Over the past year, many clients have attended Healthy Harmony Tenerife with troublesome lower back pain. The causes have been varied i.e. injury – lifting heavy objects at home, in the work place or in the gym, twisting or large force impacts, stress on the back from sudden movements or a fall, poor posture overtime. Through the use of multiple massage techniques here at Healthy Harmony, we have been able to establish the route cause and alleviate the symptoms whilst developing a rehabilitation plans to suit each client individual needs.
One of the most beneficial and popular rehabilitation plans that has been provided, is the Introduction to core strengthening, which provides the recipient with an insight into what is meant by “You need to strengthen your Core” that you may have heard from your physical trainer, doctor or maybe another therpaist but most importantly the plan addresses how to correctly strengthen their core!
At Healthy Harmony we believe “it is good to share as kindness costs nothing” so here below is your opportunity to develop the inner strength that your body craves to assist in your lumbar stability.
Core stability is the term given to the strengthening of the corset of muscles (explained below) surrounding the back and abdomen. Here we will briefly explain core strengthening theory and provide an overview of the muscles involved and benefits of strengthening.
The muscles of the core are known as the powerhouse muscles and provide a solid base upon which all other muscles can work upon to initiate movement. A comprehensive strengthening program of these core muscles can be used for injury prevention and rehabilitation.
Core muscles theory
The core can be thought of as a cylinder of muscles around the inner surface of the abdomen. There are 4 main muscle groups considered:
Transversus abdominis - The deepest of all the abdominal muscles lying under the oblique abdominals and rectus abdominus (the 6-pack muscle….oh I wish!). It is this muscle that is considered to be the corset of muscle providing stability. It connects to the individual vertebrae of the lower (lumbar often you hear terms L1-5) spine and wraps right around each side to meet in the mid line of the front of the abdomen. When contracted it functions to both increase the pressure inside the abdomen and pull tightly on the vertebrae themselves to provide exceptional stability to the spine.
Multifidis - This deep back muscle lies on either side of the spine and again connects to each individual lumbar vertebrae. It functions in extending (bending back) the spine as well as being an essential postural muscle keeping the spine upright.
Diaphragm - The primary muscle for breathing, the domed diaphragm provides the top of the cylinder core. When the Transversus Abdominus contracts, the diaphragm tightens to maintain pressure in the abdomen and so provides stability to the spine. This muscle is well known but often over looked as to the essential role it plays not only in correct breathing, but for maintinece of posture and to assist with digestion.
Pelvic floor - Famous among exercise classes and especially pregnant women, the pelvic floor muscles provide a sling running from back to front, from the bottom tip of the spine (the tail bone) to the front of the pelvis. It contracts simultaneously with the transversus abdominal to form the bottom of the cylinder of muscles. (When you next go to the loo to pass urine, stop yourself mid-flow for just a couple of seconds, to do this you are using your pelvic floor)
When all these muscles contract together they keep the spine in its most stable position or the neutral zone, and aid in preventing injury. They are known to contract prior to any arm or leg movement and so they function in keeping the center, of the body rigid during all movement.
Recent evidence has found that in people with low back pain these muscles fail to contract before limb movement and so the spine is vulnerable to injury. Thus retraining these muscles to contract at the right time is the fundamental theory of core stability.
Benefits of core stability
Injury Prevention - Strengthening the core is essential to prevent all forms of injury around the lower back area. By training the core the rest of the muscles in the area i.e. the hamstrings, gluteals, abdominal and back muscles all work more efficiently and together. Risk of injury caused by over activity is reduced in any particular muscle group due to muscle imbalance.
Rehabilitation from injury - Core stability is an essential component of any rehabilitation program not only for low back pain, sacroiliac pain and Gilmore’s Groin but also for other injuries such as hamstring strain and shoulder pain. By providing stability beneath the muscles that provide movement, core stability provides excellent rehabilitative properties for such injuries and is commonly used with Massage at Healthy Harmony with clients
Correct technique is essential to benefit from core strengthening exercises. This is the first stage of core stability exercises and sets the stage for all subsequent strengthening techniques. The following techniques are methods by which you can engage your core muscles. Trying to rush exercises without correct core contraction will not give the same benefits.
Step 1: Palpation of transversus abdominus
In order to know whether you are contracting the correct muscles it is necessary to be able to feel them working. Place your hands on the bony parts at the front of your hips. These are known as your anterior superior iliac spines (asis).
Move your hands in an inch towards your belly button and down and inch towards your toes. You should now be directly over the transversus abdominus muscle.
As all the core muscles co-contract, when you feel your transversus contract the others will be contracting also. Keep your hands in this position and try each of the techniques below to find which one works for you.
When you contract your core correctly you should feel a gentle tightening under your fingers when they are in the above position. If you feel a bulge you are contracting too much. The correct level of activity in core muscles should be 30% of their maximum so that they have enough energy to contract continuously.
To contract the right amount, use the techniques below to maximally contract, then leave off the contraction by half and then by half again. This takes practice but is extremely important to get right in the early stages. Failure to contract properly will mean unwanted contraction of the larger muscles surrounding the core. These will take over movements and thus defeat the aim of the exercises.
All the following movements should be carried out whilst lying on a firm surface. Bend your knees and hips so that you are lying comfortably on your back with your knees up and feet shoulder width apart. Make sure your shoulders are relaxed and concentrate on breathing into the sides of your ribcage to take emphasis off the diaphragm - try not to breath into your abdomen and not into your upper chest. Not an easy technique but will come with practice
Remember to breath normally throughout all the exercises- it is common for beginners to hold their breath as they focus on contracting the core.
Core contraction technique 1
Whilst lying in the above position, imagine that a belt with 10 notches is tied around your abdomen. Take a deep breath in and on exhalation visualize that the belt is being fastened up to the tenth notch. Using the above transversus palpation technique can you feel a tightening (not bulging) under your fingers? Now visualize leaving the belt off to the 3rd notch.
Core contraction technique 2
In the same position as above take a deep breath in. On exhalation focus trying to lower your belly button down towards the floor. Palpate for a contraction of the transversus. Now ease the contraction off to about 30% of its max.
The above techniques focus on contracting transversus abdominus however it is common to find these exercises difficult.
Core contraction technique 3 - is focused on contracting the pelvic floor as an alternative.
In the same position as above take a deep breath. On exhaling focus on 'drawing up' from the pelvic floor. Imagine that you wish to stop yourself going to the toilet as stated earlier, however make sure you do not over use the other abdominal muscles- this would result in a 'bulge' rather that a tightening under your fingers.
Choose one of these techniques and practice it until you can do it quite easily. It may take practicing each technique a few times before you decide which one works best for you. Once you can achieve a good independent core contraction you are ready to begin the core stability program.
Contact Healthy Harmony for more information and beginner's, intermediate and advanced exercises techniques