CORE la parte per il tutto

A Battle of Ideas: Exchanging experiences and opinions
CORE
la parte per il tutto
alberto andorlini
XXVI Congresso Nazionale A.I.P.A.C.
Firenze 16 maggio 2016
FLASHBACK
CORE
1990-2000
Core Training
In 2000, Reebok again revolutionized how people exercise and train
with its global introduction of Reebok Core Training and the
Reebok Core Board. Widely used today by professional athletes,
conditioned exercisers and beginners alike, this innovative workout is
a dynamic strength and conditioning program that focuses on
developing total body power by emphasizing the abs, torso and
"core" muscles. The training program is based on athletic and
physical therapy training principles, representing a significant shift in
how to approach exercise and training by focusing on "quality"
(not "quantity") of movement.
Central to the program is the Reebok Core Board, the first-ever
exercise board offering three dimensional action that tilts, twists,
torques and recoils with the body's movements. The board is
adjustable, so as users build strength, they can change the board's
resistance to create more versatile workouts. When used together,
Reebok Core Training and the Reebok Core Board provide a highly
effective, strength training workout that conditions the user for daily
living, whether that be in sports, exercise classes or playing with
children.
THE SIX MOST FUNCTIONAL
IMPORTANT TRAINING
COMPONENTS OF
1.
MOVEMENT
(no muscle)
2.
BODY WEIGHT
(no weight lifting)
3.
SKILLS
INTEGRATION (no
isolation)
4.
TRIPLANAR
MOTION
5.
CORE
J.C.SANTANA
PAST
1987
In
N.Bogduk and L.Towney
published the Clinical Anatomy of the Lumbar Spine.
They were the first to introduce clinical observations
of the abdominal and back muscles coordinating as
a “FUNCTIONAL UNIT”.
1989
In
Bergmark (Stability of the Lumbar
Spine: A study in mechanical engineering. Acta
Orthop Scand) differentiates the concept that
certain muscles surrounding the lumbar spine play
different roles. “GLOBAL” muscles such as the
rectus abd, ext obliques, and lat dorsi are designed
for force production, movement and torque. While
“LOCAL” muscles such as the lumbar Multifidus
and Tranversus abd are designed for intersegmental
spinal stability.
CORE
1992
In
Dr. M.M. Panjabi (The stabilizing
system of the spine. Part 1, function, dysfunction and
enhancement. Journal of Spinal Disorders 1992) defined
spinal stability as consisting of THREE
SUBSYSTEMS, passive components of the spinal
column, active control by spinal muscles, and
neuromuscular control or coordination.
1999
In
Australian scientists C. Richardson,
G. Jull, P. Hodges and J. Hides published
Therapeutic Exercise for Spinal Stabilization in Lower Back
Pain. Within they first coined the term “INNER
UNIT” describing how the deep abdominal wall
works synergistically with the “OUTER UNIT”
(the conventional targets of fitness: rectus
abdominis, obliquus externus abdominis and psoas.)
MILESTONES
CORE
1988 - “Posturo-Kinetic organisation during the early phase of voluntary Upper Limb movement.1:normal subjects” Zattara M.,
Bouisset S. . J. Neurol.Neurosurg. Psychiatry
1995 - “Following the functional path” in “The Gambetta Method”, by G.W.Gray, P.T. and V.Gambetta
1995 - “Functional progression for Sport Rehabilitation” by Voight ML, Tippett SR
1997 - “The role of Proprioception in the Management and Rehabilitation of Athletic Injuries” by S.M.Lephart, PhD, ATC; D.
M.Pincivero, MD; Jorge L. Giraldo, MD; F.H.Fu, MD; Pittsburgh Neuromuscular Research Laboratory
1998 - " Therapeutic Exercise for Spinal Segmental Stabilization in Low Back Pain". Richardson, C., Jull, G., Hodges, P., Hides
1998 - “ Functional Exercise Training” by G.Cook MSPT, OCS, CSCS
1999 - "Proprioception and Neuromuscular Control in Joint Stability" by Scott M.Lephart , Freddie H.Fu
2000 - “What is Functional Exercise” in “Movement that matters” by P.Check
2003 - “Functional Training for Sports” by M.Boyle
2006 "Anatomy Trains Myofascial Meridians For Manual and Movement Therapists" By Thomas W. Myers
2006 - “The Role of Core in Athletic Function” by B.Kibler M.D., FACSM, A.Sciascia P.T., Lexington Sports Medicine Center
2006 - “Ultimate back fitness and performance” by Stuart Mc Gill, PhD
KINESIOLOGICALMODELS
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1936 HOEPKE
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1938 MOLLIER
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1949 MEZIERES
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1956 TITTEL
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1986 DART
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1992 BUSQUET
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2001 MYERS
BIOMECHANICALMODELS
THE FOUR PILLARS OF
CORE
When the term ”CORE STABILITY ”
is used, reference is being to the
ability of the musculature to stabilize
the spine through
1.Coordination of LOCAL AND
GLOBAL MUSCLES,
2.Intra
Abdominal
Pressure
mechanism (IAP),
3.Thoraco Lumbar Fascia (TLF)
4.Pre programmed Muscle Activation
or
Anticipatory
Postural
Adjustaments (APAs)
(Cholewicki J., A.Simons, & A. Radebold,Effects of external trunk
loads on lumbar spine stability. J.Biomech.33:1377-1385. 2000)
THE CORE MUSCULATURE
Essentially, the core is where our center of
gravity is located and where all movement
begins.
…the transversus abdominis forms the walls of
a cylinder while the muscles of the pelvic
floor and diaphragm form its base and lid,
respectively.
The “CORE MUSCULATURE” can be defined
generally as the 29 pairs of muscles that
support the lumbo pelvic hip complex (LPH) in
order to stabilize the spine, pelvis and kinetic chain
during functional movements.
(Fredericson M., & T.Moore, Core stabilization training for middle and long
distance runners. New Stud.Athletics. 20:25-37.2005)).
PROXIMAL STABILITY FOR
DISTAL MOBILITY
“Core stability” is seen as being pivotal
for efficient biomechanical function to
MAXIMISE
FORCE
GENERATION
AND
MINIMISE JOINT LOADS in all
types of activities ranging from
running to throwing.
Core Stability is defined as the ability
to control the position and motion of
the trunk over the pelvis to allow
optimum
PRODUCTION,
TRANSFER AND CONTROL of
force and motion to
the
terminal segment in integrated
athletic activities.
W.B.Kibler, J.Press, A.Sciascia;
Core muscle activity is best understood
as
the
pre-programmed
integration of local, single joint
muscles and global, multi joint muscles
to PROVIDE STABILITY AND
PRODUCE MOTION.
This
results
in
PROXIMAL
STABILITY
FOR
DISTAL
MOBILITY, a proximal to distal
pattering of generation of force, and the
creation of interactive moments that
move and protect distal joints.
The Role of Core stability in Athletic Function
Sports Med 2006.
KINETIC CHAINS
CENTRAL TO ALL
Athletic Function is most often produced by the KINETIC CHAIN, the coordinated, sequenced
activation of body segments that places the distal segment in the optimum position at the
optimum velocity with the optimum timing to produce the desired athletic task.
Since the CORE is central to almost all kinetic chains of sports activities, control of
core strength, balance and motion will maximise all kinetic chains of upper and lower extremity
function.
Putnam CA. Sequential motions of body segments in striking and throwing limb movement. J Neurol Neurosurgery Psychiatry
1988
ACTIVITIES
Core functional
activities
Rolling skipping extending
kneeling twisting ascending
standing turning descending
walking pivoting reaching
stepping balancing jogging
pushing running shifting
pulling sprinting striking
lifting decelerating carrying
catching accelerating landing
stabilizing kicking bending
hopping lunging throwing
swimming jumping swinging
skating squatting skiing
Functional Biomechanics
By Gary W. Gray, PT; November 2000
TVA & MF
“…the small deep core stabilising
muscles – transverse abdominis and
multifidus – are recruited at low levels
during
all
movements.
THE
OMNIPRESENCE OF THE
TVA
AND
MF
RECRUITMENT
is
then
interpreted as proving that these
muscles must be trained in
“isolation” to ensure good core
control
and
in
“integrated
movement skills” to achieve
increased dynamic core stability.”
(G.Cook, G.Gray, P.Check; The Lunge Test; 2001)
RESEARCHES ABOUTCORE
1.
Core Stability nella
prevenzione degli infortuni
sportivi e nella
riabilitazione sportiva
2.
Core Stability nel
miglioramento della
performance sportiva
3.
Core Stability Training
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McGill et All (2001, 2003)
Arokoski et All
Zazulak et All (2007)
Caraffa et All (1996)
Fitzgerald et All (2000)
Nadler et All (1998)
Brown, McGill (2005)
Comerford, Mottram (2001)
Hadala, Barrios (2009)
Steffen, Mykelebust, et All (2008)
Wilson, Dougherty, et All (2005)
B. Krabak, Kennedy, MD (2008)
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Borghuis, Hof, Lemmink (2008)
Stanton, Reaburn, Humphries (2004)
Nesser, Huxel, Tincher, Okada (2008)
ABT, Smoliga, Brick, Jolly, Lephart, Fu
(2007)
Thompson, Cobb, Blackwell (2007)
Filipa,Byrnes,Paterno,Myer, Hevett (2010)
Saeterbakken,Tillaar,Seiler (2011)
Sato, Mokha (2009)
Asplund, Ross (2010)
Hibbs, Thompson, French, Wrigley,
Spears (2008)
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Kibler, Press, Sascia (2006)
Behm, Drinkwater, Willardson, Cowley
(2010)
Willardson (2007)
Omkar, Vishwas,Tech (2009)
Akuthota, Ferreiro, Moore, Fredericson
(2008)
Akuthota, Scott, Nadler, DO (2007)
Bliss, Teeple (2005)
Omkar, Vishwas,Tech. (2009)
CORE EXERCISE
The
beginner
level
exercises
incorporate the “BIG 3” (figs A–C) as
described by McGill
(McGill S. Low back disorders: evidencebased prevention and rehabilitation. Champaign
(IL): Human Kinetics; 2002).
D
These include the curl-up, side bridge, and the “bird dog.” The bird dog exercise
(fig C) can progress from 4-point kneeling to 3-point to 2-point kneeling.
Advancement to a physioball (fig D) can be done at this stage. Sahrmann also
describes a series of lower abdominal muscle exercise progression.
(Sahrmann S. Diagnosis and treatment of movement impairment syndromes. St. Louis: Mosby; 2002.)
PLANK VARIATIONCORE
The PLANK VARIATION in
general, in my mind, are strategies
to teach the motor skill of stiffness
and tension in the VERTICAL
POSITION. If we can feed tension
forward in lower positions, I think it
can potentiate feedback tensions in
the vertical especially when speed or
fatigue are part of the drills.
Charlie Weingroff
/2015/07/fundamental-motor.skill-acquisitions/#sthash.sjlAovhZ.dpuf
COREMATRIX
THE 4X4 MATRIX
1) SUPINE/PRONE
1) ASSISTED/UNLOADED
2) QUADRUPED
2) UNLOADED
3) HALF KNEELING
3) ASSISTED/LOADED
4) STANDING
4) LOADED
COREPROGRESSION
Decreasing the base of support
REDUCING THE POINTS OF CONTACT (4 TO 1 POINT OF
SUPPORT)
Increase duration (static movements)
Known to unknown
HORIZONTAL TO VERTICAL
Static to dynamic movement patterns
Simple to more complex movement patterns
Increase repetitions (dynamic movements)
Slow to fast / ballistic movement patterns (mimic ADL’s)
Low force production to high force production
Fabio Comana
Inner balance zone to outer balance
zone
American Council on Exercise
Manager of Certification and Exam Development
CORE SEQUENCE
CORE STAGES
STAGE 1 – train the specific co-contraction
of transverse abdominus and lumbar
multifidus with low levels of contraction. The
co-contraction must be in isolation of global
muscle activation.
STAGE 2 – encouraged to perform the cocontraction in more upright positions as sitting,
standing and walking, this must be done pain free.
Patients are then encouraged to perform tasks that
were previously pain producing. This is essential so
the patterns of co-contraction will become
automatic.
STAGE 3 – the co-contraction of the lumbar
multifidus and transverse abdominus becomes
automatic while performing the functional
demands of activities of daily living or
sports related tasks.
Hides (1996), O’Sullivan
Richardson (1996)
(1997)
+
Hodges
and
NON.PRE.FUNCTIONAL
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Rehabilitation
and
training
progression does not always
mean
pushing
forward,
sometimes the right thing to do is
to back off or to progress on
some aspects and regress in
others. Sometimes we need to
start in a
NON-FUNCTIONAL
way,
then move into a
PRE-FUNCTIONAL system
and only then to a
FUNCTIONAL method of
treatment and/or training.
THE KINETIC CHAIN
APPROACH
•
The summation of forces through sequential movements within an open, throw-like kinetic chain. Image
from ‘Kinetic Chain Approach for Shoulder Rehabilitation’ (McMullen & Uhl, 2000).
THE JOINT BY JOINT
APPROACH
MOVEMENT Functional Movement Systems: Screening, Assessment, Corrective Strategies by Gray Cook
with Lee Burton, Kyle Kiesel, Greg Rose & Milo Bryant
THE SERAPE EFFECT
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Logan, G., & McKinney, W. 1970. The serape effect. In Anatomic Kinesiology (2nd Ed., pp. 154-561). New York: William C. Brown, Co.
Santana, J.C., MEd. The Four Pillars of Human Movement. IDEA Personal Trainer. Feb. 2002; (21-28).
Gambetta, V. The Kinetic Chain in the Throwing Shoulder. E.A.T.A. Annual Meeting, Boston Mass. Sun. January 9, 2005. Retrieved October 2, 2007 from
http://www.gambetta.com/resources/clearing the Kinetic Chain in the Throwing Shoulder.pdf.
Gambetta, V. More Core-The Serape Effect. Internet posting @ 10:27 a.m., Thursday, September 15, 2005. Retrieved on October 2, 2007 from
http://www.modernskiracing.com/Serape.pdf.
THE “HOLISTIC”APPROACH
Simple
Definition
of Holistic:
relating to or
concerned with
COMPLETE
SYSTEMS
rather than with
INDIVIDUAL
PARTS.
FASCIAL NETWORK
TENSEGRITY STRUCTURE
CORE SYNONIMOUS
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Muhlabanda
Ki, Chi, Ci
Dan Tien
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Powerhouse
Contrology
Centering
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Pillar
Inner/Outer unit
Local/Global Control
Lumbo Pelvic
Complex LPC
Lumbar Interfascial
Triangle LIFT
Center Strength
Trunk Stability
Valsalva maneuver
Drawing in
Abdominal Bracing
CORE TECHNIQUES
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PILATES
TAI CHI
AIKIDO
SOMATICS
FELDENKRAIS
YOGA (SOME FORMS)
MOV NAT
PALEO FITNESS
PARKOUR
PRIMAL MOVE
ANIMAL FLOW
CROSSED DOUBLE
HELIX
PENDULUM
EXERCISES
COREINTERPRETATION
PHYSICAL INTERPRETATION
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Inner Muscle Awakening
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Balanced Stability
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Primal Pattern Or Fundamental Movement
PSYCOLOGICAL INTERPRETATION
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Being Grounded
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Focus
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Being Aware Or Awareness
THE CONCEPT OF CORE
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Muscles, tendon, fascia provide a
continous pull
Bones provide a discontinuous push
Bones float & never physically touch each
other with the exception of disease
processes
All of the spines 186 joints are involved
with every movement of the body
Support of the spine (&body) originates
from above as well as below
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THE CONCEPT OF CORE INCLUDES THE HEAD THROUGH
THE PELVIS & INCLUDES THE VISCERA
FINE
GRAZI
E