Optimal core stabilization is dependent on proper inter-coordination of abdominal and respiratory musculature. Inspiration begins as the diaphragm contracts and draws down caudally thus creating a natural vacuum in the pleural cavity. The thoracic rib cage moves in a cephalad direction only as an accessory motion to normal intercostal expansion. With diaghram contraction the contents of the abdominal viscera are compressed into the lower abdominal cavity and pelvic floor. The increase in intra-abdominal pressure through diaphragmatic activation along with proper opposition via contractions of the surrounding abdominal musculature results in “stiffness” or “bracing” of the outer wall (McGill). Core function requires an individual to be able to create three dimensional expansion (Liebenson) of the abdominal wall while positioning the ribs in a caudal direction during exhalation. Core stabilization is dependent on optimal function of respiration and diaphragmatic control. Abdominal coordination and strength may be tested by observing the athletes ability to breathe optimally and correctly utilize his diaghram as described above. This ability to generate circular stiffness can be evaluated and assigned a simple manual muscle test value. Functional stabilization is achieved only when all of the spinal musculature work as a one unit and the quality of motor program is undisturbed by dysfunction or pathology.
1) The patient lies supine with the ribs in an exhaled position. The knees are bent with the feet on the table. Instruction is given for the patient to use diaphragmatic activation to create intra-abdominal pressure in a caudal and three dimensional direction around the core during exhalation. Attention is given to providing external ques by the practitioner to guide the ribs in a caudal direction while palpating the abdominal wall to maintain “stiffness” of the oblique musculature function.
2) Training of sagittal spine stabilization continues with maintaining position of the thoracic ribs in an exhaled position and continued expansion of the abdominal wall. The hips and knees are bent to 110 and 90 degrees of flexion respectively. Attention is given to training respiration and rib positioning while maintaining intra-abdominal pressure during a static supine hip flexion position (3 month.gunnertechnetwork.comelopmental position)
3) Developing functional strength continues with the ability to maintain sagittal spine stabilization during functional movement patterns. The exercise increases in difficultly by alternating the hips in a reciprocal flexion and extension direction for specified sets and repetitions.
4) Retraining of the respiratory and abdominal function is dependent on achieving endurance of the stabilizing spine musculature. The patient is directed to maintain rib positioning and intra-abdominal pressure while progressing through more difficult reciprocating movement for up to two minutes per set for a total of four sets. Difficulty can be increased by changing surfaces and by varying levels of stability,
You can follow the same progression with the Franklin Balls. These balls are positioned directly over the PSIS activating the oblique musculature. Working up to 4 mins of time under tension is optimum.