January 31, 2012
Conversations with Shelley and Kim Congenital Muscular Torticollis
This is a classic – professionals recommend that children who have poor core strength do wheelbarrows and planks as exercise but children can’t complete these activities unless they have good core strength. I immediately begin to feel dizzy trying to sort my way out of this circular argument (not a good thing for my vestibular system). So I suggest we all hop off this merry-go-round and update our knowledge about what the core muscles are and how they work.
1. Our inner core muscles turn on first.
The inner core muscles consist of the respiratory diaphragm, the pelvic floor, the transversus abdominis and the multifidus. The inner core muscles activate as a team in the same manner before every movement that we do. They function to give us a stable spine and pelvis before movement begins. The respiratory diaphragm receives input from the vestibular system (hurray, another link between sensory and motor functions!) During the process of neurological and motor development, the inner core muscles become active and efficient during the first 2 – 3 years of life. For our children with motor challenges, the inner core muscles do not become efficient due to both neurological and alignment issues.
2. The timing of outer core muscles depends on the task.
Unlike the inner core muscles, which come on in the same manner regardless of the movement, the timing of recruitment of outer core muscles depends on the task. The inner core muscles create an anchor at the center so the outer core muscles have something to stabilize on and can function efficiently. We call this partnership of inner and outer core muscles the body’s “core strategy”. When the inner core muscles are not active, children over-recruit outer core and extremity muscles instead and this causes their clumsy movements and can also lead to pain. (This happens with adults too. Please go to www.juliewiebept.com for great information about core function in adults.)
3. The inner core muscles are easily overwhelmed.
The inner core muscles are easily overwhelmed by other muscles. A sure sign that the inner core is not active is breath holding to accomplish a challenging movement. Babies and toddlers do this naturally when accomplishing new skills but move quickly through this as their alignment improves. Alignment supports core strategy. Children with motor challenges continue to use breath holding as their way of creating a stable center.
And now how do we apply this new knowledge to help children with motor challenges?
1. Stop thinking about core exercise and start thinking about core strategy.
Core exercises (sit ups, crunches, wheelbarrow, crab walk, planks, stability balls – the list is endless!) are something separate in a childs’ day but in reality core strategy is something that should be present throughout the day. Building alignment in every activity builds core strategy, which is critical for endurance and strength.
2. A is for alignment.
Our children need to experience what it feels like to have a neutral rib cage in relationship to a neutral pelvis. Many of our children tuck their bottoms under (posterior pelvic tilt) or pop their bellies out (anterior pelvic tilt). Then they shift their rib cage forward or backward in an effort to keep the body balanced. A different alignment is needed to be able to activate the inner core muscles.
3. Everybody breathe.
When you are with a child, listen to their breathing. If they are breath holding prior to/during a task, remind them to breathe. We also need to retrain the respiratory diaphragm by encouraging expansion of the lower rib cage so that they can take a full breath. In this way, the diaphragm is fully engaged and the inner core team becomes active.
4. Movement should be fun.
Ultimately we want our kids to take their core with them wherever they go! They use it sitting, walking, running, playing hopscotch, skipping rope, hula hooping, rock climbing and rollerblading. If we train the inner core to come online first, then we can put that into play (and school and sports too!). In that way, every activity becomes a core activity.
When we work with children an up to date understanding of core muscles and how they work is crucial. Activation of the inner core should be our priority as this team of muscles supports our children in every single function they do. So in my practice you’ll find my clients working their core in everything they do – but the wheelbarrows stay in the garden and planks are just pieces of wood.