Program design and implementation

The previous article provided some valuable background information on the core and the importance of specifically training the stabilizing muscles of the body. This article aims to supplement this information and help apply it in the design of a progressive and functional core training program   

General guidelines for program design

The goal of effective core training program design is to select exercises that challenge the proprioceptive (sense of position) abilities of the individual on a constant basis while retaining functionality. It is recommended that the individual train in the most proprioceptively challenging position possible.  Recall that increased muscle strength is the direct result of an improved communication of the nerves with the muscles.  Therefore, exercise variation and progressive overload are necessary to provide optimal stimuli for the brain and central nervous system to “learn” how to activate the stabilizing muscles more effectively.  Should the stimulus remain static or unchanged, the brain will cease to learn.

Variation of the exercise stimulus can be accomplished by modifying the following factors:

• plane and range of motion
• loading parameter (stability ball/disk, wobble board, medicine ball, bodyblade, weight vest, dumbbells, tubing)
• body position (base of support)
• speed of movement
• amount of control
• duration
• frequency

Progression can be accomplished by manipulating the following factors:

• slow to fast
• simple to complex
• stable to unstable
• low force to high force
• general to specific
• correct execution to increased intensity.

To ensure a program is functional and elicits a maximal training response, the conditioning professional must ensure the following about the exercises: 

• are safe yet challenging
• stress multiple planes
• dynamic
• proprioceptively challenging
• varied
• progressive
• activity (sport) specific

Specificity is crucial to any athletic conditioning program since muscles must be recruited in specific motor patterns, which are directly dependent on the movement of the exercise.  Core strength may initially be developed in non-functional positions such as supine (laying on the back) but training must move increasingly toward standing and movements that very closely parallel the movements involved in the athlete’s sport.       

How do I start a core training program?

The first step should be for the athlete to receive an integrated postural analysis and muscle flexibility assessment to check for the presence of any muscle imbalances.  If possible, the muscle imbalances should be corrected before beginning the core routine by strengthening weak and elongated muscles and stretching tight, strong muscles with PNF stretching methods. Next, the individual must learn how to effectively control and isolate the transversus abdominis (TA) muscle. The commonly given advice of “imagine pulling your navel to your spine” tends to give the wrong visual image of the TA’s action, resulting in breath holding and activation of incorrect muscles such as the rectus abdominis (six pack ab) and the external oblique.  Rather, the individual should be asked to focus on contracting and lifting the pelvic floor muscles - like trying to stop urine flow mid-stream. As mentioned in a previous article, the pelvic floor muscles co-contract with the transversus and isolate it much more effectively.  Research has demonstrated that activating and holding this contraction during exercise greatly increases the activity of the pelvic stabilizers. 

The athlete should also be taught how to coordinate the activation of the TA with the maintenance of “neutral spine and pelvis” and perfect posture.  Neutral pelvis is midway between an anterior tipped pelvis and a posterior tipped pelvis (the pelvis can be visualized as a bowl of fruit - if it tips anteriorly the fruit will roll out the front, if it tips posteriorly, the fruit will roll out the back). A neutral pelvis is a prerequisite for a neutral spine, which displays the attributes of an ideal spine - a slight lordotic (forward) curve in the lower/lumbar region, a gentle kyphotic (backwards) curve in the middle/thoracic region and another slight forward curve in the upper/cervical area.  For individuals that assume a military position or find keeping a neutral spine difficult, the best advice is to suggest, “be tall and grow through the top of your head”.  Also, the athlete should avoid poking the chin during core exercises as this causes inhibition of the core via a complex interaction between the eyes and pelvis.  To prevent this from occurring, the athlete should press the tongue behind the teeth during all core training exercises, as this tends to stabilize the neck and prevent head protraction/chin poking. 

It cannot be overemphasized enough that core training must be performed with perfect technique – that is retaining neutral spine and pelvis throughout all phases. If the pelvis and spine deviate away from neutral at any point, the exercise no longer targets the stabilizing muscles but rather the mobilizing muscles.  For example, even if trunk curl ups are performed on a Swiss ball, the strong mobilizers of the pelvis and spine, namely the rectus abdominis and obliques perform the majority of the work (if they are performed correctly!).

Quality of movement is the number one priority, and since these exercises require precise muscle/nerve control, they should only be performed in a rested and fresh state or before any other form of fatiguing exercise.  Also, the exercise must be terminated either before or at the first indication of fatigue or bad technique as training with bad/incorrect motor patterns will only confuse the brain and nervous system.  The brain is basically a very intricate computer - if its input programs are of a low quality and full of “bugs” then its output programs will be of a similar quality.  

Develop core static stability first

Static stability is the foundation for dynamic stability; the muscles must first learn to stabilize in static positions before progressing to stabilizing during actual body movement.  Static core stability is comparable to balance training and is accomplished by maintaining optimal (neutral spine) posture in static positions.  For example, to isolate and strengthen the core stabilizers we start athletes and back rehabilitation patients alike, using pressure biofeedback.  Pressure biofeedback involves using a blood pressure cuff or the Stabilizer to monitor the curve of the lumbar spine, and test for effective recruitment of the TA. The Stabilizer is a great tool and was developed in conjunction with Carolyn Richardson and her associates at the University of Queensland in Australia.  The theory behind pressure biofeedback is this: should the pressure increase above “neutral pelvis” pressure (about 40mm Hg), then we know the transversus abdominis (TA) and other core stabilizing muscles are not strong enough or being recruited well enough to prevent the pelvis tipping posteriorly, causing flexion (flattening) of the lumbar spine. If the pressure decreases, then we know the TA is unable to prevent the pelvis from tipping anteriorly, forcing the lumbar spine into hyperextension (excessive anterior curve).  Progression of these exercises can be accomplished by using arm and leg movements to “load” the core.  An advanced example of this is the “dying bug” exercise where the subject lies on their back and moves both the arms and legs while maintaining a constant (neutral pelvis) pressure.  Pressure biofeedback can also be used in the standing position as well.   Surprisingly, these are extremely difficult exercises even for some of the most conditioned athletes to perform since they require an intense level of concentration and muscle awareness.  Athletes and back rehab patients alike find these exercises pay dividends in the long run because of renewed awareness (and strength) of the core muscles and their operation. 

Once the individual can effectively perform these biofeedback-type isolation exercises, they may progress to maintaining neutral spine and pelvis in other positions such as bridging (prone/supine on elbows, side lying ect.), quadruped (all fours) kneeling and standing. This order of positions should be followed since this will help in motor learning ( “teaching” the brain to activate the correct muscles in sequence). These exercises require additional work of the core stabilizers, since the pelvis and low back are no longer supported through ground contact in the lying position.  The program can be varied and progressed using the suggestions provided earlier, however the static position must be retained.  The simplest method to progress these type exercises is to control the base of support or the source of stability by reducing foot contact or increasing instability by using a Swiss ball, inflatable disk, foam roller or wobble board.  For example, exercises such as horizontal bridging in the supine position on the floor should progress toward the upper back resting on a Swiss ball and single leg bridging.  Side bridging on the floor may progress to the use of a Swiss ball under the pelvis. Also, static balancing in the push-up position with the hands or elbows on a Swiss ball is an excellent exercise for statically training all of the core muscles of the body and may be advanced by lifting the toes on one foot.  The same progression can be made for quadruped movements – all fours to opposite arm and leg lifts while resting on a Swiss ball. Kneeling can be advanced to the maintenance of perfect posture while kneeling on a Swiss ball.  Standing and balancing on a wobble board may progress to standing on one leg on an Airex balance pad. 

Develop core dynamic stability and strength

With a solid foundation of static stability and strength, the athlete can be moved on to the development of dynamic stability.  Dynamic stability is the ability of the core muscles to isometrically contract to stabilize the body during bodily movements.  Developing dynamic stability is critical to athletic performance since as mentioned previously, the (lower) core is where all movement begins.  With a weak core, movements lose their coordination and efficiency.  Dynamic stability can be trained by having the athlete perform many of the earlier static stability training exercises incorporating arm and leg movements.  For example, in the horizontal Swiss ball supine bridge, the athlete may use PNF diagonal shoulder movements or attempt to write their name with the toes on the extended leg.  Also, the athlete may work on flexing one hip slightly in the push-up position (see Gray Cook’s Mountain climber exercise featured in Athletic Body in Balance) described earlier while maintaining neutral pelvis and spine.  In the quadruped position, the athlete may use alternate arm and leg movements such as diagonal PNF lifts for the arms and name writing with the extended leg.  PNF diagonals performed while kneeling on a Swiss ball is a great way of training dynamic stability in this position.  In the standing position, lateral and forward/back skating on the Fitter will help develop dynamic stability as will hip flexion while standing on one foot.  Multidirectional lunging and mini squats can be performed on unstable surfaces like inflatable disks, foam pads and beams or weeble/wobble boards to enhance the proprioceptive demand on the core muscles while training lower limb strength.

Strength exercises for the upper body performed against resistance in the standing position are some of the most functional and sport-specific exercises an athlete can perform while also being an excellent method of developing dynamic core stability and strength.  The standing position very closely mimics the demands of nearly every sport, and requires the athlete to actively recruit the stabilizing muscles of the both the upper and lower body in order to generate force and power from the mobilizing muscles.  The adjustable cable column might just be one of the most functional pieces of strength training equipment on the market today.  Since the resistance can be adjusted to many different positions, this exercise machine is able to provide resistance in all three planes, either individually or simultaneously.  Many other machines offer resistance in the saggital (front to back) or frontal (side to side) planes but very few have the ability to do so in the transverse (parallel to ground) plane like the cable column.  Since most functional and sports specific movements cross all three planes, it is important to be able train in this specific manner.  The diagonal and rotary movements of PNF exercises like the chop and lift, are such exercises and are ideally suited to be performed on an adjustable cable column.

Medicine ball work is another excellent way of developing dynamic stability, however in the standing position it is impossible to resist movements requiring concentric shoulder extension.  Initially, the cable column and medicine ball exercises should be performed while maintaining perfect technique and neutral spine and pelvis in the standing position.  Once dynamic core strength has been developed sufficiently in all planes, upper body movement must be integrated with lower body movements, as in reality this how the kinetic chain operates.  For example, a chop may be combined with a lunge to closely mimic the movement pattern of a baseball pitch.

Don’t Forget the Body’s “Upper Core”

Recall that any exercises performed in functional (non supported) positions such as standing using the upper extremities requires that the stabilizers of the lower core FIRST anchor the spine and allow the shoulder muscles to pull off; making these movements as much exercise for the lower core as they are for the upper extremities.  Therefore, the exercise professional and athlete should not forget to concentrate specifically on training the stabilizers of the shoulder girdle, especially if the athlete’s sport involves throwing or swinging an implement.  The approach to training the upper core should proceed in much the same manner as previously described: flexibility to static stability to dynamic stability.  Just as standing on a wobble board, inflatable disk/ball or foam roller develops static stability and strength of the stabilizers of the LPHC; the same effect can be achieved when “standing” on the hands.  With the elbows held straight, all forces are transferred directly into the shoulder joint, forcing isometric stabilization of the shoulder girdle.  An athlete may start with multidirectional weight shifting with the hands on the floor and progress to doing the same on a medicine ball, wobble board, Fitter or Swiss ball.  Again, perfect posture must be maintained in theses exercises and the athlete must resist the urge to protrude the chin and hunch the shoulders to the ears – remember “be tall and grow through the top of the head while sliding your shoulder blades into your back pockets”.

Although the upper extremity functionally operates in the open chain, recall from the featured article on Functional Training that closed chain exercises exhibit muscle co-contraction. These exercises are therefore ideally suited for developing dynamic shoulder stability, and often used in rehabilitation.  Therefore, once static stability has been established pushups, pull-ups and dips are excellent exercises for the upper extremity and the stabilizers of the all the “core” muscles.  Examples of exercise variation and progression may be performing push-ups, and dips on a Swiss ball to increase the proprioceptive demand and using a weighted vest to overload the muscles.  

Develop explosive power

With a firm foundation of static and dynamic stability and strength, the athlete may proceed to power training.  Assuming the athlete has developed sufficient lower body and upper body strength, he or she can now incorporate explosive movements such as plyometrics and medicine ball throws. Examples of plyometric exercises for the lower body includes explosive hops, bounds and jumps; and for the upper body - clap pushups.  Medicine balls are excellent for training whole body power since they allow for a variety of different throws such as the PNF chop throw and the PNF lift throw. The athlete should concentrate on incorporating the legs and upper body to generate maximal muscle force as quickly as possible and transfer it to the ball. The exercise professional or athlete must consider when designing a power training program that the goal is to is to generate force at a high speed; therefore the ball/resistance must be released, otherwise the target muscles have to eccentrically brake and slow down the movement. Inflatable rubber medicine balls are excellent for plyometric training of the upper body, which in turn trains the power of the core muscles.  The recoil energy of the rubber ball effectively “preloads” the target muscle with an eccentric contraction to facilitate the immediate concentric contraction.  Even more effective are plyometric balls used with a rebounder – an adjustable angle trampoline that returns the ball to the thrower with a force similar to the action of the rubber ball.  The main benefit of using a rebounder is that provides multiple angles of rebound and is more effective when using smaller and lighter palm-sized plyometric balls.

In conclusion, this article has attempted to provide the reader with some basic guidelines on how to initiate and design a core strength training program.  It should be clear that to be effective, the program must be proprioceptively challenging, progressive, varied and most importantly, functional.  The progression from static stability to dynamic stability to strength and power allows for a functional and effective approach to a core stability training program.

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