444 Focus on the Core: Current Perspectives

Sarah R.Stillings, MA, PT, MPT, CHT

Sarah R. (Sally) Stillings is a PT and Certified Hand Therapist in Texas. She received her physical therapy degree from the University of North Carolina at Chapel Hill. Prior to becoming a therapist, Sally taught university-level writing courses and was assistant editor of The Journal of Craniomandibular Practice. In her extensive career as a PT, she has held a variety of clinical, teaching, administrative, and business roles, including general PT practitioner, upper extremity specialist, clinic manager, hand therapy clinic coordinator, continuing education (CE) instructor, and CE course administrator. She has also served as Executive Director of the Kellermann Foundation, a U.S. nonprofit organization supporting healthcare and community development in Uganda, East Africa. Her work now focuses on creating evidence-based CE materials for rehab professionals. Sally is a lifelong runner who celebrates all those who cover the ground.

444 Focus on the Core: Current Perspectives Course Objectives After successfully completing this continuing education course, the learner should be able to: 1. Recall the concept of the core as a flexible cube 2. List the primary muscles of the lumbo-pelvic-hip complex and their main functions 3. Identify the five main functions of the core 4. List at least 6 stated benefits of core training 5. Recognize the importance of the core to posture, balance, and force transmission 6. Recall neuromuscular considerations regarding the core 7. Recall the history of our understanding of the core 8. Identify the main theories, conceptual models, and classifications of core function 9. Delineate one or more of the challenges inherent in core assessment 10. Choose and apply appropriate assessment techniques for evaluating core function in adults 11. Identify and discuss special considerations, assessment, and intervention ideas for the following adult populations: a. Individuals with low back pain b. Athletes c. Older adults 12. List at least 4 contraindications to exercise intervention 13. Differentiate between the motor control, general exercise, and hybrid approaches to core training; provide the reasoning for your specific choice of approach 14. Provide 3 examples of specific exercise interventions for core rehabilitation in adults 15. Recognize how Pilates, tai chi, and yoga may be used for core training 16. Using case studies, identify and apply evidence-based approaches to core evaluation and treatment that will help maximize patients' function in their daily activities 444 Focus on the Core: Current Perspectives—Table of Contents Hour 1 Course Instructions 2 About the Author / Course Description 3 Course Objectives 4 Table of Contents 5 Introduction 8 Chapter 1: Applied Anatomy 10 Superior and Inferior Core Muscles 12 Anterior Core Muscles 15 Posterior Core Muscles 17 Superficial Layer 17 Intermediate Layer 19 Deep Layer 21 Lateral Core Muscles 22 Hour 2 Chapter 2: Why Is the Core So Important? 25 Functions of the Core 25 Benefits of Core Training 28 Postural Considerations 30 Balance Problems 31 Neuromuscular Considerations 32 Chapter 3: Conceptual Models 36 History of Understanding of the Core 36 Hour 3 Current Conceptual Models and Classification Systems 42 Intra-Abdominal Pressure 43 Core Stability 45 Kinetic Chain Concept 50 Core Musculature Classifications 53 Local Motor Control vs. General Exercise Approach 56 Hour 4 Chapter 4: Assessment of the Core 59 The Challenge of Core Assessment 59 Patient History 61 Medical History 62 History of the Current Complaint 63 Systems Review 65 Objective Assessment 66 Specialized Assessment Procedures 67 Observation—Sagittal Plane 68 Observation—Frontal and Transverse Planes 70 Observation of Gait 71 Range of Motion and Flexibility 72 Muscle Strength 73 Hour 5 Muscle Recruitment 78 Muscle Endurance 80 Balance 83 Dynamic Core Stability Testing 85 Chapter 5: Special Considerations for Low Back Pain 93 Core Function in the Context of LBP 95 Local Motor Control vs. General Exercise Approach 97 Hour 6 Core Assessment for Patients with Low Back Pain 100 Interventions for Patients with Low Back Pain 102 Therapeutic Exercise 104 Final Thoughts 109 Chapter 6: Special Considerations for Athletes 110 Core Function in Sport Performance 110 Core Training for Athletes 113 Current Perspectives 115 Assessment of the Core in Athletes 117 Front Abdominal Power Test 118 Side Abdominal Power Test 119 Hour 7 Core Stability and Injury Risk 121 Sample Core Stabilization Training Program 122 Cognitive Phase 123 Static Stabilization Phase 124 Dynamic Stabilization Phase 126 An Opposing Viewpoint 130 Specific Recommendations for Athletes with LBP 133 Neutral Spine 137 Abdominal Bracing 137 Partial Curl-Up 138 Side Plank 139 Quadruped Exercise 140 Supine Bridge 141 Prone Plank 142 Progression 143 Hour 8 Chapter 7: Special Considerations for Older Adults 145 Core/Trunk Strength and Function in Older Adults 145 Assessment of the Core in Older Adults 150 Intervention for Older Adults 154 Core Control 155 Balance and Proprioception 156 Flexibility 156 Aerobic and Strengthening Exercise 158 Hour 9 Chapter 8: Core Rehabilitation and Training 160 Contraindications to Core Training Exercises 160 Choosing Your Approach 162 Patient Education 163 Flexibility Exercises 164 Manual Therapy 164 Core Control Training and Core Strengthening Exercises 165 Motor Control Approach 166 General Exercise Approach 168 Hybrid Approach 171 Exercise Progressions 176 Other Exercise Disciplines 182 Pilates 182 Tai Chi 185 Yoga 186 Hour 10 Conclusion 191 Case Studies 192 Appendix: Provider and Patient Education Resources 197 References 201 Examination 214 Evaluation 225

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