What is the core and how do I use it?

Women's health physiotherapist Taryn Watson shares her insights on the importance of 'the core' for a healthy lifestyle.

health physiotherapist

Which muscles make up your ‘core’?

With the recent popularity of Pilates, the term ‘the core’ has become widely spread. When taken in the true sense of the term, it should involve activation of the pelvic floor muscles (PFM) and the deep abdominal muscles such as the transverse abdominus (TA).

Despite popular belief, your six pack muscle (more correctly termed the Rectus Abdominis or RA) is not your core. Neither are the two layers of obliques underneath this. They are 'power' muscles, and help to move your trunk, and while very important, they do not have a supportive function like the PF and TA. In fact, while the PF and TA muscles have an upward, inward motion when contracting correctly, the RA and obliques create a downward and often outward force in the abdomen.

Why is the ‘core’ so important?

The upward and inward action of the ‘core’ is very important in gynaecological and urological health. We know from research that this action of the PF, which is assisted by the TA, prevents the pelvic organs from descending (known as pelvic organ prolapse), prevents our bladder and bowel from leaking (called incontinence) and helps to support the lower part of the spine and the pelvis. 

Recent research on women has shown that it is possible to manage (or even better to prevent) incontinence and prolapse by exercising the ‘core’ muscles regularly, if done under the guidance of a Women's Health and Continence Physiotherapist (Hagen et al 2014, Neumann et al 2005).

health physiotherapist

How do you exercise your ‘core’?

The main way to exercise these muscles is to do regular pelvic floor exercises (or 'Kegels'), which involves a squeeze and a lift around the back passage, front passage and the vagina. This should not be visible from the outside, except for maybe a subtle indraw of the lower abdomen as the TA muscles come in to assist the PF. Ideally you should be doing a few sets of these a day, but there is no 'recipe'. A Women's Health & Continence Physiotherapist can give you an individualised program depending on what you can do after they check with an abdominal ultrasound, or in some cases a vaginal or rectal examination.

These exercises can be done in any position - standing, sitting, lying down - and the physiotherapist can show you how to incorporate this into your other workouts. Pilates-type exercises can complement the basic PF exercises, and this is where 'Core training' comes into play.

In reality, unfortunately, what is advertised as ‘core training’ exercises in many gym programs are double straight leg raises and heavy medicine ball work that actually cause an over-recruitment of the superficial ‘power’ abdominal muscles and completely override the more subtle, deeper muscles. When a Women’s Health & Continence Physiotherapist assesses the pelvic floor, the bearing down and bulging into the pelvic floor during these exercises is often evident. Externally this can also be obvious, with abdominal doming and breath holding occurring. Sit ups, double leg raises and planks may eventually have their place in a safe work out - but they are definitely NOT the starting point for Core Training.

What can go wrong if ‘core training’ is done incorrectly?

People often only realize that these exercises have been inappropriate when something goes wrong. This may be in the form of a musculoskeletal issue such as a lumbar disc injury, in the form of an abdominal issue such as an umbilical hernia, or in the form of a urological/gynaecological issue such as a vaginal prolapse or urinary incontinence. All of these are essentially caused by the same issue – repetitive high intra-abdominal pressure that exceeds what can be matched by the deep supporting muscles such as the pelvic floor.

So in summary – question what you are told in a gym class is a 'Core' exercise. Is it really, or are you just recruiting your upper abdominal muscles and pushing everything outwards? Do you want abdominal muscles that draw inwards and are flat, or abdominal muscles that push outwards? And more importantly, do you want your insides to be pushed downwards into your pelvic floor during a work out (like the chicken in the picture)? Probably not.

Seek help from a Women's Health and Continence Physiotherapist if you wish to learn more about how to correctly exercise your core. Taryn Watson and Robyn Hickmott both provide expert Women's Health and Continence Physiotherapy services here at LifeCare Riseley.

References: 

Hagen et al (2014), Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY): a multicenter randomized controlled trial, The Lancet, 383 (796-806).

Neumann PG, K. Grant, R. Gill, V (2005) Physiotherapy for female stress urinary incontinence: a multicentre observational study. Australian and New Zealand Journal of Obstetrics and Gynaecology;45(226-232)

Robust Inspiration

The American writer William Faulkner said, "I only write when inspiration strikes. Fortunately it strikes at nine o'clock every morning." With both writing and exercise it's healthy to want motivation but unwise to wait around for it to appear out of thin air. Here are three common barriers to exercise and some hints that will help you say, "I only exercise when I'm motivated. Fortunately, I'm motivated every day."

Robust Inspiration

TIME

Our busy lifestyles can push exercise to the fringes of our schedules. The mornings are short and cold. The evenings are when the kids do their exercise. In a busy week, making the most of short blocks of time can be crucial.

Building exercise into your daily routine can keep you active. Taking the stairs instead of the lift, going for a stroll in your lunch break, cycling rather than driving to work, walking on the treadmill while you're watching TV might not take as much time out of the day as you think.

Another good idea for the busy worker is to commit to a schedule. Joining a sporting team or gym class locks you in to a regular pattern of exercise that's more difficult to squeeze out of your calendar than that occasional run.

ENJOYMENT

Not enjoying exercise can also stand in the way of an active lifestyle. This, too, is a problem that can be overcome. The number of ways to get active is really only limited by your imagination. It's okay not to like swimming, running, or organised sport. Have you tried yoga, surfing, gardening, dancing, unicycling, or rock-climbing?

You might just learn a new skill and meet people in the process. In fact, deciding to do something with friends might be the way to make a walk (almost) as enjoyable as catching up for coffee. You can always walk to your favourite café.

Robust Inspiration

INJURY

The fear of injury sometimes prevents people from being active. Just as there are thousands of different kinds of exercise to fit everyone's interests, there are also many types of exercise to match everyone's physical capacity. If you're worried you might be stirring something up, you can always check with your physio to get the all-clear and brainstorm ideas that will fit with your body, your interests and your busy schedule.

Your knees might not let you do everything you used to be able to do, but they will definitely let you do something every day, and ultimately thank you for it.

Those dreaded three letters: ACL

When Chris Judd told his three year old son that he wouldn't be able to play football anymore because of his ACL injury, his son said, "I think you should play soccer." If only recovery from injury was that simple! In fact, the knee is one of the most complex joints in the body, and the ACL is pivotal to its function.

Judd

 

ANATOMY

There are four main ligaments that control the position of the knee. The Anterior Cruciate Ligament (ACL) and Posterior Cruciate Ligament (PCL) form a cross inside the joint, with the Medial Colateral (MCL) and Lateral Colateral (LCL) ligaments running down either side of the knee.

The ACL's main role is to prevent the knee joint from rotating and sliding when athletes are required to turn on the spot, jump and land.

Because of subtle differences in male and female anatomy, women are slightly more likely to experience ACL injuries than men.

Knee ligaments

INJURY

Chris Judd's injury was typical of the way ACLs are torn: he landed on a reasonably straight knee that was also rotated and bent to the side.

When an ACL is ruptured, the athlete often hears a pop or a crack followed by intense swelling and pain. Injuries to the ACL can also be associated with other injuries to the knee, including the meniscus and the MCL.

As signs and symptoms vary from person to person, it's important to have an assessment of the knee as soon as possible after injury, ideally before excessive swelling has entered the joint.

Initial treatment involves controlling swelling around the knee. This means icing the knee for twenty minutes every two hours, resting, elevating the leg and using compression bandage. Your physio can assess the extent of the damage and guide you through these strategies.

PHYSIO

Following ACL rupture, surgical reconstruction of the ligament is a common procedure used to return full stability to the joint. Many factors impact on the decision regarding surgery. These include your goals, other damage done to the knee, degree of instability, age and the ability to take time off work. The surgeon will often take part of the tendon from your hamstrings and use it to replace your torn ACL.

With a detailed assessment and exercise program, your physio can help you prevent ACL injuries in the first place. The better your muscles are at adapting to different positions, the less likely the knee will be placed under extreme stress. The exercises that develop these muscles are not just focussed on strength, but on the ability of your muscles to stabilise the knee (see our previous newsletter on proprioception).

After injury, regardless of whether you decide on surgical or non-surgical management, physiotherapy plays an important role in rehabilitating the knee. Your physio will guide you through protecting the joint, getting it moving, stabilising the leg and knowing when you're ready for different activities. They'll get you on the path to meeting your goals as quickly as possible - whether that's football, soccer, or just playing with your kids.

Where is your ankle?

When you're running on the beach, how does your ankle adapt to a bumpy patch of sand?
You reach your arm behind you in the car; what is it that allows you to know where your hand is?
How do you shuffle your hips from an awkward position to a comfortable one?
 

beach running

PROPRIOCEPTION

The answer is proprioception. It's your body's ability to know when your joints are moving and where they are moving to. It relies on the input of special nerve endings in your muscles that detect changes in pressure and length around the joint.

When your joint changes position, these nerve endings tell the brain what's going on. The brain can then activate the muscles needed to either keep the joint moving or change the direction towards another position.

You use proprioception whenever you're performing a task that requires balance or accuracy... more or less constantly!

INJURY

Most of the time, proprioception happens subconsciously. However, after injury, this process can be disrupted. In some cases, this increases your chance of re-injury because the body cannot respond as well to its surroundings as it did in the past.

For example, if your body cannot detect that your ankle is rolling outward, it will not be able to fire the muscles necessary for preventing excessive movement, and so risks spraining the joint.

Pilates edited

TRAINING

The good news is that your proprioception can improve with training. It's a distinct skill from strength and flexibility and needs to be specifically targeted after injury.

Progressive balance exercises can have a profound impact on joint stability. Pilates, with its emphasis on form and control, also helps to train your body to know where it is in space.

Sometimes, your physio might encourage you to use a mirror to begin with so that you can see what position your body is in. Eventually, once your proprioception is full, your joints will be able to detect this position themselves and self-correct without the need for visual cues. This is vital for preventing injury.

POSTURE

In order for your body to maintain a good position, it needs to know what that good position feels like. Postures that aggravate pain can often result from a lack of body awareness. Proprioception retraining is an important tool for developing the body's ability to find and hold a comfortable position throughout the day.

So whether you're running on the beach or sitting in your chair at work, good proprioception allows for controlled, pain-free movement.

You might have heard it said, "If you can't measure it, you can't manage it." That's true for the body's joints: your ability to detect the position of your joints is essential for your ability to manage the way they move.