
“The ability to control the position and motion of
the trunk over the pelvis and leg to allow optimum
production, transfer and control of force and
motion to the terminal segment in integrated
kinetic chain activities”

Core is also known as lumbo-pelvic-hip complex.
29 muscles attach to core
 Lumbar Spine Muscles
Ø Transversospinalis group
 Rotators
 Interspinalis
 Intertransversarii
 Semispinalis
 Multifidus
Ø Erector spinae
 Iliocostalis
 Longissimus
 Spinalis
Ø Quadratus lumborum
Ø Latissimus Dorsi


Abdominal Muscles
Ø Rectus abdominis
Ø External oblique
Ø Internal oblique
Ø Transversus
abdominis

Psoas

Gluteus medius

Gluteus maximus

Hamstrings
6

Core can be divided into :
1-Inner core(local postural muscles)
2-Outer core(global dynamic muscles)

The inner core is comprised of muscles that link
directly to the spinal cord. These muscles include:

Transversus abdominis

Lumbar multifidus

Pelvic floor muscles

Diaphragm
The inner core muscles often go
neglected as they are not visible
and have no aesthetic appearance
like the muscles of the outer core.

The outer core includes muscles that attach from
the pelvis to the spine, and from the spine and
pelvis to the body’s extremities.

The outer core muscles are more commonly seen
and exercised and include:

Internal obliques
External obliques
Erector spinae(Longissimus and iliocostalis)
Rectus abdominus




Efficient core allows for
Ø Maintenance of normal length-tension relationships
Ø Maintenance of normal force couples
Ø Maintenance of optimal arthrokinematics
Ø Optimal efficiency in entire kinetic chain during movement
 Acceleration, deceleration, dynamic stabilization
Ø Proximal stability for movement of extremities

Provide spinal stability and coordinate the
movement of the arms, legs, and spine

stabilize the person's thorax and pelvis during
dynamic movement.

Shock absorber.
reduce stress during rotational and flexion
movements .


keep the body balanced, to reduce stress and
injury, and to protect the spinal column.

The muscles of the core are also responsible for
movement.

They provide stability, torque, and momentum for
movements such as:
-
leg swing and arm swing in walking or running.
weight transfer in stepping, walking and running.
momentum shifts in movements like swinging,
throwing, or pitching.
-

The core is used to stabilize the thorax and the
pelvis during dynamic movement and it also
provides internal pressure to expel substances
(vomit, feces,giving birth etc).

Valsalva maneuver
Continence
Pregnancy


1-The first step is motor skill learning (i.e. learning how
to Isolate and activate the core muscles to train
them, to contract them)
2- The second step is strengthening/endurance of
core muscles.
3-The final step is functional progression i-e to cocontract the entire core and use this connection in
functional activities.

For sports player the final step is
sports specific training (i.e.
progressing these exercises into
drills which replicate sport)

No matter what core exercise you are doing your
aim should be for maximal control and stability
with minimal use of the global stabilizers.

If an exercise is too difficult go back and master a
simpler exercise and then progress.
Transversus
abdominis
training

Lie on your back or side with your spine in a neutral
posture.

Identify transversus abdominis by :
› Putting fingers on lower part of abdomin,gently
close the muscles around your rectum and then
connect the rectum to the back of the pubic
symphysis.You will feel a light, deep tension
under your fingertips, not a contraction that
pushes the fingers out.

Draw in muscles and hold the contraction for 10 seconds
without becoming rigid, and continue to breathe.

AVOID:
movement of the hip,spine.
Posterior tilting of the pelvis
Bulging of the abdomen
Depression of the rib cage
Breath holding
Fingertips being pressed out by a strong muscular contraction
(internal oblique)







Once you can isolate the transversus abdominis,
practice this isolation in many different positions i.e. sitting, standing, bending over etc.

Once you can turn the muscle on in different
positions easily you can progress to stage 2.
Stabilize one leg.(left)
Other leg will fall out.(right)
Stabilize one leg (left)
Perform following 3 activities on other leg (right)
A-lift bend leg with 90 degree hip flexion.
B-slide heel to extend knee.
C-lift straight leg to 45 degrees
Hold one leg at 90 degrees of hip flexion with upper extremity
assistance.
 perform following activities on other leg :
A-lift bend leg with 90 degree hip flexion.
B-slide heel to extend knee.
C-lift straight leg to 45 degrees
Hold one leg at 90 degrees of hip flexion with out upper
extremity assistance.
 perform following activities on other leg :
A-lift bend leg with 90 degree hip flexion.
B-slide heel to extend knee.
C-lift straight leg to 45 degrees
Bilateral lower limb activity i-e
A-lift both legs with 90 degree hip flexion.
B-slide both heels to extend knee.
C-lift both legs straight to 45 degrees

Begin each exercise with drawingin maneuver to
activate core muscles.

For endurance, decrease limb loading and
perform repetitive motion for 1 minute or longer.

For strength, progress load.
With all these exercises maintain
the leg lift for 10 seconds and
build 3 sets of 10 reps
 Advanced
dynamic
strengthening exercises
for abdominal muscles
The final step is to remember to use the core during
regular life activities.
 Such as:
-Getting out of chair
-Bending
-lifting
-Reaching etc .

Rehabilitation
multifidis
of


Lie on your side with your spine in a neutral posture
Palpate the multifidus you are trying to isolate,
(find the spine bone and then fall off into the gutter
just sideways from the bone)

Breathe in and out and contract the multifidus
under the fingers.

The contraction of the multifidus should feel like a
slow, firm, 'swelling' under your fingers .

You should not feel a rapid contraction.

No actual movement of the hip, pelvis or spine
should occur.

Hold the contraction without becoming rigid, and
continue to breathe.

Once you can isolate the multifidus, practice this
isolation in many different positions - i.e. sitting,
standing, bending over etc.

Once you can turn the muscle on easily you can
progress to the following exercises.
Quadruped position.
Flex one upper extremity.
Quadruped position
Extend one lower extremity by sliding it along
the exercise mat.
Quadruped position
Extend one lower extremity and lift 6-8 inches off
the mat.
Quadruped position
Flex one UE and extend contralateral LE.
Prone position.
Extend one LE.
Level 6:-extend both LE
Level 7:-extend both LE and lift head and
arms off table.
Patient position quadruped or prone
Patient assumes spine .
Perform drawing in maneuver.
Moves extrimities .
Motions are repeated or alternated from side
to side .
 Advanced
dynamic
strengthening exercises
for back extensors.

The final step is to remember to use the core during
daily life activities.

Lie on your back or side or sit with the spine in a neutral
posture.

Firmly palpate your abdomen 1-2 inches inside of your hip
bones.


Imaginary stop the urine and fecal flow.
The muscles you use to stop the flow of urine and feces are
the same muscles you will be squeezing when doing the
Kegel's exercises.

When you isolate your pelvic floor muscles you should feel a
deep tension in your abdomen (under your fingers),

you should NOT feel your buttocks tighten, legs rotate out or
movement of your spine or pelvis.

If you feel a muscle pushing your fingers out of your
abdomen, butt gripping or spinal movement then you are
not being successful in connecting to your pelvic floor
muscles.

A correct contraction should result in a very gentle tension
deep in the abdomen (often very hard to feel initially).




Begin by sitting on a firm chair.
Find your neutral spine position
Squeeze the muscles in your buttock and turn your hips out .
feel the muscles in the deep posterior pelvis contract.

draw your Ischial bones together.

Now complete relax these muscles

maintain the relaxation and gently and slowly contract the
pelvic floor muscles

Repeat this few times.

palpate the transversus abdominis just inside your anterior hip
bones.

As you contract your anterior pelvic floor you should feel a
light, deep tensioning in the lower abdomen.

Keep your buttocks relaxed, maintain your neutral spine
position and repeat this gentle contraction a few times while
focusing on relaxed breathing.