December 10, 2010
Dynamic Core for Kids
In recent posts I’ve discussed Dynamic Core for Kids (previously called Core Restoration).In this post we’re going to take a brief look at how the Core develops typically in postural control and where this process can go awry in children with movement difficulties.We’ll also discuss how it is that Dynamic Core for Kids addresses improved postural control.In subsequent posts, I’ll present several case studies so you can have practical examples of how this approach can work with children who are experience movement challenges.
The Physical Therapy research literature over the past decade has targeted the inner core unit and how it functions.The inner Core unit is made up of the respiratory diaphragm, the pelvic floor, the Transversus Abdominis and the Mulitifidus.It turns out that these 4 muscles turn on prior to movement, and they work together as a team, regardless of the direction of the movement.In other works, they anticipate and provide central stability prior to any movement.Other outer core muscles turn on in different patterns, dependent on the direction and magnitude of the movement.We can refer to the inner Core muscles as the anticipatory core and the outer core muscles as the reactive core (for more information please go to www.juliewiebept.com and read Julie’s blog, “Core Conversations: The Anticipatory vs. Reactive Core”).All provide a stable center but in a different manner.The activation of the team of inner Core muscles is alignment dependent; that is to say, if our alignment isn’t optimal, neither is the activation of our inner Core muscles and therefore we don’t have a stable center before we move.
In typical development, Core activation in postural control happens smoothly.At birth, physiological flexion provides our central stability.The central nervous system is maturing over the first several years and as this happens there are more connections and more consistent connections formed between muscles and nerves (corticospinal and vestibulospinal tracts are primarily responsible for postural tone).This causes the resting tone in our inner Core muscles to increase during our first 2 – 3 years.Further, our desire to explore the world through vision and touch drives our movement exploration.Each time a baby turns their head to use their eyes, or reaches out for Mom, the inner Core muscles have prepared a stable trunk.The more we move and explore in different positions, the more sensory information we process.This allows us to control our alignment against gravity and our anticipatory Core function becomes more consistent.Eventually there are instantaneous connections between the sensory systems, the anticipatory Core and all the other muscles of the body.The musculoskeletal, sensory and motor control systems work together for smooth, coordinated functional movement.
In our children with movement challenge this scenario goes awry.Children who are born prematurely don’t have adequate physiological flexion to provide central stability.Children with low tone don’t develop adequate resting muscle tone in their Core musculature and don’t have the strength or endurance to maintain alignment.Children with spasticity can’t spontaneously access an appropriate alignment that allows efficient activation of the Core muscles.Children with sensory processing difficulty don’t register and/or process appropriate levels of vestibular sensory input, which impacts directly on resting muscle tone, the level of activity in the respiratory diaphragm (a key Core muscle) and their perception of alignment.Children can also experience difficulty with activation of their Core muscles secondary to non-neurological issues.For instance, abdominal surgery impacts directly on several muscles of the inner Core unit and can interfere with its function. When our children have difficulty with function of the inner Core unit, they create compensations in their body that supports their central stability and therefore their functional movement.Primarily they hold their breath as a way of creating central stability in order to complete the task.Other compensations include holding their arms tight to their sides, using trunk asymmetry or locking a joint at end range.Each child creates his/her own unique set of compensations which provides a degree of central stability in that moment but these usually interfere with the development/refinement of further functional skills.
Dynamic Core for Kids accesses the inner Core unit by addressing alignment and breathing.Not only do we need to be attentive to alignment of the pelvis and spine but the alignment of the rib cage is also critical.Once alignment is present, children need to be taught to breathe in all planes rather than just relying on upper chest and/or belly breathing patterns.Finally, this new Core strategy needs to be connected to the outer core muscles so postural control supports functional movement efficiently.
In my next post, we’ll look at how this process worked for a 12 year old child with Cerebral Palsy.