Motion Stability's Blog


What Exercises for My Core Can Help Prevent Lower Back Pain? by charlestlee
Brian Yee PT, MPhty, OCS, FAAOMPT

First – generally there are different roles of muscles in your trunk. Typically the smaller ones closest to your spine are considered ‘local’ muscles. Such muscles as the transversus abdominis, diaphragm, pelvic floor, and lumbar multifidus provide segmental control of your lumbar vertebra. Real-time ultrasound imaging can be used to visualize the proper contraction of these muscles as we cannot see these muscles from the superficial skin. So first step in core stability is to ensure that the smaller muscles are engaging properly. Then you have ‘global’ muscles which are the larger muscles – such as rectus abdominis, obliques, paraspinal muscles. These muscles are designed for power and stability at higher loads. Core stability exercises should integrate the function of the ‘local’ and ‘global’ muscles in proper sequence.

Once that is established, any asymmetries of the muscles should be determined. In back pain patients, it is very common to have one side of the oblique muscles contracting properly while the other side does not. This causes an imbalance of forces on your trunk and can cause increased torque to your spine – eventually leading to back pain due to excessive torsional stresses in your daily function or sport.

Once the asymmetry is addressed, integration of muscles from above and below the core need to be assessed.  The old saying ‘the knee bone is connected to the hip bone’ goes too with the muscles in your body. Such lower leg muscles as the gluteal muscles in your hip or the latissimus dorsi in the mid back affect the way your core muscles in daily function and sport. People with back pain, typically have an improper tone and sequence of these muscles working together. Over time this places increased stress on the back – regardless of how strong your core is.

As you can tell, there is a lot to consider when training your core. To recommend a standard protocol of exercises to help your back is not specific enough. A proper assessment of your muscle control and movement patterns should be assessed by a qualified movement specialist – such as a Physical Therapist – to determine what the appropriate level and progression of exercises for proper stability and prevent back injury.

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What Can I Do to Prevent an ACL Injury? by charlestlee

Brian Yee PT, MPhty, OCS, FAAOMPT

An ACL injury is usually due to the knee going into excessive valgus (knee turning inwards) and/or some type of rotary /pivot force. Many people focus on training the musculature around the knee such as the quad and hamstrings. This does help, but one must also consider the stability of the joints above and below – which would be the hips and ankle/foot complex.The knee can be viewed as a junction between two different stilts. If the hip is not stable or has excessive mobility, or the foot / ankle is not supportive such as excessive flat feet or stiff ankles from an old ankle sprain – it can place excessive valgus force at the knee – possibly leading to increased stress to the ACL.
Training thus should consist of hip and thigh training that does not promote internal rotation/valgus to the knee – such as gluteus medius / lateral hip stabilization, as well as improving ankle mobility/foot stability exercises. Once proper movement patterns are established, progression to higher level plyometrics, as well as sports specific training should be introduced.



How Can a Weak Core Lead to Back Pain? by charlestlee
Brian Yee PT, MPhty, OCS, FAAOMPT
According to Panjabi’s model, we can view spinal stabiilty based on 3 key elements:

1. Passive Structures: The spinal column itself and the ligaments, fascia and other static tissues that hold it together.

2. Active Structures: The muscles that surround the trunk and pelvis ‘actively’ contract to provide muscle support.

3. Cognitive / Motor Control: The brain has a way to coordinate how muscles will be used to anticipate how the spine is used with functional activities.

The passive structures and the spine itself is limited in its ability to stabilize the spine, especially in dynamic function or prolonged positions such as standing or sitting. The brain thus needs to coordinate the proper timing of muscle contractions and muscle forces to hold the spine together. Without proper muscle control and force the vertebrae of the spine will have increased shearing, torque or compression eventually leading to such things as vertebral degeneration, herniated discs, or other structural issues that may lead to back pain.

The notion of the ‘stronger you are – the better you’ll be’ needs to be carefully considered as it is more important to develop stability in the core that is efficient and properly coordinates with proper movements in your upper and lower body. There are many disciplines out there that teach movement patterning and stabilization, this can include pilates, yoga, functional movement training, feldenkrais, janda approach, and more. Each discipline has their specific methods, while there are also similarities. Please consult a qualified physical therapist or other health practitioner to learn more about proper movement training to stabilize your core.



Why do I get pain on the inside of my foot when I increase my training? by charlestlee

image source: massageinflorida.com

Brian Yee PT, MPhty, OCS, FAAOMPT
Pain that occurs on the inside of the foot when increasing your training is usually due abnormal forces placed upon it. This can occur with the foot either pronating too much (going flat) or the foot loading to the ball of it excessively.
Either way, increased stress is placed along the arch and pain can occur there.
Training then should be modified not to allow the arch to collapse or load to the front of the foot excessively. Small tips would include – putting more equal weight through the heel and ball of the foot, watching you knee angle so that it does not go into valgus (turning in) as that place more stress on the arch, and training hip stability primarily in the gluteal muscles as opposed to the calf and quad musculature.