It All Starts with The Core
The Core
Remarkably, while almost everyone agrees that the core is vital to injury prevention and sports performance, this is a topic that still needs to be discussed and written about, largely because there seem to be some fundamental and persistent misunderstandings regarding the why, what, how, and perhaps most importantly, when regarding training of the core. The short answers to these questions are as follows:
Why
To provide a stable postural platform from which to transfer force to the limbs during athletic movements while breathing effectively and efficiently.(1-6)
What
The core is most certainly not just the six-pack many people attempt to cultivate by doing endless crunches, sit-ups, bicycles, flutter kicks, and leg lifts, but more on that later. Primarily, the core is comprised of the diaphragm, the pelvic floor complex, the splenius and erector complexes, the deep spinal muscles including the rotatores, multifidi, and semispinalis, the transverse abdominis, the internal and external obliques, and of course the six pack (rectus abdominis). This grouping of muscular systems are fascinating as many are largely, but not always, reflexive in their control over posture, breathing, motion, and stability, sometimes referred to as stiffness, at the spine. Other muscle groups may be considered secondary core structures depending on the task at hand. For example, the latissimus dorsi work to assist in stabilizing the lumbar and lower thoracic spine when deadlifting, the psoas, primarily a lumbar spine stabilizer, may function as a demand dependent hip flexor, and depending on increases in ventilatory demand, muscles such as the scalenes may shift from primarily controlling motion of the neck to assist in respiration.
How
Breathing: If one of the goals of core training is to optimize diaphragmatic function during breathing it is useful to assess whether or not the athlete exhibits dysfunctional breathing patterns under low threshold conditions. A simple way to accomplish this is with a high-low self-assessment where the athlete may also observe their own breathing patterns by placing one hand on the upper chest and one hand on the belly. It is then possible to see if, at minimum, the lower hand moves earlier, longer, and with greater mobility during normal deep breathing than the top hand.(3-6) If this is not the case, it is likely that the athlete is exhibiting signs of dysfunctional breathing patterns. Strategies to resolve dysfunctional breathing patterns may include but are not limited to cuing, breathing exercises, and breath holds, potentially coupled with rotational movements of the trunk, to elicit a reflexive response from the diaphragm.(3-6) While breathing seems simple, it is also important to breathe appropriately for the task at hand. The diaphragm should always be the driver of respiration, however this large muscle can also be the driver of trunk stability. The diaphragm moves up and down creating pressure in the chest cavity like a pneumatic pump and pressure against the abdominal chamber like a hydraulic pump during bracing or feed forward strategies such as wearing a belt during heavy lifting. It is important to note that bracing and pushing out against a belt are two different trunk stability strategies and should not be confused. The diaphragm is of the utmost importance.
Rolling: Rolling, a form of trunk rotation, is a remarkably complex developmental movement pattern that requires coordination between the eyes, core, and limbs to complete in an efficient manner that is core dominant. While this pattern continues to be utilized throughout life, it can often become uncoordinated and dysfunctional for a variety of reasons including muscular tension, weakness, and/or compensation.(7,8) At the most basic level, a human should be able to roll from a prone to a supine position, or visa versa, moving either the upper or lower quarter in a core dominant fashion.(7,8) These movements should be assessed and addressed by the appropriate type of professional, but from a movement perspective, they may require cuing or pattern assistance or resistance to re-establish a coordinated pattern. This should be followed by limited practice to ensure coordination and control over trunk rotation starting with the core in order to effectively and efficiently transfer force to the extremities as movements become more complex and athletic.(7,8)
Planking (And Other Sagittal Plane Stability Training): If the goal is to provide a stable postural platform from which to transfer force to the limbs during athletic movement, controlling sagittal plain stability at the trunk is profoundly important. Unwanted and uncontrolled lateral and rotational motion, particularly at the trunk, hips, and pelvis, can create strength ‘leaks’, inefficiency, and compensation when performing in events ranging from running to powerlifting. The plank, a classic when considering posture, core stiffness, and sagittal stability, is remarkably versatile as it can be progressed by changing the length of the lever at the arm (low on elbows v. high on hands), the number of points of contact (combining knees, feet, hands, elbows, single leg, single arm, and single arm/single leg), the angle of the contact point of the arms or legs, and the inclusion of surface instability at the arms and/or legs in order to change muscle activation patterns and coordination.(9-10) The plank is also crucial as it represents a position analogous to a host of other exercises like the push-up, bench press, the top of the front rack position, the deadlift, and a variety of squats, while also preparing the core to create stiffness and stability through a number of positions required for most other lifts. However, it is important to not just relax in a plank position and expect to get stronger. Creating tension strategically throughout the body, while still breathing correctly is highly important during a plank. Activation of the lats and the muscles surrounding the scapulae as well as the muscles of the lower extremity while abdominal bracing making the plank a much more effective and efficient method of training. These exercise variations coupled with abdominal bracing are preparing you to take on load and force by stabilizing the spine.(11,12) Don’t plank lazy.
Crawling: Crawling represents the combination of the rotational control of rolling with the sagittal stability of plank variations and progressions while including upper and lower extremity motion. Crawling can be done in a spine supported position such as dead bug variations, static variations including progressions of the quadruped or ‘bird dog’ exercise, and a variety of actual crawling variations including reverse, lateral, circular, and complex crawls.(7,8,10)
Loaded Carries: Loaded carry variations such as farmer carries, suitcase carries, rack carries, overhead carries, zercher or husafell variations, and mixed position carries as well as marching variations challenge the core to create stability and coordinated extremity activity in environments that replicate athletic circumstances in a controlled manner.(10,13,14) These exercises, similar to crawling, combine the need for reflexive core stiffness in response to load, sagittal plain stability, and rotational control with the advantage of elevated external load.
Proper Training: Each of the strategies listed above support both training and athletic performance and have been suggested to assist in injury risk mitigation.(2-18) It may be significant to point out that crunches, sit-ups, bicycles, flutter kicks, and leg lifts etc. have not been mentioned since the third paragraph of this blog, and for good reason, it has even been reported that the US military is re-thinking these methods.(19) Each of these exercises typically target the rectus abdominis without considering its role in postural control and sagittal plain stability by creating repetitive spinal flexion in a supported position against gravity, or tax the hip flexors far more specifically than they do any other core musculature creating a disadvantageous environment regarding postural integrity and pelvic positioning. Without proper and rather specific context exercises such as crunches, sit-ups, bicycles, flutter kicks, and leg lifts are doing far more harm than good.
When
This is where many coaches look at me like I’m out of my mind so I’ll be direct. It is advantageous to include core work, as described above, as part of your pre-training and pre-competition warm-up. There is a building body of evidence that suggests that core work and core activation patterns may have significant positive effects on active range of motion at both the hip and shoulder in athletic populations.(14-18) Let me say it again. If the goal is to provide a stable postural platform from which to transfer force to the limbs during athletic movements while breathing effectively and efficiently, AKA being a better and potentially safer athlete, do core at the beginning of your warm-up and do it well.
References
1. Gandevia, S. C., Butler, J. E., Hodges, P. W., & Taylor, J. L. (2002). Balancing acts: respiratory sensations, motor control and human posture. Clinical and experimental pharmacology & physiology, 29(1-2), 118-121.
2. Kibler, W. B., Press, J., & Sciascia, A. (2006). The role of core stability in athletic function. Sports medicine, 36(3), 189-198.
3. Nelson, N. (2012). Diaphragmatic breathing: The foundation of core stability. Strength & Conditioning Journal, 34(5), 34-40
4. Chapman, E. B., Hansen-Honeycutt, J., Nasypany, A., Baker, R. T., & May, J. (2016). A clinical guide to the assessment and treatment of breathing pattern disorders in the physically active: Part 1. International journal of sports physical therapy, 11(5), 803.
5. Hansen-Honeycutt, J., Chapman, E. B., Nasypany, A., Baker, R. T., & May, J. (2016). A clinical guide to the assessment and treatment of breathing pattern disorders in the physically active: part 2, a case series. International journal of sports physical therapy, 11(6), 971.
6. https://www.functionalmovement.com/articles/780/take_a_deep_breath - Accessed April 18, 2020
7. Hoogenboom, B. J., Voight, M. L., Cook, G., & Gill, L. (2009). Using rolling to develop neuromuscular control and coordination of the core and extremities of athletes. North American journal of sports physical therapy: NAJSPT, 4(2), 70.
8. Hoogenboom, B. J., & Voight, M. L. (2015). Rolling revisited: using rolling to assess and treat neuromuscular control and coordination of the core and extremities of athletes. International journal of sports physical therapy, 10(6), 787.
9. Snarr, R. L., & Esco, M. R. (2014). Electromyographical comparison of plank variations performed with and without instability devices. The Journal of Strength & Conditioning Research, 28(11), 3298-3305.
10. McGill, S. (2010). Core training: Evidence translating to better performance and injury prevention. Strength & Conditioning Journal, 32(3), 33-46
11. Vera-Garcia, F. J., Elvira, J. L., Brown, S. H., & McGill, S. M. (2007). Effects of abdominal stabilization maneuvers on the control of spine motion and stability against sudden trunk perturbations. Journal of electromyography and kinesiology, 17(5), 556-567.
12. Grenier, S. G., & McGill, S. M. (2007). Quantification of lumbar stability by using 2 different abdominal activation strategies. Archives of physical medicine and rehabilitation, 88(1), 54-62.
13. McGill, S. M., & Marshall, L. W. (2012). Kettlebell swing, snatch, and bottoms-up carry: back and hip muscle activation, motion, and low back loads. The Journal of Strength & Conditioning Research, 26(1), 16-27.
14. Dexter, R. R., Renggli, C. P., May, J., & Larkins, L. (2020). The Effects of Strength and Conditioning on Functional Movement Screen™ Scores in Secondary School Basketball. Journal of Sports Medicine and Allied Health Sciences: Official Journal of the Ohio Athletic Trainers Association, 5(3), 5.
15. Gamma, S. C., Baker, R. T., Iorio, S., Nasypany, A., & Seegmiller, J. G. (2014). A total motion release warm‐up improves dominant arm shoulder internal and external rotation in baseball players. International journal of sports physical therapy, 9(4), 509.
16. Gamma, S. C., Baker, R., May, J., Seegmiller, J. G., Nasypany, A., & Iorio, S. M. (2018). Comparing the Immediate Effects of a Total Motion Release Warm-up and a Dynamic Warm-up Protocol on the Dominant Shoulder in Baseball Athletes. Journal of strength and conditioning research.
17. Dexter, R. R., Loftis, T. K., Baker, R. T., & Speicher, T. E. (2019). Regionally Interdependent Applications of TMR® and Active Rotational Shoulder Range of Motion in Overhead Athletes. Clinical Practice in Athletic Training, 2(2), 20-36.
18. Dexter, R. R., Loftis, T. K., Pettaway, A. N., Baker, R. T., & May, J. (2019). THE IMMEDIATE EFFECTS OF A TOTAL MOTION RELEASE® WARM-UP ON ACTIVE ROTATIONAL HIP RANGE OF MOTION IN OVERHEAD ATHLETES. International Journal of Sports Physical Therapy, 14(6), 898.
19. https://www.washingtontimes.com/news/2018/jul/10/armys-new-fitness-test-ready-by-2020-officials-wan/ - Accessed April 19, 2020.