Protect the Lower Body by Working the Core

You can work your core a lot, but make sure you perform exercises properly to avoid injury! If you experience any pain, come see us at San Diego Sports Physical Therapy – 619.756.7500

What are the first things you think of when you hear someone talk about working the “core”?
Crunches
Sit-ups
Abs
The list could go on with similar exercises, but if these, and others like them, are the only exercises used, you may be not be working a significant part of the core. The core has been defined (Wilkerson, et al., 2012) as:
The lumbopelvic-hip complex, which is composed of the lumbar vertebrae, pelvis, and hip joints and the active and passive structures that either produce or restrict movements of these segments.

In short, or easier to understand terms, the core is more than just the abs, or the muscles on the front side of the body. The core also includes the muscles of the hips and low back. These muscles are important to the lower body as they assist in controlling the position and motion of the trunk over the pelvis and leg.
In a study by Leetus, et al. (2004), individuals who had sustained a lower body injury were found to have statistically significant differences in strength on hip abduction and hip external rotation exercises compared to non-injured participants. Another study (Wilkerson, et al., 2012), found that low back dysfunction and poor endurance of the core musculature were predictors of injury that could be modified.

By working all of the muscles of the core, individuals can increase core strength and core stability in hopes of modifying lower body injury risk predictors. A few simple exercises that you might consider adding to a workout might include:



Back Extensions on the ground or on a ball as in the picture above

Clamshells as is described below:
For this exercise, position the body in a supine position on the floor with the hips and knees bent about 45 degrees with a mini band around knees and heels on the ground. The knees should be placed beside each other while keeping the band taut.
Movement: Keep one knee stationary throughout the movement. Open the other knee to the outside of the body by performing hip external rotation against the resistance while keeping the heel planted on the ground. Slowly return to the starting position.
Tips: Do not allow the stationary knee to move during the exercise. This exercise can also be done by lying on your side if lacking stabilization in the hips to keep the “stationary”leg/knee from moving.

These exercises along with many other traditional exercises such as crunches, bridges and side bridges may help increase the motor control and muscular capacity of the lumbo-pelvic hip complex leading to increased core stability, which has been found to be a possible modifiable risk factor for lower body injuries (Leetun, et al., 2004; Wilkerson, et al., 2012). While the research is somewhat mixed on the importance of force output compared to endurance of these muscles, for beginners it appears it may be more important to start with muscular endurance.

References
Leetun, D. T., Ireland, M. L., Wilson, J. D., Ballantyne, B. T., & Davis, I. M. (2004). Core stability measures as risk factors for lower extremity injury in athletes. Med & Sci in Sports & Exercise, 36(6), 926-934. doi: 10.1249/01.MSS.0000128145.75199.C3
Wilkerson, G. B., Giles, J. L., & Seibel, D. K. (2012). Prediction of core and lower extremity strains and sprains in collegiate football players: A preliminary study. Journal of Athletic Training, 47(3), 264-272. doi: 10.4085/1062-6050-47.3.17

Bone Health

Whether or not you know this, bone health has a lot to do with mobility! Take a look at this article from MoveForwardPT to learn more about the different aspects of bone health and how to prevent injury.

Physical therapists are experts in improving and restoring mobility and play an important role in ensuring optimal bone health. Healthy bones can help you stay strong and active throughout your life. If good bone health is achieved during childhood and maintained, it can help to avoid bone loss and fracture later in life. For healthy bones, it is important to maintain a physically active lifestyle and eat a balanced diet with plenty of calcium, vitamin D, and perhaps other supplements as needed. Physical therapists can design a unique program for you to help keep your bones healthy.

Osteoporosis is a common bone disease that affects both men and women (mostly women), usually as they age. It is associated with low bone mass and thinning of the bone structure, making bones fragile and more likely to break.

Some people are more at risk for osteoporosis than others. Not all risk factors can be changed, but healthy habits and a proper exercise routine designed by your physical therapist can keep bones healthy and reduce risk. Risk factors* include:

Age: More common in older individuals
Sex: More common in women
Family History: Heredity
Race and Ethnicity: Affects all races. In the US, increased risk for Caucasian, Asian, or Latino
Weight: Low body weight (small and thin)
Diet, especially one low in calcium and vitamin D
History of broken bones
Menopause
Inactive lifestyle
Smoking
Alcohol abuse
Certain medications, diseases, and other medical conditions

Physical therapists can help prevent osteoporosis and treat its effects by designing individualized exercise programs to benefit bone health, improve posture, and enhance core stability and balance. Most of these exercises are simple and can be done at home with no special equipment.
Fight Fracture with Fitness

Inactivity is a major risk factor for osteoporosis. The right exercises and good habits can keep bones strong and prevent or reverse the effects of osteoporosis. Weight-bearing exercise, such as walking, is an important way to build and maintain healthy bones. Muscle strengthening exercises have been found to stimulate bone growth and can help prevent and treat osteoporosis. These types of exercises are best if started early in life and done regularly. However, it is important to remember that you can begin exercising at any age and still reap great benefits.

If you have osteoporosis, are at high risk for a fall or fracture, or have a medical condition, affecting your ability to exercise, do not begin an exercise program without first consulting your physician and a physical therapist.

Avoid exercises and daily activities, which round the spine, such as sit-ups, crunches, bending down to tie your shoes, exercise machines that involve forward bending of the trunk, and movements and sports that round and twist the spine.
Benefits of Good Balance

Preserving balance and stability with exercises can help reduce falls and resulting fractures. Exercises that improve posture, core stability, balance, and coordination, can also protect the spine against compression fractures. An individualized program may include a walking regimen, Tai Chi, and other exercises geared toward conditioning, balance, and coordination.
Bone Health Begins With Good Posture

Physical therapists recommend good posture and safe movements to protect bones from fracture during daily activities. Using proper posture and safe body mechanics during all activities protects the spine against injury. Here are some tips:

Keep your back, stomach, and leg muscles strong and flexible.
Keep your body in alignment, so it can be more efficient when you move.
Do not slouch. When sitting, keep your spine and head straight. Put a small pillow behind your waist to keep your spine in a good position.
Use good body positioning at work, home, or during leisure activities.
When lifting or bending forward, bend your knees, keep your back straight, bend forward at the hip crease, and lift with your legs. Keep the load close to your body.
Ask for help or use an assistive device to lift heavy objects.
Maintain a regular physical fitness regimen. Staying active can help to prevent injuries.

*National Osteoporosis Foundation

Acknowledgements: APTA Section on Geriatrics