Chapter 11

### INTRODUCTION

Core strength and stability is very important to me. Tennis is all about rotation of the body and my ability to create power. I incorporate a lot of abdominal, back and glute exercises into my gym sessions.

Samantha Stosur

‘Core stability’ refers to control of proximal regions of the body during movements and function. Although the concept appears straightforward, different interpretations or misconceptions of the term, and differences in applying this concept to the design of exercise programs for lumbopelvic pain, have led to substantial confusion and debate.

‘Stability’ has been interpreted to mean many things and, commonly, a simple objective to restrict motion. This has led to the development of many exercise programs that emphasise static maintenance of a specific lumbopelvic position during loading. Although this may be appropriate for some functions, restriction of motion does not necessarily assure stability of a system.

A stable system is one in which its intended position or trajectory (i.e. movement path) can be maintained, despite perturbation or disturbance.1 This may be achieved by restricting motion in some tasks (e.g. restriction of spinal motion during lifting), but requires movement to manage, reduce or transfer internal and external forces in others (e.g. counter-rotation of the shoulders and pelvis during walking) (Fig. 11.1). Further, in a complex dynamic system such as the spine, the stability of many goals (e.g. spine control, breathing, balance) must be maintained concurrently.2

###### Figure 11.1

Optimal control of the spine depends on a balance between movement and stiffness. At one end of the spectrum are functions such as lifting that require high stiffness of the trunk; at the other are functions such as running and walking that demand movement to meet the demands of the task. Both too much and too little movement and stiffness could underlie suboptimal loading

The ‘core’ refers to proximal regions of the body, which can include the spine, pelvis, scapulothoracic region and even the hips and shoulders. These regions are functionally distinct from the distal limbs, which have a critical role in fine controlled, goal-directed movements. The principal functions of the core are to provide a foundation for limb movements, a stable base for limb muscle contraction and a major contribution to overall postural control of the body. This latter aspect is particularly important as the trunk contributes about 70% of body weight. The focus of this chapter is consideration of the lumbopelvic region, but clinical management must involve consideration of the adjacent regions, as they cannot act independently.

When the concepts of ‘stability’ and the ‘core’ are fully appreciated, it is clear that the design of exercise programs for lumbopelvic pain require the term ‘core stability’ to be applied in its broadest sense to encompass all features that might be necessary to ...

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