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Introduction

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Annika Sorenstam’s 500 daily sit-ups are famous.

EJ Clair, Junior Editor Pacific Northwest Golf Magazine

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In recent years, an understanding of the concept of core stability has changed the way in which we rehabilitate our patients. This book uses the term “core stability” but there are many other interchangeable terms (Table 14.1). The musculoskeletal core of the body includes the spine, hips and pelvis, proximal lower limb, and abdominal structures.

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Table 14.1

Terms used to describe core stability

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We use the term “stability” rather than “strength” because strength is just one component of the dynamic stability required. Dynamic stabilization refers to the ability to utilize strength and endurance and motor control in a functional manner through all planes of motion and action despite changes in the centre of gravity.1 A comprehensive strengthening or facilitation of these core muscles has been advocated as a preventive, rehabilitative, and performance-enhancing program for various lumbar spine and musculoskeletal injuries.

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The stability of the lumbopelvic region is crucial, to provide a foundation for limb movement, to support loads, and to protect the spine.2 Nearly 30 years ago, Panjabi2 described an innovative model of spinal stabilization that still serves as an appropriate model of understanding core stability today. The model incorporates a passive subsystem, an active subsystem, and a neural control system (Fig. 14.1).

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Figure 14.1

The spinal stability system consists of three subsystems: passive spinal column, active spinal muscles, and neural control unit

FROM PANJABI2

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The passive subsystem consists of bony and ligamentous structures of the spine. While passive components of the system are integral components of spinal stability, on their own they are unable to bear much of a compressive load3, 4 and offer most restraint toward the end of range. Thus the active subsystem is vital to allow for support of the body mass and additional loads associated with dynamic activity.2, 5 The active subsystem consists of the muscles that attach directly and indirectly to the spinal column; this system, however, is only as good as the system that drives it—the control subsystem.6 The control system must sense the requirements of stability and plan strategies to meets these demands—thus activating muscles at the right time, in the right amount, and in the right sequence; it then must turn these muscles off appropriately. Thus, Panjabi contends that these three subsystems are interdependent components of the spinal stabilization system, with one subsystem capable of compensating for deficits in another.

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The muscles that make up ...

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