The Hip Muscles are Part of the Core

Weakness or muscle imbalance in the hips impacts the core. 
   
Continuing the discussion of the core, I am moving from the spine now onto the primary stabilizers in the extremities, this week we consider the small muscles in the hip. The hip is an integral part of the core as many of the muscles attach directly to the spine and cross the pelvis to attach to the leg. Hip weakness effects the lower extremity and spine with movement.  See the anatomy pictures below and note the attachments of the psoas, iliacus, piriformis, glutes, adductors, and obturators as they course from the pelvis and spine to the top of the femur.

 

The stabilizers are small but have important attachments in order to keep the leg stable on a moving trunk or to move the leg away from the trunk in functional movements. If these muscles become weak or imbalanced, the hip joints and lower leg joints undergo more stress than they can handle which leads to pain and injury. Hip weakness also leads to movement deficits impacting efficiency, coordination, and decreases sports performance.

So how should we incorporate the hips into core strengthening? Start adding specific hip exercises into a maintenance routine and think of them as part of your core. A good place to start is with planks, side planks as the video shows, forward and backward planks. Other great exercises include clam shells, leg lifts, bridges, bent knee fall outs, etc. Keep your core tight and limit all motion through the spine while just working into the hip. If done properly, just a couple of reps make your hips feel "on fire." This sensation is normal with proper hip strengthening. Mild soreness usually follows the day after but subsides. Soreness and muscle burning should never produce pain though.

Consult your local skilled Physical Therapist for more core strengthening exercises at www.RMSSPT.com. Follow our blog for more helpful info … 

Meredith Bremner, PT, DPT, cert DN 
Doctor of Physical Therapy 

Rocky Mountain Spine and Sport

The Core Continues … around to the Back

 Ever thought of doing back exercises to improve your core strength?

 

In the last post I talked at length about the anterior core muscles and the importance of targeting each layer when doing core strength. I defined the core as "a group of muscles that supports the axial skeleton and acts as the foundation off of which the extremities move." That said, we need to now direct our attention to the core muscles in the back.

 

Anatomy review - Just as with the anterior aspect of the spine and the abdominals, the posterior back muscles have layers as well. The outer layer consists of the erector spine or paraspinal muscles which extend from the neck down through the base of the spine and sacrum. Deep to that layer is the multifidus, the key muscle which stabilizes the spine during and prior to movement. (Sound familiar to last week's post on the abdominals?) The multifidus can become under worked, inefficient, and uncoordinated if not isolated in exercise. When this happens, the larger, outer layer muscles overpower it and cause translational forces in the spine resulting in pain with movement. However, the multifidus should create a deep contraction on each segment which unifies the entire spine into one supported column off of which the spine is able to bend forward/backward, side to side, and rotate when the paraspinals activate.

 

 

How do we train or retrain this muscle? Go back to very simple exercises that require less movement and more focus on the neuromuscular system's control. Lay on your stomach, face down. Focus on gently "lifting your tailbone as you pull your navel to your spine." This is a small movement which should feel like next to nothing. If possible, place your fingertips just to the sides of your spine and feels for a tightening down on the back muscles near midline. If you are lifting your head or working too hard, you will notice the larger side muscles start to kick in.

 

 

Once you have a good multifidus contraction, then work up to more challenging exercises such as the "superman" or alternating arm to leg lifts as seen below.

 

 

These exercises require focus and awareness but should never cause pain. If you feel back pain, stop and go back to square 1. Consult your local skilled Physical Therapist for more core strengthening exercises at www.rmsspt.com. Follow our blog rmsspt.blogspot.com for more helpful info …

 

Meredith Bremner, PT, DPT, cert DN

Doctor of Physical Therapy

Rocky Mountain Spine and Sport

The Core

Core strengthening gets a lot of attention these days. But what really is the "core?" Why is it so important? How do we strengthen it properly?

 

The core is a group of muscles that supports the axial skeleton and is the foundation off of which our extremities move. Let's briefly review the anatomy. In the trunk the core is made up of 3 layers of muscles: the outer, middle, and inner abdominals. The outer layer is the rectus abdominis, or "6 pack," muscle which attaches to the base of the ribs and breast bone and extends down to the pelvis. Its role is to bend the spine forward in a sit-up type motion. The middle layer is made up of the 2 diagonal muscles called the abdominal obliques which attach the rib cage to the tops of the pelvis and side bend the spine or stabilize asymmetrical movements. The innermost layer is comprised of the transversus abdominis, or TA. This muscle runs horizontally over the trunk and attaches the thick band of tissue under the naval to the back of the spine. The job of the transversus is to tighten down the abdominal contents and stabilize the spine prior to and during movement. 

 

 

It is important to understand these 3 layers of muscles when doing core exercises. Too often individuals do sit-ups and crunches but never train the deepest TA muscle to stabilize their spine; they end up with back pain and strong outer abdominals which do not adequately support the spine. Also, many people stop doing core exercises because they are unsure how to safely strengthen their abdominals without doing situps, which may be painful. 

 

So, let's go back to the basics and train the core from the inside out, gradually progressing from deepest layer to outermost layer as we up the challenge. Start by laying on your back and think of drawing your naval down toward your spine. Don’t hold your breath. It will help to put your hands just above the tops of your pelvic bones and feel the muscles tighten down from the inside across the stomach region. Then, once you have that contraction, try to hold it for up to 10 seconds. The next progression is to keep your spine completely stable and supported with your TA contraction and then lift one leg slightly. Alternate legs. See the video below for a more advanced exercise where both feet are held in up while still drawing the navel down toward the spine.

 

 

As you progress with the exercises, then start challenging yourself with bigger movements such as situps or planks but continue to draw in as to keep the spine supported by contracting the TA. You will notice much more support through the trunk and an increase in challenge.

 

These exercises require focus and awareness but should never cause pain. If you feel back pain, stop and go back to level 1 by drawing the navel into the spine. Consult your local skilled Physical Therapist for more core strengthening exercises at www.RMSSPT.com

 

Meredith Bremner, PT, DPT, Cert DN

Doctor of Physical Therapy

Rocky Mountain Spine and Sport

The Neck is Part of the Core - Chin Tuck Exercises

How do we strengthen our neck? In High Intensity Interval Training (HIIT) workouts, it's not uncommon to hear people say that their neck fatigues before anything else when they are working on core strengthening. They are limited by neck pain when doing V-ups, sit-ups, bicycles, etc.

Research has shown that the way we strengthen our core is from the inside out. Meaning, we have to address the deepest layer of muscles that stabilize the spine before we ask the bigger muscle groups to start working on movement. In my last post, I made an argument that the core includes the neck, shoulder, abdomen, and hip stabilizers. For the neck, the deep neck flexor muscles as a group should be addressed with core strengthening. The neck is very similar to the low back. Think of the low back and how the abdominals are in the front of the trunk and work to bend the spine and/or keep it stable. Now, looking at the neck, it has the same directional curve and the deep neck flexors are positioned in front to draw the chin down or keep the spine supported. Essentially, the deep neck flexors are the "abdominals" of the neck, stabilizing it prior to and during movement.

The chin tuck is a simple exercise that draws attention to the deep neck flexors. As you can see in the video, I am gently tilting my chin down as if I am making a double chin. Ideally, one would perform a chin tuck and then hold the position for up to 10 seconds for 10 repetitions every hour through the day. Note that I am not jamming my chin down but simply nodding. This puts the neck in an optimal position for the deep neck flexors to protect and support the spine as one progresses into crunches, sit-ups , V-ups, and more challenging exercises. Several peer reviewed studies have shown significant improvement in neck pain and neck strength when subjects performed chin tucks frequently through the day. If you are unable to lay down through the day, you may also perform this exercise in a sitting position. Remember again that it is a simple chin tuck taking the head back over the shoulders, not looking down and flexing your neck. If you feel like you are hardly doing anything, you are likely doing it right. The movement is subtle but important for proper head and neck positioning.

 Meredith L. Bremner, PT, DPT, Cert. DN

Doctor of Physical Therapy

Rocky Mountain Spine and Sport, LLC

For further information on neck pain and strengthening, visit our website and schedule to see a skilled physical therapist. www.rmsspt.com

5 Ways to Improve Your Overall Fitness

   

1.    Get up and get going … no matter what the exercise is, just start somewhere. "Motion is lotion" and the body was designed to move. Our joints, ligaments, muscles, and connective tissue are all at their optimal function when challenged on a daily basis. For some, this may be through high intensity interval training (HIIT) workouts and for others this might be walking 30 minutes. Just start somewhere!
 
2.    Work on your core regularly. We used to think that the core was limited to the abdominal muscles, but it pertains to the axial skeleton which includes the neck, shoulders, back, abdominals and hips. There are key exercises for each region that should be in your routine to maintain a strong foundation on which you can move. Stay tuned on our website to see an example exercise for each region.
 
3.    Vary your training and goals - Our bodies respond to change. This means that if we are doing the same exercises over and over with the same amount of load, our bodies won't respond. If you would like to get stronger or more fit, consider changing the type of exercise or vary your weight and intensity. Sometimes this can best be done through the year with the changes in season. In the summer, take the opportunity to get outside with the nice weather and take a break from lifting in the gym. You will notice a change with more cardio and your muscles and joints may thank you for the much needed break.
 
4.    Find a training buddy … Research has shown that people do much better with exercise in a social setting provided there are common goals. Find someone who will keep you honest and even push you a bit. This can really help you with your consistency and improve your overall fitness.
 
5.   See your local Physical Therapist for a precise exercise program and recommendations tailored to your body's unique needs. A Physical Therapist is trained in the evaluation and examination of human movement and function and can identify movements that will help you reach your goals.

See rmsspt.com for locations and our staff bios. 

Meredith L. Bremner, PT, DPT, Cert DN

Doctor of Physical Therapy

Rocky Mountain Spine and Sport, LLC