 systematic review of more than 50 studies found no association between measurements of spinal curves and pain. “Differences in regional lumbar spine angles or range of motion between the segments failed to show an association with the future development of LBP” (Hellsing,1988b;Burton&Tillotson,1989; Hamberg-­‐ van Reenen, 2007, syst. rev.; Mitchell et al., 2008) The spinal “neutral zone” & LBP: “No study exists to show a correlation between mechanical changes in the neutral zone changes and LBP” (Leone et al., 2007, review) Taken from Lederman, Fall of the PSB Model. (27) 28
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Pelvic Position, Lumbar Curve, Abdominal Strength, Psoas Tightness & LBP “No relationship to exist between pelvic angle, lumbar lordosis, and abdominal strength” Orthop Sports Phys Ther. 1995 May;21(5):287-­‐95 & Phys Med Rehabil, 1997; 78:1215-­‐23. The researchers (in another study) urge physical therapists to “avoid prescribing therapeutic exercise programs of abdominal muscle strengthening in patients with low back pain based solely on assessment of standing posture”. Phys Ther.1987; 67:512–516 Hamstrings and Psoas tightness & LBP: “Prospective studies of inflexibility of the lower extremities and hamstrings and psoas tightness also fail to predict future episodes of LBP” (Hellsing, 1988c; Nadler, 1998) Summary of (research) correlations between low back pain and pelvic tilt or related spinal curves §  No difference in lumbar curvature between people with and without low back pain;1 §  No difference in lumbar lordosis between people of different ages or in people with and without pain;2 §  No difference in thoracic kyphosis, lumbar lordosis and sacral inclination between people with acute low back pain and chronic low back pain;3 §  Low back pain is not associated with the degree of lumbar lordosis or pelvic tilt;4 §  2008 systematic review of 56 studies finds no strong evidence of an association between measurements of spinal curves and pain.5 Taken from “Does Anterior Pelvic Tilt Cause Low Back Pain?” by Todd Hargrove (36) 4 Most Common Arguments against the Research findings
§  Cherry Picking -­‐ (a few studies vs. the majority) §  Sub-­‐groups – (Generalizations. The need for special assessment.) §  Dr.McGill’s Work – (Spine Sparring Ex vs. the “Fix”: Removing specific painful positions and movements while emphasizing pain-­‐free exercises and activities). §  I’ve seen it work! – (Regression to the mean: statistics show that most acute LBP begins to improve after 2 to 5 days and typically resolves itself in less than 1 month with non-­‐steroidal anti-­‐
inflammatories (NSAIDs) and (tolerable) activities. “A common explanation for this
discrepancy is the perceived heterogeneity
(difference) of patients with chronic nonspecific low back pain. It is felt that the
effects of treatment may be diluted by the
application of a single intervention to a
complex, heterogeneous group with
diverse treatment needs. This argument
presupposes that current treatment is
effective when applied to the correct
patient…An alternative perspective is that
the clinical trials are correct and current
treatments have limited efficacy. This
paper argues that there are numerous
problems with the sub-grouping approach
and that it may not be an important reason
for the disappointing results of clinical
trials.” (37)
Wand & O’Connel, BMC Musculoskeletal
Disord. 2008
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Conclusion: §  We don’t get caught up with trying to use core (strength or stability) training as “corrective therapy” for lack of evidence that we should. §  We don’t make claims that core (strength or stability) training is a “fix” for posture or LBP. §  We use integrated (CLT & CCT) and targeted core exercises that each individual can do with control and comfort. §  Instead of worrying about the “it sounds pretty good” (but highly debated and often anecdotal or pseudoscientific) stuff, we focus on the proven principles of training: SAID and Overload. Thank You!!! PerformanceU.net
References: 1.  Mathew, D.K. and Fox, E.L. Physiological basis of Physical Education and Athletics, W.B.. Saunders Co., Philadelphia, 1976) 2. Essentials of Strength & Conditioning, 3rd Edition. . Edited by Thomas R. Baechle and Roger W. Earle. NSCA -­‐National Strength & Conditioning Association. Human Kinetics. Copyright 2008 3. Interview with Dr. Stuart McGill: Back Health, Core Exercises and More. 1/12/2010, By Mark Kennedy. http://www.healthynomics.com/2010/11/dr-­‐stuart-­‐mcgill-­‐
interview-­‐back-­‐health-­‐core-­‐exercise/ 4. W. Gilleard , European journal of applied physiology and occupational physiology, volume 63, number 5, 381-­‐386) 5.  Motor Control. 1999 Oct;3(4):346-­‐71. Natural goal-­‐directed movements and the triphasic EMG. Morrison S, Anson JG. 6.  Movement-­‐related phasic muscle activation. I. Relations with temporal profile of movement. S. H. Brown and J. D. Cooke, J Neurophysiol 63: 455-­‐464, 1990; 7. Research in Sports Medicine: An International Journal. Volume 15, Issue 2, 2007. Do Bilateral Power Deficits Influence Direction-­‐Specific Movement Patterns? Jay R. Hoffman, Nicholas A. Ratamess, Marc Klatt, Avery D. Faigenbauma & Jie Kang. 30
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References: 8. Developing Power to Turn. Frank J. Spaniol, EdD. NSCA Strength & Condtioning Journal. Vol.
34, #6. Dec 2012. 9. J Strength Cond Res. 2012 Feb;26(2):373-­‐80. Effect of core strength on the measure of power in the extremities. Shinkle J, Nesser TW, Demchak TJ, McMannus DM. 10. J Strength Cond Res. 2007 Nov;21(4):1271-­‐7. A kinetic and electromyographic comparison of the standing cable press and bench press. Santana JC, Vera-­‐Garcia FJ, McGill SM. 11. Integration core exercises elicit greater muscle activation than isolation exercises. Gottschall JS, Mills J, Hastings B. J Strength Cond Res. 2013. 12. J Orthop Sports Phys Ther. 2010 May;40(5):265-­‐76. Core muscle activation during Swiss ball and traditional abdominal exercises.
Escamilla RF, Lewis C, Bell D, Bramblet G, Daffron J, Lambert S, Pecson A, Imamura R, Paulos L, Andrews JR. 13. Effect of Two Contrasting Types of Physical Exercise on Chronic Neck Muscle Pain. Lars L. Andersen, Michael Kjaer, Karen Sogaard, Lone Hansen, Ann I. Kryger, Gisela Sjogaard, Arthritis Care & Research, January 2008; 59:1; pp. 84-­‐91. NOTE: Go to this link to read the rebuttal papers to Eyal Lederman’s Fall of the PSB Model -­‐ http://www.sigurdmikkelsen.no/admin/dokumenter/JBMT%20debate%20-­‐
%202011%20-­‐%20Is%20a%20postural-­‐structural-­‐biomechanical%20model,%20within
%20manual%20therapies,%20viable%3F.pdf References 14. Man Ther. 2001 Feb;6(1):3-­‐14. Functional stability re-­‐training: principles and strategies for managing mechanical dysfunction. Comerford MJ, Mottram SL. 15. Scott M, Comerford MJ, Mottram SL – 2006. Transversus Training -­‐ A Waste of Time in the Gym? FitPro Network (Apr-­‐May).
http://www.performance-­‐stability.com/document/Publication/
31_33backpain_tranversusFitProSpring06.pdf 16. Cholewicki J and McGill S (1996), Mechanical stability in the vivo lumbar spine: implications for injury and chronic low back pain, Clinical Biomechanics, 11(1): 1-­‐15. 17. Hoffer J, Andreassen S (1981), Regulation of soleus muscle stiffness in premamillary cats, J Neurophysiology, 45: 267-­‐285 18. Journal of Bodywork & Movement Therapies (2010) 14. The myth of core stability. Eyal Lederman. 19. Hodges PW, Richardson CA (1996) Inefficient muscular stabilisation of the lumbar spine associated with low back pain: a motor control evaluation of transversus abdominis. Spine 21(22): 2640-­‐2650 20. Hodges PW and Richardson CA (1997) Contraction of the abdominal muscles associated with movement of the lower limb. Physical Therapy. 77: 132-­‐143 References 21. Hodges PW, Richardson CA. Transversus abdominis and the superficial abdominal muscles are controlled independently in a postural task. Neurosci Lett 1999;265(2):
91-­‐94 22.Hides JA, Richardson CA, Jull GA (1996) Multifidus muscle recovery is not automatic after resolution of acute, first-­‐episode low back pain. Spine 21(23): 2763-­‐2769. 23. O’Sullivan PB. Lumbar segmental ‘instability’ clinical presentation and specific stabilizing exercise management. Manual Therapy 2000;5(1): 2-­‐12 24. Jull GA. Deep cervical flexor muscle dysfunction in whiplash. Journal of Musculoskeletal Pain 2000;8(1/2):143-­‐154. 25. Exp Brain Res. 2007 Aug;181(4):537-­‐46. Epub 2007 May 3. Immediate changes in feedforward postural adjustments following voluntary motor training.
Tsao H, Hodges PW. 26. Brain. 2008 Aug;131(Pt 8):2161-­‐71. Reorganization of the motor cortex is associated with postural control deficits in recurrent low back pain. Tsao H, Galea MP, Hodges PW. 27. CPDO Online Journal (2010), March. The fall of the postural–structural–
biomechanical model in manual and physical therapies: Exemplified by lower back pain. Eyal Lederman. 28. Thoughts about Transversus Abdominis. 21st November 2011. http://
www.kineticcontrol.com/page.php?Plv=1&P1=16&Blog=46 31
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References 29. Gibbons SGT, Comerford MJ and Emerson PL – 2002. Rehabilitation of the stability function of Psoas Major. Orthopaedic Division Review. Jan/Feb. 7-­‐16. http://www.kineticcontrol.com/document/Publication/FunctionofPsoasMajor.pdf 30. Gibbons SGT (1999) A review of the anatomy, physiology and function of psoas major: A new model of stability. Proceedings of: The Tragic Hip: Trouble in the Lower Quadrant. 11th Annual National Orthopaedic Symposium. Halifax, Canada. Nov 6-­‐7. 31. Bogduk N (1997) Clinical Anatomy of the Lumbar Spine and Sacrum 3rd Ed. Churchill Livingstone, New York 32. Bogduk N, Pearcy M and Hadfield G (1992) Anatomy and biomechanics of psoas major. Clinical Biomechanics. 7: 109-­‐119 33. Gibbons SGT (2001) The model of psoas major stability function. Proceedings of: 1st International Conference on Movement Dysfunction. Edinburgh, Scotland. Sept 21-­‐23 34. Rab GT, Chao EYS, Stauffer RN 1977 Muscle force analysis of the lumbar spine. Orthopaedic Clinics of North America 8(1):193-­‐199 35. J Biomech. 1995 Mar;28(3):339-­‐45.The psoas major muscle: a three-­‐dimensional geometric study. Santaguida PL, McGill SM. 36. Posted on March 12, 2012 by Todd Hargrove. http://www.bettermovement.org/2012/does-­‐anterior-­‐pelvic-­‐tilt-­‐cause-­‐low-­‐back-­‐pain/ 37. BMC Musculoskeletal Disorders 2008, 9:11. Chronic non-­‐specific low back pain – sub-­‐groups or a single mechanism? 32