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What even is a core?

Megan Kressbach, DPT

April 29, 2021

We hear this word all the time. Core equals abs, right? There are a lot of different definitions of this elusive “core”. Mostly it is used colloquially as our abs, or that nice six pack. However core should be thought of as a system of stabilizers that help with just that; stability.

Kibler et al 2006, defines core as that which includes the spine, hips and pelvis, proximal lower limb, and abdominal structures. The core muscles are responsible for our stability of the spine and pelvis and help the transfer of energy throughout our body. But for the purpose of this topic, lets keep it simple and synthesize “core” down to four major muscle groups: diaphragm, transverse abdominis, multifidus, and the pelvic floor.

(Photos from Pelvic Guru)

Think of your core as a cylinder. The top would be our diaphragm, the bottom our pelvic floor, and the circumference as our transverse abdominis and multifidus muscles. As we take a breath in, our diaphragm and pelvic floor descend, and as we breathe out, they ascend. We can use these muscles as a type of brace or piston system.

If you’ve ever bought a house, there are a few things that you pay close attention to during the inspection process: the foundation and the roof. This “top and bottom” of the house is important to the structural integrity since this supports and protects the house. Our bodies are similar in the sense that our pelvic floor ideally should provide our body with a stable foundation. Our diaphragm also impacts much of our general well-being and stability. Our transverse abdominis and multifidus muscles comprise the walls which complete our stable and sound structure. (Julie Wiebe, Piston Science Part 1)

Why is this important:

Fun fact: when you start to move your body, regardless of the direction you are going, regardless of the limb you plan to move, these core muscles, or central stabilizers, fire first! This means, as soon as you go to take a step, reach for a cup, or swing a baseball bat, our core is active before even moving the limb! (De Blaiser et al, 2018)

So why can’t I just do sit ups to strengthen my core? Our abdomen consists of a few different layers of abdominal muscles including rectus abdominis, internal obliques, external obliques, and transverse abdominis. A study by Hodges et al 2000, found little evidence to support rectus abdominis or obliques playing a direct role in core stabilization as it relates to the diaphragm. However, there was statistical significance that shows as the diaphragm descends (as you inhale) the transverse abdominis responds directly to this change in pressure. This pressure that is created with just our breath can help improve the stability of our spine, pelvic floor, and decrease pain by providing stabilization and support.

It seems like pressure helps create stability, and it can! But it can also become an enemy if not utilized appropriately. Remember that we defined core as four muscles working synergistically to create stability. As we breathe in and out, it changes the length (read: contraction or relaxation) of our pelvic floor muscles as well. If there is uneven distribution in pressure, issues may arise such as incontinence, pelvic floor prolapse, constipation, low back pain, shoulder issues, pain with intercourse, and even hip pain. 

(Photo from Cloverdale Chiropractic)

A few populations that are at a higher risk includes moms (both new mommas or even decades later), weight lifters with ill form, chest breathers, and those with chronic pain since pain can change the responsiveness of our system.

Breathing is more than just oxygen. Because our diaphragm is connected with our vestibular system, we can experience balance deficits. Because our diaphragm can be affected with conditions such as allergies and asthma, it can increase the likelihood of low back pain. These are just a few examples of how it is all connected!

What can this lead to:

Dysfunction in our core stability may lead to several things, here are a few common complaints.

1. Incontinence

2. Constipation

3. Sexual dysfunction

4. Low back pain

5. Hip pain

6. Shoulder pain

7. Balance issues

What should I do?:

I wish there was an easy answer such as, “just breathe” but core dysfunctions don’t come with a one-size-fits-all solution. Luckily, physical therapy can help! We are trained to assess how your body works together, not just one piece of the puzzle. We can analyze your breathing pattern, muscle recruitment, and general movement in order to see how this may contribute to pelvic floor issues as well as back pain and extremity issues.

Six packs may look cool, but maybe it is time to focus more on central stability with a balanced recruitment of muscles for optimal health and wellbeing!

*If you have any questions, concerns, or comments please email megan@soulpt.com or stop by Soul Physical Therapy!*

Citations:

De Blaiser, C., Roosen, P., Willems, T., Danneels, L., Bossche, L. V., & De Ridder, R. (2018). Is core stability a risk factor for lower extremity injuries in an athletic population? A systematic review. Physical Therapy in Sport, 30, 48–56. doi:10.1016/j.ptsp.2017.08.076

Kibler, W. B., Press, J., & Sciascia, A. (2006). The Role of Core Stability in Athletic Function. Sports Medicine, 36(3), 189–198. doi:10.2165/00007256-200636030-00001

Hodges, P. W., & Gandevia, S. C. (2000). Changes in intra-abdominal pressure during postural and respiratory activation of the human diaphragm. Journal of Applied Physiology, 89(3), 967–976. doi:10.1152/jappl.2000.89.3.967

Golf Series

D.J. Marquis, DPT
March 4, 2021

Time to talk golf! Spring is right around the corner and now is the time to work on some key aspects of your body's strength and mobility to ensure a great season. While you may not be able to swing the club as much at the range, you can hit the gym to workout at home.

For this first blog post I’ll touch on key areas to improve mobility. For the most optimal golf swing, the body must be able to:

1) Rotate at the hips

2) Rotate at the lumbar/thoracic/cervical spine

3) Maintain adequate shoulder motion

The following sections will highlight each body region with some exercises to work on improving the body's mobility.

HIPS

During both phases of the golf swing the hip is required to rotate roughly 45 degrees. A lack of this mobility will lead to compensations at the pelvis/low back leading to suboptimal power and accuracy.

Here are 3 great exercises that can help improve your hip mobility:

1. Supine 90/90 Hip IR with ball squeeze

1. While laying on your back against a wall try to maintain pressure into a yoga block, pillow, or ball between your knees.

2. Slowly try to spread your feet apart.

3. Hold at your end range for a slow 1-3s count or 5 deep breaths.

4. Return to starting position and repeat 12-15 times to improve hip rotation mobility.

2. Standing Airplane

1. While in a staggered stance hold a dowel or cross your arms across your chest.

2. With a slightly forward lean of your trunk, rotate towards the outside of your leading leg

3. Return to starting position and repeat for 12-15 repetitions to improve hip mobility.

3. Loaded Pivot Step with kettlebell

1. While standing and holding a kettlebell or dumbbell directly overhead.

2. Perform a pivot step across your body moving to the side that the arm is extended overhead with the weight.

3. Return to starting position and repeat for 12-15 repetitions to improve hip mobility.

THORACIC

It is important to have adequate extension and rotation mobility throughout the golf swing. Within today’s culture we spend more time in a flexed or bent over position. Whether we work at a desk, spending a great deal of time on our phones, or commuting to work we will inevitably be forced into a bent-over or hunched posture.  Over time this can lead to postural adaptations and soft tissue structures.

Here are 3 great exercises to improve the mobility of the thoracic spine:

1. Tall kneeling thoracic extension rocks

1. In a tall kneeling position with elbows resting on a bench, chair, ottoman, sofa and a dowel in your hands

2. Slowly rock back while maintaining your elbows pressed into the surface

3. Time it with your breathing so breath out as you rock back

4. Return to starting position and repeat for 12-15 repetitions to improve mid-back extension mobility

2. Side Lying thoracic rotations (Open Books)

1. While laying on your side and your legs stacked and bent up to your chest.

2. Open the top arm across your body while maintaining eye contact with your thumb

3. Hold at the end of your range of motion for 1-3 seconds

4. Return to starting position and repeat for 12-15 repetitions on both sides to improve mid-back rotation

3. Half-kneeling thoracic rotations

1. While in a half-kneeling position and a ball or pillow at your knee.

2. Maintain pressure into the ball/pillow to limit rotation at your low back.

3. With the arm closest to the wall try to maintain your hand on the wall as your rotate around your body

4. Limit the amount of side-bending you are doing to ensure pure rotational movement

5. If this is easy perform same rotational movement with your hand not contacting the wall.

6. Return to the starting position and repeat for 12-15 repetitions to improve mid-back rotation mobility.

CERVICAL SPINE

An often forgotten area when it comes limiting a golf swing is the neck. Along with the thoracic spine or mid-back, the postures that we are in throughout the day tend to be more forward flexed. Though this is unavoidable at times, this can lead to stress on soft-tissue structures of neck, altered breathing patterns, postural adaptations, and poor loading strategies of the spine. This is not to frighten anyone, it is important to know that the best posture is your next posture and a new concept of movement variability is what I believe is crucial than forcing oneself to fear certain positions. It is important to take the time to work on improving these postural habits and move more into postures that you frequent less.

When it comes to golf the neck must be able to rotate and side-bend. Roughly you need around 70 degrees of rotation to each side to avoid compensations.

Here are great exercises to work on improving mobility in key areas crucial to a golf swing:

1. Chin-Tucks with overpressure

1. While laying on your back, sitting, or standing your going to try and make a double chin motion

2. Imagine your chin is resting on a table and you have to slide back without going into the table

3. While at the end range of motion apply gentle overpressure at your upper lip

4. Repeat for 12-15 repetitions to improve neck ROM, and to decrease pain/stiffness

Chin-Tuck- Video: https://www.youtube.com/watch?v=zgn86w2hD7U

1. Repeated Movements into retraction and side-bend

1. While maintaining a chin-tuck try and touch your ear to your shoulder

2. If one side feels tighter or more painful than the other a strategy to improve this is to load that side of your neck

3. Perform a chin tuck and gently pull your head/neck into that side-bent motion

4. Repeat for 12-15 repetitions multiple times daily to improve ROM, and decrease pain/stiffness.

SHOULDERS

Lastly, ones shoulder strength and stability is vital to a great golf swing. A adequate amount of rotation is required to achieve an optimal golf swing. Here are a few great exercises to help improve shoulder mobility

1. Shoulder ER at wall in pec stretch

1. While standing facing a wall place your arm against the wall as if to try and open up your chest

2. Lean into this until a stretch is felt

3. Maintain this position and try to lift up your arm off the wall

4. Repeat this for 12-15 repetitions to improve shoulder rotation.

2. Lat stretch w/ Diaphragmatic breathing

1. Holding onto a STABLE surface such as an exercise pole, support beam, or golf cart.

2. Slowly sit back with arms holding stable surface until a stretch is felt in your shoulders

3. While maintaining this stretch perform 10-12 belly breaths being sure to fully exhale through your mouth.

4. Repeat for 2-3 sets to improve shoulder range of motion.

If you have any questions, concerns, or comments please email dj@soulpt.com or stop by Soul Physical Therapy!

Sources:

1. Body-Swing Connection: Adam Scott. (n.d.). Retrieved December 12, 2018, from http://www.mytpi.com/articles/swing/body-swing_connection_adam_scott

2. Gulgin, H. R., Schulte, B. C., & Crawley, A. A. (2014). Correlation of Titleist Performance Institute (tpi) Level 1 Movement Screens and Golf Swing Faults. Journal of Strength & Conditioning Research (Lippincott Williams & Wilkins), 28(2), 534–539.

3. McHardy, A., & Pollard, H. (2005). Muscle activity during the golf swing. British Journal of Sports Medicine, 39(11), 799–804. https://doi.org/10.1136/bjsm.2005.020271

4. When Working To Improve Rotational Capabilities, Don’t Overlook The Neck. (n.d.). Retrieved December 12, 2018, from http://www.mytpi.com/articles/health/when_working_to_improve_rotational_capabilities_don’t_overlook_the_neck

5 Tips to Prevent Pain While Working from Home

Kara Jesi, DPT

February 9, 2021

Many people have found themselves working from home during this pandemic and in turn their living rooms and bedrooms have become their new home office. Here is a quick checklist of things to try in order to avoid neck and back pain and to ease the stress of balancing work and life. Obviously, setting up a work station at a desk is ideal, but for those who don’t have that option we have some quick tips to help working on your couch, countertop, or even your bed, less painful.
 
1.     Try using a pillow or a tray to raise the computer to eye height. (whether on your lap or on a coffee/side table)
2.     Avoid hunching by adding a pillow behind your low and/or mid-back.
3.     Keep your feet flat on the floor if your sitting. If you are lying in bed, it is important to take frequent breaks and make sure you are supported appropriately from the head down. The best position for lying in bed is to have your back and neck supported and to use a tablet so that you can raise the screen up to your face and rest your elbows next to you.
4.     Take breaks frequently. Setting a timer on your phone, or using a sticky note is a quick/easy way to remind yourself!
5.     Hydrate. Staying hydrated can help keep you focused and even boost your immune system! Try using a fun, new water bottle to mix it up. Quick tipà women are encouraged to drink 2.7 liters of water a day while men are recommended 3.7 liters. **
 
 The U.S. National Academies of Sciences, Engineering, and Medicine determined that an adequate daily fluid intake is:
·       About 15.5 cups (3.7 liters) of fluids a day for men
·       About 11.5 cups (2.7 liters) of fluids a day for women
These recommendations cover fluids from water, other beverages and food. About 20% of daily fluid intake usually comes from food and the rest from drinks.

Need help with your sitting posture? Come on in!

Beverly 978.524.0333

Danvers 978.304.0536
GetWell@SoulPT.com

The Importance of Pain Science and Progressive Loading to reduce your Chronic LBP

Jennifer Hahne, DPT

November 10, 2020

Chronic pain can be debilitating to one’s daily life. With Physical Therapy there are ways to reduce your Chronic pain and get you back to living your best life. 

Think about your pain level as water in a glass. ( water= pain, glass= your tolerance to discomfort). 

Ways to decrease water level (decrease direct pain)

o   Manual Therapy

o   Light Movement

o   Understanding Pain

o   Dry Needling

Ways to increase size of your glass( overall health)

o Slowly start participating in hobbies and events that bring you joy

o Stay hydrated

o Eat a balanced diet

Strength training

oLoading the tissue with the issue

oPrioritize sleep

oManaging Stress

oPractice Gratitude

If you need help managing your chronic pain, come see us in Beverly or Danvers!

Beverly 978.524.0333

Danvers 978.304.0536

GetWell@SoulPT.com

Single Leg Work for Back Health and Resiliency

Andy McLlarky, PT, Owner

October 20, 2020

When we think of building some resiliency at our lower back people often think about doing core work.  While building some pillar strength can be helpful with lower back pain we also try to build a solid base in single limb movements. 

Having a solid base on each leg impacts the forces going up to one’s lower back.

Since we move in different ways it’s appropriate to train single limb movements in multiple planes / multiple ways.

Here are a couple of our more recent favorites that are appropriate for most folks:

Single limb RDL with one leg on wall

Why Choose this Exercise?

• Single leg Deadlifts are a very helpful movement to own. 

• Many people don’t have the requisite balance to perform this movement well so one leg on the wall helps a ton to clean up form

• Work on keeping a neutral “ish” back when performing this exercise

• Go down until you feel a stretch in your hamstrings and pull back up

• Once you own it; Load it!

Wall Propped RDL

Front foot elevated Split Squat:

• Split squats are an absolute staple here at Soul PT

• Lunges are awesome; many folks struggle to own the deceleration and for many just focusing on going down and up correctly is the perfect level of difficulty

Front Foot Elevated Split Squat

Give these variations a try.

If you need help with your low back pain come see us in our Beverly or Danvers locations:

Beverly 978.524.0333

Danvers 978.304.0536

GetWell@SoulPT.com

Benefits of Block/Square Breathing

Andy McLlarky, PT, Owner

September 15, 2020

Many different types of breathing techniques exist and can have different impacts upon your body. 

Block Breathing, sometimes called Square breathing, has actually been popularized by NAVY Seals who use this breathing technique to remain calm in very stressful situations.

It has many benefits including;

• Decreasing Stress / Anxiety

• Helping one fall asleep

• Helping with pain management

Simple Application

• INHALE for 4 seconds

• HOLD for 4 seconds

• EXHALE for 4 seconds

• HOLD for 4 seconds

While this can be done for any length of time shoot for 5 minutes.

Why Box Breathing works

Holding one’s breath allows for Carbon Dioxide to build up in your bloodstream. 

Increased Carbon Dioxide in the bloodstream inhibits your vagus nerve and stimulates your parasympathetic nervous system. 

Stimulating your parasympathetic nervous system calms you down (lowers blood pressure, helpful for your immune system and calms pain)

How we use it at Soul Physical Therapy

Often we tell patients to perform this as a part of a bed time routine to improve sleep quantity / quality.

Improving sleep quality helps physical and mental recovery and improves the pain threshold of those with persistent pain.

Also many of our patients also have anxiety that presents as physical problems - jaw clenching, neck pain and headaches.  Box breathing is one method to calm their nervous system and help with some of these symptoms as well.

Need a guide? 

Found this useful Youtube guide for this method:

https://www.youtube.com/watch?v=FJJazKtH_9I

Suffering from headaches, jaw pain or persistent neck discomfort reach out to Soul Physical Therapy - Beverly 978.524.0333 or Danvers 978.304.0536

Or email Getwell@SoulPT.com

Dance-Specific PT

Taylor Darwin, DPT

June 7, 2020

Our talented PT Taylor Darwin created an excellent breakdown of some dance-specific exercises. Having a history of being a competitive dancer, Taylor is your go-to PT for any dance-related injuries or questions!

For dancers, there are specific muscle groups that need to be strong in order to achieve specific goals. There are also muscles that require a certain amount of flexibility. These few exercises target muscles that contribute to adequate turnout, hip flexor, quadriceps, and calf strength along with posterior chain flexibility. Turnout is very important with this population and learning to work through what they have naturally along with strengthening the muscles that control it can prevent further injury.

1. Quadruped Tendu Extension: With leg at 45 degree angle, adduct and externally rotate while lifting your leg towards the ceiling while maintaining pelvic control. This exercise is great for improving turnout and glute strength!

2. Inchworms: Start by standing and walk hands down into a plank position. Hold the plank, and then walk both legs towards hands, doing your best to maintain knee extension. This exercise is great for hamstring flexibility and core strength!

3. Second Plié Squat: While standing in second position and maintaining hip external rotation, alternate between a deep squat and high relevé with an added hold for balance. This exercise is great for improving turnout and quad/calf strength.

4. Standing Marches: Add a band underneath feet for increased tension, and perform standing marches. This exercise is perfect for improving hip flexor strength and control!

5. Side-lying Passé: While side-lying, externally rotate your bottom leg while keeping the other leg behind. You foot should be flat on the mat and your knee bent in a passé position. With a band around your knees and maintaining pelvic control, slowly externally rotate the leg that is in passé.