Core to the Fore!
Susan Mitchell
Scottish Manual Handling Forum
May 28th 2015
(c) Susan Mitchell, for SMHF 28/05/2015
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What is the ‘Core’?
• body region bounded by the: abdominal wall,
the pelvis, the lower back and the diaphragm
• Main muscles involved include transversus
abdominis, internal & external obliques,
quadratus lumborum and diaphragm.
• Action of muscles contracting together upon
the incompressible contents of the abdominal
cavity that provides support to the spine and
pelvis during movement
(c) Susan Mitchell, for SMHF 28/05/2015
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Who can benefit?
There is preliminary evidence for a clinical prediction rule
identifying people with low back problems more likely to
respond to specific motor control/specific muscle activation of
the local muscles [6]:
•Younger age (<40)
•Greater general flexibility (hamstring length greater than
90°, postpartum)
•Positive prone instability test
•Presence of aberrant movement during spinal range of
motion (painful arc of motion, abnormal lumbo-pelvic
rhythm, and using arms on thighs for support)
(c) Susan Mitchell, for SMHF 28/05/2015
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Research
Richardson, Jull, Hodges, Hides 1999
Local Muscle Dysfunction in back pain – links multifidus and TA
Kuo, Tully, Galea 2009
Sagittal spinal posture after Pilates-based exercise in healthy
older adults
Demoulin, Vanderthommen, Duysens, Crielaard
Spinal muscle evaluation using the Sorensen test: a critical
appraisal of the literature ( <176s LBP during next year in
males, >198s = no LBP.)
(c) Susan Mitchell, for SMHF 28/05/2015
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Intra-abdominal pressure
(Australian Screening Tool)
(c) Susan Mitchell, for SMHF 28/05/2015
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Pelvic Floor
• Screening
• High risk activities
• Enrolled Nurses – 60% more likely to
have Sx for Prolapse/SUI
• Factors – Age, Wt, Parous,
Smoker/Cough/Constipated = > risk of
prolapse
(c) Susan Mitchell, for SMHF 28/05/2015
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Achieving a neutral spine
• Lying
• Standing
• Sitting
(c) Susan Mitchell, for SMHF 28/05/2015
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Posture in standing
• Kuo et al – Adults over 60 – stood with
decreased thoracic flexion and sat with slightly
increased lumbar extension
• Dynamic
• Kyphotic/Lordotic/Swayback
(c) Susan Mitchell, for SMHF 28/05/2015
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Testing Core Stability
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Prone instability test
Prone extension endurance test (Sorenson)
Side bridge endurance test (quad. lumb. endurance strength)
Pelvic bridging
Leg lowering test (lower abdominal strength)
Trunk curl
Hip external rotation strength
Modified Trendelenburg test (SLS, frontal plane observation)
Single leg squat in sagittal plane
Single leg squat in transverse plane
‘Marching’ in supine
(c) Susan Mitchell, for SMHF 28/05/2015
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Pilates (From APPI website)
• Based on Yoga, Martial Arts, Zen Meditation
and Greek and Roman exercises
• Increase muscle strength/endurance,
flexibility and improve balance/posture
• 5 essentials:
– breathing,
– cervical alignment,
– rib & scapular stabilisation,
– pelvic mobility
– using TA
(c) Susan Mitchell, for SMHF 28/05/2015
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Exercise Ball
(c) Susan Mitchell, for SMHF 28/05/2015
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Increasing difficulty
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Change of lever length
Change of ‘base’
Change of speed
Using body weight as resistance
Add equipment
Using resistance bands
(c) Susan Mitchell, for SMHF 28/05/2015
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Moving and Handling
• High risk industry (handling = 5% RIDDOR injuries/8%, STF = 62/41, Assault = 16/5)
• Reinforces principles of spine alignment, load
close, use of legs, stability
• Could replicate transfer ‘postures’
• Encourages balance
(c) Susan Mitchell, for SMHF 28/05/2015
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Lateral Thinking
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Work/task seating – dynamic not passive
Standing Workstations
‘dots’ as triggers
Generally be more active!
– Cycling
– Swimming
– Horse Riding
(c) Susan Mitchell, for SMHF 28/05/2015
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Any questions?
• Don’t try this at home……..
(c) Susan Mitchell, for SMHF 28/05/2015
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