Core stability training for injury prevention

Kellie C Huxel Bliven, Barton E Anderson, Kellie C Huxel Bliven, Barton E Anderson

Abstract

Context: Enhancing core stability through exercise is common to musculoskeletal injury prevention programs. Definitive evidence demonstrating an association between core instability and injury is lacking; however, multifaceted prevention programs including core stabilization exercises appear to be effective at reducing lower extremity injury rates.

Evidence acquisition: PUBMED WAS SEARCHED FOR EPIDEMIOLOGIC, BIOMECHANIC, AND CLINICAL STUDIES OF CORE STABILITY FOR INJURY PREVENTION (KEYWORDS: "core OR trunk" AND "training OR prevention OR exercise OR rehabilitation" AND "risk OR prevalence") published between January 1980 and October 2012. Articles with relevance to core stability risk factors, assessment, and training were reviewed. Relevant sources from articles were also retrieved and reviewed.

Results: Stabilizer, mobilizer, and load transfer core muscles assist in understanding injury risk, assessing core muscle function, and developing injury prevention programs. Moderate evidence of alterations in core muscle recruitment and injury risk exists. Assessment tools to identify deficits in volitional muscle contraction, isometric muscle endurance, stabilization, and movement patterns are available. Exercise programs to improve core stability should focus on muscle activation, neuromuscular control, static stabilization, and dynamic stability.

Conclusion: Core stabilization relies on instantaneous integration among passive, active, and neural control subsystems. Core muscles are often categorized functionally on the basis of stabilizing or mobilizing roles. Neuromuscular control is critical in coordinating this complex system for dynamic stabilization. Comprehensive assessment and training require a multifaceted approach to address core muscle strength, endurance, and recruitment requirements for functional demands associated with daily activities, exercise, and sport.

Keywords: exercises; kinetic chain; neuromuscular control; trunk muscles.

Conflict of interest statement

The authors report no potential conflicts of interest in the development and publication of this manuscript.

Figures

Figure 1.
Figure 1.
Functional core stability. This figure illustrates the various components and roles that interact to achieve functional core stabilization.
Figure 2.
Figure 2.
Extensor endurance test.
Figure 3.
Figure 3.
Side bridge test.
Figure 4.
Figure 4.
Flexor endurance test.
Figure 5.
Figure 5.
Sample core stability training program progression.

References

    1. Akuthota V, Ferreiro A, Moore T, Fredericson M. Core stability exercise principles. Curr Sports Med Rep. 2008;7(1):39-44
    1. Akuthota V, Nadler SF. Core strengthening. Arch Phys Med Rehabil. 2004;85(3)(suppl 1):S86-S92
    1. Alentorn-Geli E, Myer GD, Silvers HJ, et al. Prevention of non-contact anterior cruciate ligament injuries in soccer players: part 1. Mechanisms of injury and underlying risk factors. Knee Surg Sports Traumatol Arthrosc. 2009;17:705-729
    1. Arendt EA. Core strengthening. Instr Course Lect. 2007;56:379-384
    1. Asplund C, Ross M. Core stability and bicycling. Curr Sports Med Rep. 2010;9(3):155-160
    1. Barr KP, Griggs M, Cadby T. Lumbar stabilization: a review of core concepts and current literature, part 2. Am J Phys Med Rehabil. 2007;86(1):72-80
    1. Behm DG, Drinkwater EJ, Willardson JM, Cowley PM. The use of instability to train the core musculature. Appl Physiol Nutr Metab. 2010;35(1):91-108
    1. Bergmark A. Stability of the lumbar spine: a study in mechanical engineering. Acta Orthop Scand Suppl. 1989;230:1-54
    1. Bien DP. Rationale and implementation of anterior cruciate ligament injury prevention warm-up programs in female athletes. J Strength Cond Res. 2011;25(1):271-285
    1. Bliss LS, Teeple P. Core stability: the centerpiece of any training program. Curr Sports Med Rep. 2005;4(3):179-183
    1. Borghuis J, Hof AL, Lemmink KA. The importance of sensory-motor control in providing core stability: implications for measurement and training. Sports Med. 2008;38:893-916
    1. Carpes FP, Reinehr FB, Mota CB. Effects of a program for trunk strength and stability on pain, low back and pelvis kinematics, and body balance: a pilot study. J Bodyw Mov Ther. 2008;12(1):22-30
    1. Cholewicki J, Silfies SP, Shah RA, et al. Delayed trunk muscle reflex responses increase the risk of low back injuries. Spine (Phila Pa 1976). 2005;30:2614-2620
    1. Chorba RS, Chorba DJ, Bouillon LE, Overmyer CA, Landis JA. Use of a functional movement screening tool to determine injury risk in female collegiate athletes. N Am J Sports Phys Ther. 2010;5(2):47-54
    1. Colston M. Core stability, part 1: overview of the concept. Int J Athl Ther Train. 2012;17(1):8-13
    1. Colston M. Core stability, part 2: the core-extremity link. Int J Athl Ther Train. 2012;17(2):10-15
    1. Cook G, Burton L, Hoogenboom B. Pre-participation screening: the use of fundamental movements as an assessment of function. Part 1. N Am J Sports Phys Ther. 2006;1(2):62-72
    1. Cook G, Burton L, Hoogenboom B. Pre-participation screening: the use of fundamental movements as an assessment of function. Part 2. N Am J Sports Phys Ther. 2006;1(3):132-139
    1. Crisco JJ, Panjabi MM. The intersegmental and multisegmental muscles of the lumbar spine: a biomechanical model comparing lateral stabilizing potential. Spine (Phila Pa 1976). 1991;16:793-799
    1. D’Hooge R, Hodges P, Tsao H, Hall L, Macdonald D, Danneels L. Altered trunk muscle coordination during rapid trunk flexion in people in remission of recurrent low back pain. J Electromyogr Kinesiol. 2013;23(1):173-181
    1. Ekstrom RA, Donatelli RA, Carp KC. Electromyographic analysis of core trunk, hip, and thigh muscles during 9 rehabilitation exercises. J Orthop Sports Phys Ther. 2007;37:754-762
    1. Engebretsen AH, Myklebust G, Holme I, Engebretsen L, Bahr R. Prevention of injuries among male soccer players: a prospective, randomized intervention study targeting players with previous injuries or reduced function. Am J Sports Med. 2008;36:1052-1060
    1. Escamilla RF, Lewis C, Bell D, et al. Core muscle activation during Swiss ball and traditional abdominal exercises. J Orthop Sports Phys Ther. 2010;40(5):265-276
    1. Gibbons SGT, Comerford MJ. Strength versus stability: part 1. Concepts and terms. Orthop Division Rev. 2001;2:21-27
    1. Hebert JJ, Koppenhaver SL, Magel JS, Fritz JM. The relationship of transversus abdominis and lumbar multifidus activation and prognostic factors for clinical success with a stabilization exercise program: a cross-sectional study. Arch Phys Med Rehabil. 2010;91(1):78-85
    1. Hewett TE, Torg JS, Boden BP. Video analysis of trunk and knee motion during non-contact anterior cruciate ligament injury in female athletes: lateral trunk and knee abduction motion are combined components of the injury mechanism. Br J Sports Med. 2009;43:417-422
    1. Hill J, Leiszler M. Review and role of plyometrics and core rehabilitation in competitive sport. Curr Sports Med Rep. 2011;10(6):345-351
    1. Hodges PW, Richardson CA. Delayed postural contraction of transversus abdominis in low back pain associated with movement of the lower limb. J Spinal Disord. 1998;11(1):46-56
    1. Hodges PW, Richardson CA. Inefficient muscular stabilization of the lumbar spine associated with low back pain. A motor control evaluation of transversus abdominis. Spine (Phila Pa 1976). 1996;21:2640-2650
    1. Holmich P, Larsen K, Krogsgaard K, Gluud C. Exercise program for prevention of groin pain in football players: a cluster-randomized trial. Scand J Med Sci Sports. 2010;20:814-821
    1. Hubscher M, Zech A, Pfeifer K, Hansel F, Vogt L, Banzer W. Neuromuscular training for sports injury prevention: a systematic review. Med Sci Sports Exerc. 2010;42:413-421
    1. Hungerford B, Gilleard W, Hodges P. Evidence of altered lumbopelvic muscle recruitment in the presence of sacroiliac joint pain. Spine (Phila Pa 1976). 2003;28:1593-1600
    1. Kiani A, Hellquist E, Ahlqvist K, Gedeborg R, Michaelsson K, Byberg L. Prevention of soccer-related knee injuries in teenaged girls. Arch Intern Med. 2010;170(1):43-49
    1. Kibler WB, Press J, Sciascia A. The role of core stability in athletic function. Sports Med. 2006;36:189-198
    1. Kiesel K, Plisky P, Butler R. Functional movement test scores improve following a standardized off-season intervention program in professional football players. Scand J Med Sci Sports. 2011;21:287-292
    1. Kiesel K, Plisky PJ, Voight ML. Can serious injury in professional football be predicted by a preseason functional movement screen? N Am J Sports Phys Ther. 2007;2(3):147-158
    1. Knapik JJ, Bullock SH, Canada S, et al. Influence of an injury reduction program on injury and fitness outcomes among soldiers. Inj Prev. 2004;10(1):37-42
    1. Konin JG. Facilitating the serape effect to enhance extremity force production. Athl Ther Today. 2003;8(2):54-56
    1. Lederman E. The myth of core stability. J Bodyw Mov Ther. 2010;14(1):84-98
    1. Leetun DT, Ireland ML, Willson JD, Ballantyne BT, Davis IM. Core stability measures as risk factors for lower extremity injury in athletes. Med Sci Sports Exerc. 2004;36:926-934
    1. Liebenson C. Spinal stabilization training: the transverse abdominus. J Bodywork Move Ther. 1998;2(4):218-223
    1. Liemohn WP, Baumgartner TA, Fordham SR, Srivatsan A. Quantifying core stability: a technical report. J Strength Cond Res. 2010;24(2):575-579
    1. Liemohn WP, Baumgartner TA, Gagnon LH. Measuring core stability. J Strength Cond Res. 2005;19(3):583-586
    1. Macdonald DA, Dawson AP, Hodges PW. Behavior of the lumbar multifidus during lower extremity movements in people with recurrent low back pain during symptom remission. J Orthop Sports Phys Ther. 2011;41:155-164
    1. McGill SM, Childs A, Liebenson C. Endurance times for low back stabilization exercises: clinical targets for testing and training from a normal database. Arch Phys Med Rehabil. 1999;80:941-944
    1. McGill SM, Karpowicz A. Exercises for spine stabilization: motion/motor patterns, stability progressions, and clinical technique. Arch Phys Med Rehabil. 2009;90(1):118-126
    1. Minick KI, Kiesel KB, Burton L, Taylor A, Plisky P, Butler RJ. Interrater reliability of the functional movement screen. J Strength Cond Res. 2010;24(2):479-486
    1. Nadler SF, Malanga GA, Bartoli LA, Feinberg JH, Prybicien M, Deprince M. Hip muscle imbalance and low back pain in athletes: influence of core strengthening. Med Sci Sports Exerc. 2002;34(1):9-16
    1. Panjabi MM. Clinical spinal instability and low back pain. J Electromyogr Kinesiol. 2003;13:371-379
    1. Panjabi MM. The stabilizing system of the spine. Part I. Function, dysfunction, adaptation, and enhancement. J Spinal Disord. 1992;5: 383-389
    1. Panjabi MM. The stabilizing system of the spine. Part II. Neutral zone and instability hypothesis. J Spinal Disord. 1992;5:390-396
    1. Peate WF, Bates G, Lunda K, Francis S, Bellamy K. Core strength: a new model for injury prediction and prevention. J Occup Med Toxicol. 2007;2:3.
    1. Sadoghi P, von Keudell A, Vavken P. Effectiveness of anterior cruciate ligament injury prevention training programs. J Bone Joint Surg Am. 2012;94:769-776
    1. Smith CE, Nyland J, Caudill P, Brosky J, Caborn DN. Dynamic trunk stabilization: a conceptual back injury prevention program for volleyball athletes. J Orthop Sports Phys Ther. 2008;38:703-720
    1. Steffen K, Myklebust G, Olsen OE, Holme I, Bahr R. Preventing injuries in female youth football: a cluster-randomized controlled trial. Scand J Med Sci Sports. 2008;18:605-614
    1. Stevens VK, Coorevits PL, Bouche KG, Mahieu NN, Vanderstraeten GG, Danneels LA. The influence of specific training on trunk muscle recruitment patterns in healthy subjects during stabilization exercises. Man Ther. 2007;12:271-279
    1. Tsao H, Druitt TR, Schollum TM, Hodges PW. Motor training of the lumbar paraspinal muscles induces immediate changes in motor coordination in patients with recurrent low back pain. J Pain. 2010;11:1120-1128
    1. Tsao H, Galea MP, Hodges PW. Reorganization of the motor cortex is associated with postural control deficits in recurrent low back pain. Brain. 2008;131(pt 8):2161-2171
    1. van Beijsterveldt AM, van de Port IG, Krist MR, et al. Effectiveness of an injury prevention programme for adult male amateur soccer players: a cluster-randomised controlled trial [published online August 18, 2012]. Br J Sports Med.
    1. Walden M, Atroshi I, Magnusson H, Wagner P, Hagglund M. Prevention of acute knee injuries in adolescent female football players: cluster randomised controlled trial. BMJ. 2012;344:e3042.
    1. Wedderkopp N, Kaltoft M, Lundgaard B, Rosendahl M, Froberg K. Prevention of injuries in young female players in European team handball: a prospective intervention study. Scand J Med Sci Sports. 1999;9:41-47
    1. Weir A, Darby J, Inklaar H, Koes B, Bakker E, Tol JL. Core stability: inter- and intraobserver reliability of 6 clinical tests. Clin J Sport Med. 2010;20(1):34-38
    1. Willson JD, Dougherty CP, Ireland ML, Davis IM. Core stability and its relationship to lower extremity function and injury. J Am Acad Orthop Surg. 2005;13:316-325
    1. Zazulak BT, Hewett TE, Reeves NP, Goldberg B, Cholewicki J. Deficits in neuromuscular control of the trunk predict knee injury risk: a prospective biomechanical-epidemiologic study. Am J Sports Med. 2007;35:1123-1130
    1. Zazulak BT, Hewett TE, Reeves NP, Goldberg B, Cholewicki J. The effects of core proprioception on knee injury: a prospective biomechanical-epidemiological study. Am J Sports Med. 2007;35:368-373

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner