In December of 2011, CNN reported some of the top fitness trends that we can look forward to in 2012.  We are proud to say that we are ahead of the trends.  

Educated, Certified, and Experienced Fitness Professionals

An educated and experienced staff can adequately meet the needs of a very diverse fitness population.   At All-Access we have one of the most knowledgeable and experienced staff available to work with you!  Our collective staff has a wide range of experience in working with the young to older populations as well as experiences training athletes for improved performances, clients for weight loss, and patients for quick recovery from injury. In addition to an experienced staff, the AAFA personal trainers are Certified Strength and Conditioning Specialists through the National Strength and Conditioning Association.  The trainers will design a comprehensive program that will assist in reaching your fitness goals, help you see results faster, and you will be instructed in a safe manner to prevent any injury in your exercise program!  

An Emphasis on Strength Training

All-Access is a firm believer in strength training as gaining lean muscle mass will help burn fat and raise your resting metabolic rate so that you will burn more calories at rest.  Strength training also aides in injury prevention by addressing possible muscular imbalances.  Classes such as Boot Camps and Morning Madness offer a full body strength workout that is challenging and fun.  Our personal training services that provide a direction for your strength training program, track your progress, and make modifications as needed to make sure you don’t plateau.  Our personal trainers are great motivators and keep you on track!

Fitness Programs for Children and Older adults.

Inactivity and obesity amongst the US youth has become a growing epidemic. That is why we offer a variety of programs for children including our Fit Kids and Junior Elite classes.  These classes provide a variety of strength training and cardiovascular activity that is appropriate for the age level, provides proper instruction for exercise technique, and includes fun games and competitions that keep the children entertained. It is important to be active at EVERY age and older adults can take advantage of our customized six week programs.  Our Certified Strength and Conditioning Specialists will design a program that will address previous injuries, build strength and endurance, and assist in improving the quality of life! 

Strength training is critical at every age - from youths, to adults, to older adults there are numerous reasons to incorporate some form of strength training into your fitness regimen. 

Studies show that children as young at 8 can benefit from age appropriate strength programs.  These programs (such at AAFA Doctor of Fitness and Fit Kids) can enhance Musculoskeletal development and bone formation during the prepubescent years, improve muscular strength and endurance, enhance sports performance, improve body composition, improve motor skills, and increase resistance to injury.  Strength training for children focuses on body weight and low to moderate weights, controlled movements and an emphasis on safety and technique. 

Adult strength training has many of the same benefits as for youth training but can also result in decreased blood pressure, decreased risk of heart disease, relieve body aches and pain, weight loss and management, decreased occurrence of depression, and improved stress management.

Strength training for older adults has a few but very specific benefits in addition to all the health and wellness benefits listed above.  Building strength has shown to decrease fall risk and improves performance in daily tasks such as walking up and down stairs.  Strength training in the older adult can lead to maintaining independence for longer. 

Please speak with your All Access Physical Therapist or Fitness Professional to determine and strength program that is right for you.  We can design and program that is tailored to your individual needs and goals - At Every Age!!!

At All Access, assessing foot mechanics is an integral part of any lower body and spine evaluation.  Flat arches (known as ‘overpronation’) are common in many adults, and can contribute to many conditions including plantar fasciitis, shin splints, knee pain, sciatica, and low back pain. An excessive lowering of the inside arch of your foot during gait causes aberrant movement in the joints of your foot and leg, which results in abnormal stress on the tissue and muscles in the area. Over time, these repetitive mechanics can cause cumulative injuries through the affected joints. While stretching and strengthening exercises can improve the injury, an external arch support is an integral part of the treatment plan to correct the underlying arch problem. At All Access, we design Sole Supports custom orthotics (http://www.solesupports.com/PUBLICHOME/WhySoleSupports.aspx) . These are the highest level of custom orthotic that will not only provide your foot with the appropriate support, they will actually correct your gait and improve leg strength.  Schedule your free foot consultation today with an All Access physical therapist to see if Sole Supports custom orthotics can improve your posture! 

The gluteus maximus is the largest of a group of three gluteal muscles, including the gluteus medius and gluteus minimus.  These three gluteal muscles act together to provide stability and to produce mobility of the trunk and the legs in order to enable functional movement of the body. 

One of the most common problems associated with deficits in the gluteal muscle structure is the development of low back, hip, and knee pain.  This can occur as a result of inactivity or weakness of the muscles which render them powerless to carry out their stabilizing function.  In some cases, people inadvertently utilize the thigh muscles to conduct the functions of the gluteal muscles.  In this situation it is a challenge for the person to recruit the horsepower that strong gluteals could provide them.  Working on building gluteal strength could assist them in gaining success in athletic activity as well as reducing pain. 

Strengthening the gluteals is important if you have experienced any type of pain or discomfort your low back, hips, or knees due to inactivity or because there is an imbalance between your gluteal muscles and the muscles of your thigh.  Building additional strength in the gluteals will enable them to stabilize the upper and lower body at ease while allowing other muscles to do their job.  A correct application of muscle structure and mechanics will help reduce and eliminate low back pain, hip pain, and some knee pain. 

If you would like to rebuild strength in your back and hips, we can aide you by creating an individualized exercise plan to strengthen your gluteals based on your specific activity needs.  We will assess the current status of your muscular strength and muscular balance and recommend and exercise plan.  Our support through the process will enable you to get back on track to meet your specific goals.   

It can be argued that preseason conditioning is the most important part of an athlete’s sport season.  A proper preseason conditioning program addresses general conditioning and sport specific movements.  It is vital in reducing the risk of injury and preparing the athlete to be both physically and mentally prepared for the start of the regular season.  The 3 primary components of a well rounded preseason conditioning program include general fitness conditioning/strength training, endurance training, and agility/sport specific training. 

A general fitness program will not only increase an athlete’s strength but address possible muscular imbalances that may lead to injury during the regular season.   Enhancing an athlete’s flexibility will also lead to injury prevention.  Increasing a joint’s movement capabilities can help to prevent common injuries such as ankle sprains.

A proper preseason conditioning program should also address an athlete’s endurance capabilities to prepare them for practices and competitions.  Interval training increases conditioning by including short bursts of high intensity cardiovascular training combined with short rest periods.  Interval training can train the body more specifically for the individual demands of many sports. 

The final aspect of preseason conditioning is sport specific movement and agility training.  The preseason is the perfect time to address any skill deficits that might hinder performance during the regular season.  Practicing agility drills not only helps an athlete learn to change direction faster and safer, but it improves reaction time to various visual and verbal cues. 

A complete preseason conditioning program will address the physical needs of the athlete.  With training and skill improvement, a sense of confidence is built for the challenges the athlete will face in the upcoming season.  A consistent training routine will will get athletes out of their comfort zone in order to improve themselves as well as their team.  A physically and mentally prepared athlete is a winning athlete! 

#1 - Decrease Your Carbohydrate Intake

Carbohydrates are one of the three macronutrients (fat and protein are the others) contained within food that our bodies use for energy.  There is nothing inherently wrong with carbohydrates as they are filled with nutrients.  Too many of them can hinder your weight loss because every gram of carbohydrate requires a significant amount of water to be stored in your body.  This means that when you reduce your carbohydrate intake your body will release some of the stored water.  Limit yourself to vegetables as your only source of carbohydrates with 1-2 servings of fruit per day.

#2 - Chill Out

Stress is a large part of our daily lives, and it also plays a role in making us look heavier than we really are. When stressed, we tend to get far less sleep than we need.  Under these conditions (increased stress, lack of sleep), certain hormones in our body begin to contribute to us holding onto excess water from the liquids and foods we ingest.  Make the commitment to get 7 hours of sleep per night and engage in activities that help you to de-stress.  Doing so will help you to wake up a few pounds lighter. 

#3 - Create a Caloric Deficit

Without creating a caloric deficit, any weight loss will be short term.  You need to burn more calories than you consume in order to lose weight.  Commit to daily physical activity and make sure that your nutrition plan meshes with you weight loss goals.

For more information on weight loss and nutrition, contact your All Access Fitness Academy professional. 

Most anyone who played high school sports, had a paper route, or engaged in playground snowball warfare has thrown their fair share of objects.  As is true with all athletic endeavors, proper form and technique ensure good performance and safety.  But what exactly constitutes good throwing mechanics? 

First and foremost, the body needs to be positioned correctly in order to take advantage of the powerful muscles of the legs and trunk, not solely the arm.  In order to engage the trunk and leg muscles into the throw, you must place your front shoulder and front leg toward the target.  While stepping toward the target with your front leg by pushing off the rear leg, the throwing arm needs to be properly positioned to deliver the throw.  In essence, the arm should follow a circular path. 

This path begins at the waist and then follows back overhead with the elbow bent halfway.  In this position, it is important that the muscles of the shoulder blade be engaged to set the shoulder blade down and back, in it's most powerful position.  At this time the trunk muscles activate to turn the throwing arm toward the target. 

 As the final link of the chain, the arm then follows through toward the target.  This follow through should carry at a slight diagonal off of the vertical.  All of these elements combine to carry the most energy to the ball through utilization of the entire body. 

 Overlooking these basic elements of throwing can lead to overuse injuries of the arm, most often the shoulder and elbow.  The important stabilizing muscles of the shoulder, known collectively as the rotator cuff, are often the site of injury.  Injuries can occur here due to underutilization of the leg, trunk, and scapular muscles, which places too much stress on the relatively small muscles of the rotator cuff.  A rotator cuff that has been overused will often develop strength and motion imbalances, further predisposing an individual to injury. 

If you have a throwing injury or want to know more about how to prevent a throwing injury, please free to contact your All Access Physical Therapist or Fitness Professional. 

It is well known that our balance changes and declines as we age.  Vision changes, declining strength, and changes in the way our brain receives, processes, and sends signals all contribute to this inevitable change.  It is possible to halt and delay balance changes that may lead to injuries and falls by incorporating balance training activities into your regular exercise regime.   

Try these easy activities to start improving your balance TODAY!

1. Stand on one foot – practice balancing on one foot and give yourself a time goal, try for 20 seconds and increase to 60 seconds as you improve
2. Stand in “tandem” stance – stand with one foot behind the other so that the toes of one foot line up with the heel of the other foot, again give yourself a time goal
3. Add a dynamic surface – perform your usual exercises such as bicep curls or squats on an unstable surface such as a BOSU, foam pads, or dyna discs.  You can also use this same technique at home while washing the dishes or folding laundry.
4. Agility ladder drills – fun and challenging, the agility ladder will improve your coordination, balance and cardiovascular endurance with endless activities
5. Take a class that focuses on balance, core strength and posture – NIA, yoga, and pilates are great options and all are offered at All Access!!!

For additional information on how to improve balance or to have a specific balance program designed to meet your needs, contact your All Access Physical Therapist or Fitness Professional.   

Increase Your Protein Intake - When you consider the fact that some pretty cool parts of our body are made up of protein (muscles, hair, nails, your heart), the importance of consuming enough protein within our diet becomes clear.  Did you know that you can decrease the blood sugar response from a meal by simply including a source of protein along with it?  Keeping your blood sugar levels from fluctuating wildly will help ensure that your energy levels are more stable throughout the day.  The best sources of protein are found within meats such as chicken, beef, seafood, and pork but can also be found in dairy products and beans.

Eat Your Fiber - Fiber can be found within all the good stuff in life - fruits and vegetables.  While fiber is great for your digestive health, it also plays an important role in keeping your energy levels in check.  When you eat a significant amount of fiber (10-15 grams) along with a meal, physical stretching of the stomach occurs, which goes a long way towards preventing you from overeating and experiencing that sleepy "Thanksgiving Dinner" effect.  Fiber also slows the rate at which food leaves your stomach, ensuring that you'll be satisfied for many hours to come.

Consider Intermittent Fasting - This sounds complicated but all it means is that you would fast (not eat any food, non-calorie containing liquids are fine) for a predetermined amount of time while then eating the rest of your food during a short eating window.  During the fasting period, certain hormonal processes within the body are expressed that help blunt hunger as well as increase your focus, concentration, and energy levels.

For additional information on these methods of boosting your energy levels or others, contact your All Access Fitness Academy professional.

Resistance bands are a fast, fun, and simple way to get a killer workout wherever you are.  You don't have to be in a gym, but can use them at home, work, or even the beach.  All  you need to get a kick ass resistance band workout are a few bands and a strong work ethic.  Using a little creativity, just about any movement can be executed using bands as resistance.  While free weights are a great way to increase strength and muscle mass, bands have just about as many benefits.  

Bands are convenient and safe.  You do not need a spotter.  Bands have the added component of increased tension throughout the entire range of motion.  As the band stretches, more resistance is generated.  This creates more tension during the stronger phase of the movement forcing more overall work to be performed.  Resistance bands utilize both the concentric (shortening) and eccentric (lengthening) part of the movement, allowing for increased muscle stimulation.

For the most effective workout, pick a place where you can attach one side of your band to a solid base like a tree, post, door, or hook in the wall.  This will increase the number of exercises to be performed.  For any standing movement place the band under your feet to create a base for the resistance.  From here you can perform squats, lunges, bicep curls, shoulder presses, lateral raises, or anything you can think of.  Lie on your back with the band under your back for bench press or tricep extensions.  Attach the band to a base and you can perform a face pull, trunk rotation, standing or seated row, hip extension and many other variations.  

For a fast effective workout, include a variety of bands with different resistance levels.  Perform 2-3 sets of 6-10 exercises with minimal rest between sets.  Make sure there is plenty of resistance during the movement and push yourself to the appropriate number of repetitions for a hard workout.

for more information about resistance band workouts or to get help in designing a resistance band program tailored for your needs, contact your All Access Fitness Academy trainer.

The Anterior Cruciate Ligament (ACL) is one of the major stabilizing ligaments in the knee.  Its role is to prevent the forward motion of the shin bone (tibia) in relation to the thigh bone (femur).  It is essential for the control or the knee in pivoting movements.  Pivoting movements are required in many sports, especially soccer, basketball, and skiing.

 Whether a patient chooses surgical repair or conservative management of their ACL injury, an extensive rehabilitation program is required.  The decision to opt for surgery is based on the patient’s level of functional instability, their age, profession, level of activity, and the presence of associated injuries. 

 Rehabilitation programs for surgically managed repairs are largely dependent upon the technique used.  Exact time frames for rehabilitation milestones will vary but the overall goals will be the same:

• Maximize range of motion as early as possible in order to prevent excessive scar tissue formation
• Strengthen the muscles surrounding the knee to support and protect the ligaments and the joint
• Maintain flexibility of the muscles to reduce tension on the joint

 The average time for rehabilitation after ACL reconstruction to return to sport is around 6-9 months (2).  A sound rehabilitation program should always include specific drills and exercises designed to return the patient/athlete to their desired functional goals.  Core stability, proprioceptive and balance exercises are commonly used in ACL rehabilitation programs as well.

 All Access Physical Therapy provides expert care during all phases of ACL rehabilitation – from pre-hab to post operative management.  Our goal is always to return our patients to their highest level of functioning.  We are able to address prevention of ACL injuries through our many sports conditioning classes offered at the Fitness Academy.  For more information about ACL injury prevention or ACL rehabilitation, please contact All Access Physical Therapy at (508) 845-3500. 

 One of our primary concerns when treating our athletic clientele is further injury prevention.  We are very conscious of what we do within our treatment program that will help our athletic clients decrease their risk for other common yet traumatic injuries.  A common athletic injury that we frequently rehabilitate and work to prevent is an anterior cruciate ligament (ACL) tear. 

The ACL prevents the anterior (forward) movement of the tibia (shin bone) in respect to the femur (thigh bone) during walking, running, recreational and sports related activities.  ACL injuries occur as a result of both contact and non-contact  situations where the increase in force of movement is too much for the ligament to hold.  These movements place increased stress on the knee joint, typically with forces in the rotational and horizontal planes in respect to the knee, which causes the ACL to tear.

Research has shown that athletic women suffer this type of injury an average of 3 times more that men competing in the same sports.  It has been suggested that women are more likely to ACL tears due to the changes in hip and knee alignment they go through during adolescence.  As a result, women are more susceptible to the rotational and horizontal forces mentioned above during sports participation.  These forces are highest during cutting movements, quick direction changes, and when landing from a jump. 

A recent study by Imwalle et al., published in the Journal of Strength and Conditioning Research looked at the possible link between cutting movements and non-contact ACL injuries using a subject sample of high school female soccer players.  The study compared rotational forces placed on the hop and knee during 45 degree and 90 degree cutting movements.  The researchers found that hip and knee internal rotation were increased more during the 90 degree cut versus the 45 degree cut.  As a result, the subjects' knee abduction increased during a 90 degree cut putting the subjects at greater risk for an ACL injury.  The researchers concluded that targeted neuromuscular strength training to the trunk and hips may improve the athletes' ability to control knee and hip internal rotation during cutting movements, and therefore decrease their risk for ACL injury.

Our rehabilitation programs and strength and conditioning plans fall in line with this research. Our programs focus on core strength with targeted training for the low back, gluteus maximus, gluteus minimus, and abdominals.  Targeting these muscle groups improves the participants' ability to control hip and knee internal rotation during cutting movements.  Our therapists look at our clients' form during agility and plyometric (jumping) activities that put greater stress on the knees and correct that form as needed. 

Our Physical Therapists and Fitness Staff are experts at working with athletes during all stages of ACL injuries, from prevention to post operative rehabilitation.  Contact us if you have questions about how All Access can help you rehabilitate or prevent an ACL injury. 

 Reference: Relationship Between Hip and Knee Kinematics in Athletic Women During Cutting Maneuvers: A Possible Link to Non Contact Anterior Cruciate Ligament Injury and Prevention.  Lauren E. Imwalle, Gergory D. Meyer, Kevin R. Ford, and Timothy E. Hewett: Cincinnati Children's Hospital Research Foundation Sports Medicine Biodynamics Center and Human Performance Laboratory, The University of Cincinnati College of Medicine, Cincinnati, OH, and Graduate Program in Athletic Training, Rocky Mountain University of Health Professions, Provo, Utah.  Journal of Strength and Conditioning Research: Volume 23, Number 8, November 2009, pgs 2223-2230. 

The Facet joints are located at the back on either side of the spinal column, between the discs and the vertebral bodies. Each vertebra has bony prominences on each side that form a facet joint with the vertebra above and below. The role of the facet joints is to limit excessive movement and provide stability for the spine.

Facet joints are a potential source of pain which can affect the neck, middle back or lower back. Poor posture is commonly implicated in the development facet joint pain. Prolonged sitting and bending postures places an increased load on the facet joints which then become inflamed and painful. The muscles surrounding the spine also become affected. When considering how poor posture can affect the neck and thoracic spine (middle back) we can see that the thoracic spine becomes round, the shoulders hunch and the head pokes forwards; this leads to tightness of the muscles at the front of the chest and overload of the muscles around the shoulder blades and neck. The paraspinal muscles (long muscles which run the length of either side of the spine) in particular become knotted and tender ⁽¹⁾. 

How can foam rollers help with cervical and facet joint injuries?

A foam roller is a firm solid cylinder which is about 6 inches in diameter and 3 feet long. A roller can be used to isolate specific injured areas of the body and treat restrictions in the soft tissue⁽²⁾as well as perform balance training exercises, core activation exercises and stretching.

Stretching exercises on the foam roller for neck and thoracic facet joint pain.

This exercise is great for extending the middle back and neck and opening out across the front of the chest.

Lie on your back with the roller placed vertically along the length of the spine, feet on the floor and knees bent. Try to keep the spine in contact with the roller and open the arms out to the side. Feel the stretch across the front of the chest, lengthen the neck by tucking the chin inwards.

Muscle release techniques for the middle back using the foam roller

This exercise is to release tension in the muscles either side of the spine, it may feel a little uncomfortable initially but this does ease the more you do it.

Lie on your back with the roller placed horizontally between you and the floor. Your feet should be on the floor with your knees bent. Use the legs to push the body up and down the roller (like a rolling pin) to release tension within the muscles either side of the spine.

By improving your posture, the alignment of your spine is more efficient and the loads placed on the facet joins are reduced.

One of the major benefits of using a foam roller is that it is a relatively inexpensive way to treat injury on your own. It can be used to maintain joint alignment and muscle flexibility in between treatment sessions or for prevention of recurrence of symptoms.

For more information about the use of foam rollers to treat back and neck pain or to purchase a foam roller contact us at (508) 845-3500. 

References

1. Referred pain distribution of the cervical zygapophyseal joints and cervical dorsal rami. Fukui S, Ohseto K, Shiotani M, et al.  1996, Pain, Vol. 68 (1), pp. 79-83.

2. A comparison of the pressure exerted on soft tissue by 2 myofascial rollers. Curran, PF, Fiore, RD and Crisco, JJ. 2008, Journal of sports rehabilitation, Vol. 17, pp. 432-442. 

Patello-femoral syndrome is a relatively common condition which causes pain at the front of the knee. The pain is associated with positions of the knee which result in increased or misdirected mechanical forces between the kneecap (patella) and the thigh bone (femur) (1).

Despite being a common and relatively easy to diagnose injury there is much to learn about the exact pathology involved in the presentation of this condition. There are a number of probable causes which include:

• Muscle Tightness (calf, hamstrings, ITB)
• Weakness or lack of coordination in muscles that should help maintain normal patella tracking
• Altered hip, knee or foot posture
• Anatomic variations

Stability and normal function of the knee joint depends on precise interaction between the muscles, ligaments and fascia which surround and support the joint. Any tightness or weakness can cause an alteration in the normal mechanics which leads to pain. Exercise programs used to treat Patello-femoral pain syndrome should be based on sound biomechanical foundations and sensible exercise progression (2).

The quadriceps muscle group is directly involved in the mechanics of the patella-femoral joint as the patella is enclosed within the quadriceps tendon. Strengthening of the quadriceps is considered to be beneficial. However, the pain of patella-femoral pain syndrome is typically associated with movements which result in strong forces going through the joint so traditional knee extension exercises are not appropriate. Knee extension exercises will stress the already aggravated patella-femoral joint. Therefore, “closed chain exercises” (those where the foot is in contact with a solid surface) are preferred and should initially be performed within a pain free range of motion. Once larger ranges of motion are tolerated without pain, open chain exercises may be introduced. Research data tells us that between 0-50 degrees of knee flexion closed chain exercises produce less stress on the patella-femoral joint, beyond this range open chain exercises produce less stress (2).

Muscle coordination as well as overall muscle strength is important. The vastus medialis oblique (VMO) muscle forms part of the quadriceps muscle group and is the innermost muscle of the group. It is believed to help maintain the knee cap in its correct position (3). Specific focus should be placed on encouraging activity of this muscle when strengthening the overall quadriceps group. When prescribing strengthening exercise, those muscle groups not directly involved in patella-femoral joint mechanics should be considered as well, especially the “core” muscle group.

Concurrently to performing strengthening exercises, those structures which are tight must also be addressed. The calf muscles, hip flexors, hip rotators, and Iliotibial band are all commonly tight where patello-femoral pain is seen. Foam rolling, static stretches, and mobility drills are used to lengthen these tight structures. Full recovery and return to normal function can be achieved if exercises for managing patella-femoral pain syndrome are appropriately chosen and progressed.

 For more information about patello-femoral pain syndrome and how Physical Therapy can help you in your recovery from knee pain please contact Steve Messineo at (508) 845-3500 or This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

References

1. Associates of physical function and pain in patients with patellofemoral pain syndromme. Piva, SR, Fitzgerald, GK and Irrgang, JJ. 2, 2009, Arch Phys Med Rehabil, Vol. 90, pp. 285-295.

2. Rehabilitation of patellofemoral joint disorders: A critical review. Powers, CM. 5, 1998, JOurnal of orthopaedic and sports physical therapy, Vol. 28, pp. 345-354.

3. Patellofemoral Disorders: A classification system and clinical guidelines for nonoperative rehabilitation. Wilk, KE, et al. 5, 1998, Journal of orthopaedic and sports physical therapy, Vol. 28.

There are many causes of low back pain; it can be the result of a range of conditions that affect the muscles, joints, ligaments, discs or nerves. Regardless of cause, back pain has a negative effect on the muscles which support and stabilize the lumbar spine (these muscles are collectively known as ‘the core’). This phenomenon is known as pain inhibition.

Counteracting the negative effects of pain inhibition by strengthening the core is essential to overcome chronic low back pain and return to normal function. Core exercise progression, balance activities and dynamic movement exercises all contribute to this cause.

The ‘core’ is a group of muscles which include the Transversus Abdominis, Multifidus, Internal Oblique, Paraspinal, and pelvic floor. Initially it is a big enough challenge to learn how to activate the ‘core’ muscles when lying down still! But for maximum effect therapeutic exercises must go beyond this and the muscles have to be taught how to control the position of the lower back during dynamic, everyday, movements.

It is not just the ability of these muscles to contract that is important, but also the way in which they contract; the order in which they ‘fire’. Transversus Abdominis and Multifidus in particular are what are known as pre anticipatory muscles; this means that their job is to switch on just prior to dynamic movement in order to stabilize the spine in preparation for movement.

Core Exercise Progression

Like any training program, core training needs to be within the capabilities of the individual becoming more challenging in line with improvements. Initially volitional activation of the core muscles should be practised; this is normally done in lying encouraging the Transversus and Multifidus to return to its role of stabilization prior to movement .

Once the muscles are ‘awakened’ this should be transferred to more functional positions. Functional progression is vital, there is no blue print of exercises; a ‘one size fits all’ prescription is useless. Exercises need to be individualized to meet the needs of the individual. All programmes should incorporate exercises in sitting, standing and walking ⁽¹⁾.

Balance Activities

Training using an unstable surface has been shown to increase core muscle activation ⁽²⁾. Examples of such unstable surfaces that are commonly used in recreation and rehabilitation are: physio balls, BOSU’s, foam rollers and wobble boards.

Dynamic Movement Exercise

Everyday activities involve movements which are side to side, front to back and up and down. To complete a rehabilitation programme, the core needs to be challenged in all these planes and at different speeds. Faster movements change the centre of gravity relative to base of support. This means that the muscles are required to make quicker adjustments in order to maintain stability and control of the spine.

By mastering the ability to control the lumbar spine through the application of a progressive and individually tailored exercise programme, full resolution of back pain can be achieved. The negative effects of pain inhibition can be countered and future episodes of back pain can be minimised or even eliminated.

References

1. Core Strengthening. Akuthota, V and Nadler, SF. 2004, Archives of physical medicine and rehabilitation, Vol. 85, pp. S86-92.

2. What I always wanted to know about instability training. Fowles, JR. 2010, Applied physiology nutrition and metabolism, Vol. 35, pp. 89-90.