Abdominal or core training has become extremely popular so I thought a review of the
basics was in order.
One of the basics of many core exercise programs is the sit-up or crunch. However, it
places a high compressive load on the disc especially and when done in the morning, as many
people do due to busy schedules, can be disastrous. The reason is that the discs have been
absorbing water throughout the night increasing disc pressure. When you add a sudden
increased load by doing crunches the massive increase in disc pressure can disrupt the disc and
result in a herniation. My colleagues and I have probably saved dozens of patients from this fate
by instructing them to wait a few hours after they first get up before they perform these
exercises. It may be inconvenient but less so than surgery.
The purpose of core training is to increase the endurance and coordination of the abdominal, back and gluteal muscle. These two factors and not strength are the mainstays of core integrity. But before the actual core exercises can be performed to the greatest benefit there are four simple techniques that need to be learned. Let’s call them the” pillars” of core exercise.
The first is Respiration, the maintenance of normal breathing pattern throughout the exercise.
Many people will hold their breath or exhale during the strenuous part of the exercise. This
pattern must be broken.
The next pillar is the Diaphragm. Control of the diaphragm know as diaphragmatic breathing
needs to be maintained during exercise. This actually activates the abdominal muscles adding to
core stabilization.
The third is the Abdominal Brace. This is actively maintaining tension throughout the abdominal
and back muscles. This can best be illustrated by pretending you are about to be pushed by
someone.
The last pillar is the Neutral Spine Position (normal lumbar lordosis). This position maintains a
normal distribution of forces through the lumbar spine.
This may sound daunting but they can be mastered as you do the actual core exercises.
What are the core exercises you ask? And how do I incorporate the four pillars into the
exercises? My answer is What do you think Chiropractic is for.
Cholewicki J, Panjabi MM, Khachatryan A. Spine, 1997;22:2207-12
Hodges PW, Richardson CA. Arch Phys Med Rehabil, 1999;80:1005-12
Panjabi MM. J Spinal Disorders, 1992;5:383-9
Liebenson C. Rehabilitation of the spine: A Practitioner’s Manual, 2nd ed. Lippincott, Williams and Wilkins, 2007.