July 26, 2013
In my practice, I address the postural control and motor skills of children with motor and sensory challenges. Every day I have parents coming to me, lamenting their child’s lack of core strength.
I think it’s great that parents understand that central stability is key to motor skills and coordination. But several times a week, someone says, “Our therapist/coach/teacher says they should do sit-ups. What do you think?”. I’ll bet many of you also have this experience. So I thought I would put my “core speech” in a blog. It usually takes several sessions to educate parents well on what we are doing and how it works. But knowledge for parents is power and this ultimately it helps them to understand and advocate for their children. I invite you to add to my thoughts and together, we can come up with a final answer to that question.
“It is so exciting because we understand so much more now about core stability than we did 20 years ago when we all did sit-ups and crunches at the gym! There are actually 4 inner core muscles that stabilize the spine and pelvis before we move. In addition, there are outer core muscle groups that stability depending on how we are moving.
The key to getting these groups of muscles to work together and at their best is alignment. We need the rib cage stacked over the pelvis and then we need to take a good breath with our diaphragm, not with just our shoulders or just our chest or just our belly.
Sit-ups are not useful for our children. More often than not, my clients have to hold their breath to pull off even part of a sit-up, which means this actually isn’t a core stability exercise at all because the diaphragm is being held. Our children need that alignment, they need to learn to breathe in that alignment and then they need to activate/strengthen the inner and outer postural muscle groups in functional movements and in play. That’s really how they will develop core stability.”
That’s my final answer. Do you have something to add?
1. The 4 inner core muscles are the respiratory diaphragm, pelvic floor, transversus abdominis and multifidus. These 4 muscles work best as a team; working on one muscle in isolation of the other 3 does not help the team function as a whole.
2. The outer core muscle groups, which activate in diagonals, need to be strengthened in partnership with the inner core muscles so that we create good stability before and during all movements (see Where is Superman).
3. Control of diagonal movement (rotation) is a crucial component of central stability. Functional movements, from crawling, walking or crossing midline, require an element of rotation.
4. Working muscles in isolated exercises is not consistent with our present knowledge of motor learning. Integrating alignment and activation of the inner and outer core muscle teams in movement and play activates core stability in function (see Round and round the garden).
5. Simply practicing sit ups, superman, crab walk, wheelbarrows, planks etc. does not guarantee that the appropriate muscles are working as we can compensate for poor core stability in many ways. Many activities can work core stability but not without first paying careful attention to alignment, breathing and proper muscle activation. This is true for typical children as well as children with sensory/motor challenges.
I enjoyed reading your post, as well as the two you’ve linked. I am in agreement that sit-ups and other isolated movements are ineffective in providing the core stability that so many of our kids need. I’m curious as to what types of activities you use to develop core strength/efficiency in children? Also, do you have recemndations on research/literature that I can study to increase my understanding of the topics you’ve discussed? I would love to share with my colleagues but I know we all will benefit from having the research to support our recommendations for services/therapies!
Thank you for your comments Karen. My website has a synopsis of a case study with a 12 year old boy with CP that documents our approach to central stability in children. We will be ready to submit the manuscript for publication shortly. There is also one other case study outlining my work with a child with ASD. Several of my blogs discuss the the inner and the outer core muscle groups and how they function.
There is only one study that examines core function in children. Kane K, Barden J. Contributions of trunk muscles to anticipatory postural control in children with and without developmental coordination disorder. Hum Mov Sci 2012. There is a great deal of literature in the adult orthopaedic literature; Paul Hodges has done a great deal of work documenting how the inner core muscles function. Dianne Lee also discusses the postural synergist groups.
There will soon be a webinar of the presentation I did with my colleague, Julie Wiebe PT,at the 2012 APTA CSM which provides more specifics regarding our approach.
Hope that helps!
Thank you! Exactly the information I’ve been desperate to track down. Any other play activities?
Thanks for your comment Irene, I love to put core stability into all kinds of play. As I mentioned in the post, it really is less about the activity and more about the alignment within that activity. In our Dynamic Core for Kids education courses we teach how to specifically assess and treat children with sensory and motor challenges so they can maintain the necessary alignment that will activate the inner and outer core muscles in relationship with each other. After that, every activity can be a “core” activity!