Redefining the CORE: it’s more than just your abs!

Redefining the CORE: it’s more than just your abs!

What is the core?

‘The Core’ is essentially a collective term to refer to the primary muscles at your centre. These muscles collectively bring stability to the spine and support movement of the limbs. The core makes up nearly half the body, and includes all the muscles that attach to the pelvis and spine.

To the rehabilitation world the core is the thoraco-lumbar-pelvic (trunk) complex. It is composed of as many as 35 different muscle groups! These muscles connect into the pelvis from the spine and hip area. In order to simplify the Core muscles I usually divide them into four regions; back extensors, abdominals, lateral trunk muscles, and the hip muscles.

The core as a cylinder, not a 6 pack

Put simply, you can think about the core as a cylinder; it has a bottom (the pelvic floor muscles), a top (the diaphragm) and sides (the abdominals, obliques and back muscles). I’ve put in some diagrams to really help you see how all these muscles come together to create ‘the Core’.

the front of the core, the most superficial muscles

The back of the core, the most superficial muscles

See how it looks like a cylinder? You can see the deep back, front, side and pelvic floor muscles

the deep back muscles of the core

the lateral or side muscles of the core

The core’s VIP: The Diaphragm

We already know that it’s primary function is to stabilise, but how? Well, this is where the diaphragm is really funky and important: the core creates stability when it generates intra-abdominal pressure by a gentle ‘drawing in’ action from all sides of the cylinder at the same time… but particularly from the diaphragm being a secure lid.

So what happens if our diaphragm doesn’t function optimally?

Well, studies have looked at the associations between lower back pain and diaphragm functioning. One study in particular found:

  • Comparing people with lower back pain (LBP) to people without, the LBP group had less diaphragm movement when they inhaled and exhaled
  • The difference was more noticeable during inhalation, and they noted the diaphragm was positioned higher than the other pain-free group
  • This finding was even more pronounced when they added a level of physical exertion (a simple postural task)

The researchers hypothesize that this dysfunction of the diaphragm may exacerbate syptoms of lower back pain by increasing the anterior shear forces on the ventral region of the spinal column.

It’s all very interesting. But how does this information help you?

Well, it means you now know where to start if you want to prevent or start treating lower back pain. Let the process of holistic treatment begin…

 

 

How to train and strengthen your core

There are a plethora of ways to train your core. Let me tell you, sit-ups and crunches are NOT THE ONLY WAY! (they’re actually the worst way). Now that you understand how the core functions, you can see how it comes into play all the time, not just when we try to isolate it. Since our centre of gravity resides within our pelvis, and is where all movement begins; our core becomes fundamental for creating stability of all our lower limb movements. This even includes simple ankle and knee movements!

Start with:

  • Diaphragmatic breathing
  • Transverse abdominus activation
  • Pelvic tilts
  • Isometric exercises (no movement) e.g. dead bugs

Then build strength and control:

  • Animal crawls
  • Bird-dog (4-point alternative arm leg extension)
  • Forearm plank and side plank

Then implement into:

  • Compound movements e.g. lunges or lunges with single arm press
  • Dynamic movements e.g. cable rotations
  • Unilateral exercises e.g. single arm cable or dumbbell press

There are many exercises that I prescribe to my patients for core strengthening. The exercises include basic body-weight movements, sometimes really simple exercise to increase body awareness, proprioception and neuromuscular connection; it doesn’t always need to feel like its burning for it to be having seriously positive benefits!

Our philosophy is to progress things to more functional movement patterns where they have to rely on core strength and stability to complete movements with good technique and control.

A strong and stable core can improve optimal performance throughout the whole body and enable you move better, move more, and move longer, as well as preventing injuries!

If you want to train with me, you can book online here: https://informhealth.com/people/jacinta-brinsley/
If you want to read more of my blogs, click here: https://informhealth.com/author/jacinta-brinsley/
If you’re interested in doing yoga with me, click here: http://bit.ly/iwanttodoyoga

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5 Yoga Poses to Reduce Back Pain

5 Yoga Poses to Reduce Back Pain

Do you sometimes feel tight or stuck in particular parts of your body? Perhaps from being in a certain posture for too long? I have five gentle yoga postures for you (and they’re even based on scientific research).

What a pain in the… back!

In a world where we spend so much of our time seated at a desk. or in the car. or on the couch… it’s no wonder most of us experience some kind of non-specific musculoskeletal pain at some point. As an exercise physiologist, I hear a lot of complaints about back pain, and more specifically, lower back pain… and I’m going to talk about this in a blog all of its own next month; keep your eyes peeled for ‘Low back pain is a tug-of-war between your abs and hamstrings’!

Why do I get back pain?

The short of it is this: when we’re sitting down, the muscles at the front of our body are in a shortened position, whilst the muscles on the back of our body are typically in a lengthened position. Our bodies are really, really smart organisms that want to adapt to make our life easier. So if we sit for 8-9 hours a day, then our body is going to adapt to this shape by adding adhesion to the muscles around our hips and chest, and it’s going to ‘tune-out’ from the muscles on our back body, since we don’t really activate these much *cough, glutes*.

Solution 1 – Increasing neuromuscular connection

By waking up some of these ‘sleeping’ muscles, we increase our brains ability to communicate with that muscle and it’s surrounding muscles so that we can utilize them for movement. A great example of this is our glutes. As I hinted at above, many of us sit on our bum all day long and as a result of this we actually really struggle to consciously activate and squeeze our glutes on our own command. Try it now, lay down on your back and see if you can squeeze your glutes one at a time! (and you’re not allowed to let your hamstrings switch on!). It’s really hard for the majority of people! Our glutes should be the biggest and strongest muscles on our body, these guys are really important and their main job is to stabilise our pelvis, which gives rise to our spine – and that’s a pretty important structure! If we can’t recruit our glutes then other muscles have to do the work that they should be doing, and this is how and why we often get tightness in our back.

If glutes don’t work, then these muscles here (see below) do the brunt of the work when we’re walking, stabilising, leaning, running, reaching, bending over, standing up, climbing the stairs etc.

 

Solution 2 – lengthening the myofascia

Just as importantly, we need to lengthen the muscles, and more importantly the fascia that are have adapted to be short, tight, and a bit sticky from our lifestyle of habitual sitting. This is where these yoga postures will come in handy! I recently read a research article about a yoga study that showed 96% of people in the yoga group experienced significant reductions in musculoskeletal pain (compared to 36% in the control group) with just a single session of five yoga poses! This builds on existing evidence that regularly attending yoga may improve pain and reduce pain medication usage. So below is a short, evidence-based yoga program that absolutely anyone can do at home to help ease back pain or discomfort!

Instructions:

Aim to hold each posture for about 4-5 minutes. When you’re setting yourself up, you don’t want to go past 60% stretch; this is important as if we go past this point we typically start to see the central nervous systems automatic response to protect our muscles and joints kick in and the muscle will actually be holding on to protect you! So a gentle, light sensation is okay – but nothing strenuous. And lastly, try to pay attention to your breath – particularly noticing the length of your inhale and the length of your exhale and trying to make them smooth, steady and even – this helps put our nervous system at ease and will allow the tissue (muscle and fascia) to ‘soften’ a bit more.

Forward fold, foot to thigh

Great for the hamstrings, the glutes, the fascia that all our back muscles insert into across our sacrum and our adductors (inner thigh muscles). You can use a pillow, a rolled up blanket, or anything really to support your forehead so the stretch isn’t too intense.

Half pigeon pose

This accesses the hip flexors of the leg behind you, if you can, play with gentley engaging the glute and seeing how that changes the sensations at the front of the hip. Chest can stay up, or you can fold forwards onto a pillow. Note: the knee should be out wider than your hips, and if this doesn’t feel great in your knees – don’t do it. 

Bound angle pose

This is a favourite. Feet together, knees out wide. Hands can be out like cactus arms, on your belly, or above your head – whatever feels good for you! If it’s too intense, pop a rolled up towel under each knee.

 

 

Supine twist

Make sure your knees are relatively even (the top knee will try to crawl back), and then twist from above your navel. It doesn’t matter if both shoulders aren’t on the ground, as you relax into the pose they may head in that direction. Your arm can be outstretched or you can pop the hand behind the head.

Legs up wall

This can be done with or without props. Definitely recommend elevating the hips either on a yoga block or on a rolled up blanket. Arms out (as pictured) is a nice way to open up the fascia in the chest area. If it feels like a struggle to keep your legs up, you can pop a belt/strap around them… and then relax into this juicy pose.

Now let’s be honest, there’s definitely more than 2 solutions. There’s probably hundreds! But increasing your bodies neuromuscular connections, and lengthening out the myofascia that surrounds our muscles can only be a great place to start! Your body is unique, and your discomfort and pain is unique to you, so if you experience back pain and it doesn’t want to go away, or if you’ve nailed the first two steps in this blog and now you’re ready to start loading up the musculoskeletal system to get nice and strong (the ultimate pain preventative); it might be time to see one our Exercise Physiologists.

What should you do now?

  • Check in with your glutes daily. Once that’s easy, it’s time to challenge them with some load.
  • Do these five yoga poses at the start and/or end of each day, and see what differences you notice
  • Set little reminders throughout the day to get up, sit up straight, elongate your spine, pull your shoulders back, squeeze your glutes, stretch, or whatever works for you!

 

If you would like to join our Clinical Yoga classes, you can click the link below and we’ll contact you with more information shortly!
http://bit.ly/2wJPOCH

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Running is NOT bad for your knees

Running is NOT bad for your knees

There is no shortage of people who want to discourage you from running. “It’s bad for your knees!” they knowingly proclaim. Worryingly, some of these people are Medical and Health Professionals. Aren’t we supposed to be encouraging Australians to be more active? So what’s with this?

Is there evidence to link running and knee injury?

Well yes and no. If you take a group of runners and monitor them over the course of a year, some will get injured- and the most likely part of the body that will sustain the injury is the knees. There are a few studies that have looked at this, and the numbers vary from study to study but the consistent themes are; running comes with injury risk; and the knee is the most likely spot you’ll feel it.

But does this justify the blanket rule that running is bad for your knees? If so, we would also have to conclude the golf is bad for your back, swimming is bad for your shoulders and cycling is bad for your neck. Should we also avoid these forms of physical activity?

Why do some runner’s knees get injured?

There is no single answer to this, and the reality is that injuries that develop over time generally do so because of the convergence of a number of factors. Here is a case study that can illustrate this point:

Steve is 45 and works long hours as a Chartered Accountant. He spends extended stretches of time at his computer, occasionally getting up to make another coffee. He often skips lunch, but when he can sneak out he usually grabs whatever is quick and easy from the Bakery across the road. After work he drops in to his local for a quick beer or two with a couple of mates, before getting home in time for dinner with the family. When the kids are off to bed, the feet are up and he spends more time than he should watching Netflix. His sleep is short and poor in quality as a result.

Steve sees his Doctor who informs him his blood pressure, blood glucose and waist circumference are all trending towards the red-zone, and that he needs to start doing some exercise immediately to turn things around. Steve heeds the warning, so early Saturday morning he laces up his ten year old sneakers he usually wears to mow the lawn, chucks on a t-shirt and shorts and gets out to his local Park-Run 5km. Steve starts out confidently but after about 500m starts to puff and pant. By 2km his knees and lower back are getting sore but he is a determined bugger, so he drags himself across the next 3km with a slow, loping stride. ‘This will only get easier’ he tells himself, and to his credit he repeats this torture for the next 3 weeks.

By Sunday after week 4, his knees are swollen, sore and hot to the touch. He sees his Doctor again the following day and fills him in. “Well you shouldn’t have started running, don’t you know running is bad for your knees?! You should walk, or maybe ride a bike instead”.

Was running the problem here? Or what is that Steve, although well-intentioned, just plunged himself into a task he was completely under-prepared for and hurt himself as a consequence?

Steve’s current lifestyle needs a dramatic overhaul- his overall health could benefit greatly from making some improvements to his diet, reducing his sedentary time, reducing his alcohol frequency and making sleep a greater priority.

Steve could get some advice on footwear by someone who knows what they are talking about. He could also invest some time and money speaking to an expert on how to build his body and his running form so that when he does run he has the strength and the technique to do so more efficiently.

This sounds like an awful lot. But the reality is that running is hard on your body but that is why it can impact our health in such profound, positive way. Our body adapts and evolves to physical stress if it is dosed out appropriately. It is worth making the health changes to equip your body to not only meet the demands of running, but to thrive on them.

Running is not inherently bad for your knees. Running does put your overall health under the microscope, and penalises you for what you neglect. Rather than discouraging people from running, we as Health Professionals should be encouraging our clients to audit and refine how they take care of themselves.

About the Author

Three Reasons Why You Should Exercise With An Expert.

Three Reasons Why You Should Exercise With An Expert.

    It would be rhetorical to say: that your body is special. And you would only want the best to be guiding you through your health and well-being safely. And yet, one can still be suggestible- picking up dodgy anecdotal tips from ‘that guy’ on the lat-pull-down machine.
    I have personally experienced the exercise benefits, being safely loaded, and moving with confidence with one of my colleagues. Leaving my body and surrendering to an expert has given myself a deeper appreciation of the importance of finding an expert in human movement. I have always been on the other side to what I have been accustomed too- and as bias as it sounds: my colleagues here at iNform health really know how to manage and care for their clients.

Here are three reasons why you should be exercising with an expert.

 

1. Your tissues need time to adapt to load. 

Your tissues, all the way down to the extracellular matrix- are for ever adapting to stressors and making proteins. Prescribing appropriate load- will ensure ones tissues will safely adapt; which will add a host of benefits to ones neuromuscular system. Reduced risk of tendonopathies, appropriate motor learning and myonuclei growth (muscle hypertrophy). On the contrary, excessive loading that exceeds the capacity of the neuromuscular system can induce the contra effects to the aforementioned. Tendon pathology, disorganised motor learning due to inappropriate load and systemic inflammation (abnormal prostaglandin levels) due to poor tissue healing.

 

2. Assessing the capacity of the neuromuscular system before undertaking load is paramount- and if neglected, your ‘health professional’ is going in blind. 

If there is a muscle inhibition due to de-conditioned tissues, or a previous pathology that was poorly rehabilitated, would you feel safe to be loaded? Or if you were unable to co-contract your gluteus maximums, or have adequate lumbo-pelvic control? And yet, you may still be subjected to axial loading in your first session…! A thorough musculoskeletal assessment can identify any red flags and give your health professional valuable subjective/objective information to prescribe appropriate exercise correctives.  This will then ensure more complex movements are performed safely.

 
3. Co-care is so important in addressing the whole individual. 

Here at iNform, our clients are closely monitored by a wonderful internal/external team of allied health professionals; ranging from: GP’s, physio’s, osteo’s, chiros, pod’s and psychologist (without exhausting). All working and communicating together for the greater good of your physical and mental health. Co-care leads to better clinical outcomes, a proper working diagnosis, and the right form of treatments that benefit you the individual.

So, next time you are wanting to move with confidence. Be interrogative with your research. Find an evidence based approach that doesn’t involve a lecture from ‘that guy’ wearing a weight belt with a skimpy muscle singlet (stereotyping much?).

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Strength Training for Injury Reduction in Athletes: The Evidence

Strength Training for Injury Reduction in Athletes: The Evidence

The British Journal of Sports Medicine recently published a review of the evidence for Strength Training as a strategy to reduce injuries in Athletes- and the results are impressive! For those that tend to just read the first few lines of an article, take this away. If you are an athlete, or you coach athletes, strength training should be a priority in your programming if you want to reduce injury risk. For the rest of you, please read on.

This article was by Lauresen, Andersen and Andersen (2018). Below is a summary:

The Interventions

  • 6 studies were included, totaling 7738 participants aged between 12-40 y.o.
  • The average intervention duration was 21.39 weeks.
  • Average volume of training was 80 reps per week.
  • Average intensity was 8.39 RM (these means the maximum number of repetitions that can be performed for a given exercise).

The Outcomes

  • Strength Training reduced sports injuries by 66% with a 95% confidence interval of 52% (combined results from 4 of the 6 studies).
  • A 10% increase in strength training volume resulted in reduced injury risk of 4%.
  • No injuries occurred as a result of the strength training throughout the interventions.
  • Strength training was both safe and effective for adolescents as well as adult athletes.

Why? The Mechanisms

The authors can only speculate as to why strength training helped protect athletes from injury, but their proposed mechanisms to explain its effectiveness are:

  • Preconditioning- effectively toughening up the muscles/tendons so they can deal with greater loads.
  • Variation of loading across the body so that parts of the body that are not stressed by the sport take more of the load in the gym.
  • Improved coordination and technique in the gym crossing over to movements in sports.

The Recommendations

The authors concluded with the following recommendations for strength training, and I advise that if you choose to trust an Exercise Professional to help you or your athletes commence a strength training program that they can demonstrate an understanding and adherence to these principles.

  • Commence with a familiarisation period so that the athletes can develop the confidence and capability to perform the exercises correctly.
  • Ensure the athlete is supervised in the gym so that exercises can be completed well and loads are monitored accurately.
  • Loads are individualised to the athletes capability and are altered appropriately over a training cycle.
  • Exercises are varied across the year of training.

I would add in that it is also important that the strength training program is correctly synchronised with the training and competition schedules, so the Exercise Professional must be in regular communication with the athlete’s coach. For example, during an athletes off-season they can focus on improving function and technique; during pre-season switch to muscle building; and within season aim to build/maintain strength and power. The Exercise Physiologists at iNform have extensive experience managing the strength training programs of athletes across many sports. If you would like to speak to one of our EPs about the services we offer athletes, please contact us!

About the Author

Lauersen, J. B., Andersen, T. E., & Andersen, L. B. (2018). Strength training as superior, dose-dependent and safe prevention of acute and overuse sports injuries: a systematic review, qualitative analysis and meta-analysis. Br J Sports Med, bjsports-2018.

Injury Risk Factors for Elite Junior Tennis Players: What you need to know

Injury Risk Factors for Elite Junior Tennis Players: What you need to know

Recently the Journal of Sports Sciences published a Systematic Review detailing the factors associated with injury in Elite Junior Tennis players. It is important that coaches and parents of such athletes are aware of the findings (Oosterhoof et al, 2018).

Risk Factors for Lower Back Injury

Previous Lower Back Injury:

Previous injury is often a good predictor of future injury. Why? That is not clear, but one reason may be that rehabilitation of injuries is often not done to the level that it needs to. Rehab is often done adequately to get a player back on the court, but functional deficiencies can remain. This can predispose the athlete to recurrence, or to injury of another part of the body due to compensation. Elite Junior Tennis players should undertake their rehabilitation under the guidance of a Physiotherapist and Exercise Physiologist that are experienced in this field.

Training Loads > 6hrs p/wk:

Elite Junior Tennis players will be training and playing at least this amount. So how do we mitigate against this as a risk factor? For one, the athlete needs to have a good recovery repertoire and be diligent with it. A recovery program should be personalised for the athlete, but some common features of an athlete recovery plan are; adequate sleep; good diet, hydration and nutritional support (protein especially); massage; stretching and cold-water immersion. Secondly, Functional Resistance training can help build strength in muscles and tendons, mobility in joints, stability in movement, balance and spatial awareness. If your child, or an athlete under your guidance does not have a recovery plan, and/or is not undertaking a quality, personalised functional strength program I would speak to a qualified and experienced Exercise Physiologist to help them build one.

Risk Factor for Upper Extremity Injury

Fewer Years of Playing Experience

The authors do not specify what it meant by ‘fewer years of experience’ so we can only speculate. But generally speaking, when a young person starts at a new sport, their body is going to be exposed to forces that they may not be conditioned to deal with. I recommend that young people new to tennis undertake an overall movement capacity assessment, such as the ‘Movement Screen’ (Movement Screen ). This will identify any functional limitations that can be corrected through a functional strength training program. We use the Movement Screen with all of our young athletes at iNform.

Risk Factor for Lower Extremity Injury

Stretching

Interestingly, in the studies included in the aforementioned review players that regularly stretched the muscles of the lower body had an increased risk of injury than those that didn’t. This is counterintuitive for most, as stretching is supposed to be good for us, right? Stretching can be useful for increasing the mobility of a restricted joint. However stretching can also acutely reduce our muscles responsiveness and power. So there are pros and cons to stretching for athletes. If an athlete is going to be prescribed stretches, they should be recommended only for areas that display movement restriction (and have shown a positive response to stretching) and should be timed so that performance is not impacted negatively. The Exercise Physiologists at iNform can easily identify whether a young tennis player would benefit from stretching, and recommend when is best to do it.

Summary

Whilst there are injury risks associated with playing Elite Level Tennis at the junior level, they can be mitigated by taking an intelligent and strategic approach to the young athletes programming. The Exercise Physiologists at iNform have extensive experience helping Elite Young Tennis players stay strong and healthy and on the court.

About the Author

  1. Jacobien H.F. Oosterhoff, Vincent Gouttebarge, Maarten Moen, J. Bart Staal, Gino M.M.J. Kerkhoffs, Johannes L. Tol & Babette M. Pluim (2018) Risk factors for musculoskeletal injuries in elite junior tennis players: a systematic review, Journal of Sports Sciences, DOI: 10.1080/02640414.2018.1485620