The purpose of this article is to give a new perspective on core training. The reader should have an advanced knowledge of function, anatomy and human movement. Current core training programs place emphasis on the transvereus abdominis, multifidi and/or the inner and outer units. The problem with this is, in all other aspects of training, fitness professionals are taught that the body knows of movements, not muscles. The solution can be found in Gray Cooks’ seven movement screens or as presented here by the Egoscue Method. What makes these two methodologies effective is that they focus on the total body equation. The sum is greater than its parts. The other common denominator is that they both work on asymmetries first. How can you expect a body that has two of almost everything to function optimally if one side either looks or is not functioning as well as its counterpart? Let’s take a beginning look into a new perspective of training. This is the first part in a series.
The Egoscue Method utilizes a holistic approach to training and conditioning as well as rehabilitation. It does so by looking at the body as a whole and deducing between the compensations and the dysfunction. By addressing the dysfunction, the body's need for compensating reduces. And if there was injury previously, as Gary Gray says, you create an environment for healing. An example would be when you have a cold, you go to a doctor who prescribes drugs. The drugs aren’t what kill the virus. It only slows down the production of further harmful cells and allows the body's immune system to regain control and eliminate the cause. The drugs go after the symptoms: running nose, coughing, headache, etc. The human body eliminates the cause, but ONLY through an environment that is conducive to healing.
The Method simulates this by having a basic blueprint of the human body (see Figures A and B below). These pictures show the ideal blueprint of the human body. The Method is not unique in its view of an ideal posture; the American Physical Therapy Association as well as the NASM both share this view. In this environment, the muscles are able to fully do the job of shock absorption when the foot impacts the ground, reducing the possible consequences of a serious fall or injury. In addition, and perhaps most importantly, it is able to allow the bones to go through full ranges of motion. This ensures that the various types of proprioceptors are being engaged and sending the correct signals via the CNS to the brain and vice versa.
In order to understand the difference between the training utilized by the Method, we need to break down the body into the three types of postures seen within the population.
Condition 1 (see Figures 1A and 1B below):
This person is generally tight, with tight hamstrings, pelvis and thoracic spine. Most commonly a former athlete, present athlete or weightlifter.
Condition 2 (see Figures 2A and 2B below):
Generally tight, probably unilateral tightness causing rotation, shoulder depression or torso offset. Most likely a hip disparity (one side being facilitated the other not).
Condition 3 (see Figures 3A and 3B below):
This client is generally weak. Pelvis tilts posterior. Most common seen posture, also commonly confused with Condition 1, due to the hips being displaced forward of the plumb line. Swayback looking but the ASIS and/or PSIS palpate posterior tilted. Also, very common among spinners and accompanied with thoracic tightness and convexity.
Every person falls into one or possibly even two of these groups. As with all successful programs that treat the entire body, Condition 2, which shows asymmetries between the left and right side of the body, is the first priority. The goal is to get the body as bilateral as possible. When we refer back to figure A, we see that that is where the body wants to be, and at some point in life, it was.
The goal of the Method is simply to return the body to where it once was and wants to go. It just needs a reminder of where it should be. You can describe this as kinesthetic sense, body awareness, whatever. We all have dealt with clients who cannot “feel” or sense what or where their body is in space. To get the “reconnection,” we use simple exercises designed to engage, stretch or reposition the load-bearing joints of the body. The load-bearing joints are defined as the ankles, knees, hips and shoulders. These are the major joints that are responsible for dealing with carrying the weight of the body against gravity, responding to ground reaction forces. When these joints are in line, as shown in Figure A, the net translation of force becomes zero.
What does this have to do with the “core” and training the “core?” If we look over the information just listed, it is easily seen that what happens at the foot creates a chain reaction all the way up through the body, regardless of the muscles that lie in between or attach onto the hips. How can I say this? Easy. What happens in one position - as in walking - requires different muscular engagement than jumping, running, cycling, etc. Each position puts the body into a different postural position, and with the joints contorted to various positions, the muscles have no choice but to follow.
Since everyone falls into the above categories, we will list one exercise and show the effects from the three conditions listed above. Remember, the Method's definition of the core is the load-bearing joints vertically stacked and horizontally aligned with its counterpart. As an example, let's look at a client doing box jumps, jumping on to an object of 6-12 inches in height. Now that we know the three main conditions, let's look at how exercise affects each condition.
The condition 1 client presents an anterior pelvic tilt, rounded shoulders, forward head, external at the femurs and the feet. When this client initiates the loading phase, he is unable to properly load the lower extremity. Due to the anterior tilted pelvis and rounded shoulders, he will load the thoracic spine and quads, not truly utilizing the full power potential of the hips, glutes, hamstrings, etc. When the client lands due to the compression already occurring in the lumbar spine region from the anterior tilt, it will be the point that absorbs the shock and force from the landing. This is also due to the position of the femurs and the feet. With the feet external, the hips just as in take off are unable to fully absorb shock, instead of the muscles being able to help perform their role as shock absorbers, having never being facilitated prior to the exercises and now being strengthened in their abnormal length tension relationships.
The condition 2 client presents either a shoulder or pelvic rotation, meaning one is forward of the other. Imagine the shear forces occurring both above and below the pelvic or shoulder rotation. Now picture the external loads effect on a rotated body. What position is the ACL most commonly injured? Change of direction (i.e., rotation). Now you take that same person and have her land with a force 10 times greater than her body weight. It is obvious that this person does not need to be doing any jumping until the rotation is eliminated with the chance of injury is diminished from postural deviations.
The condition 3 client presents a posterior pelvis, which is a function of weakness. The muscles in her body were never fully developed. While you may think that a box jump is perfect, it will strengthen the hips/glutes as well as increase power production. The problem is that in the initial loading and landing, there is a certain amount of anterior tilt required. Without it, similar to condition 1, the spine is an easy target for shock absorption. In condition 3, the vertebrae are “loosely packed,” meaning they have limited integrity. The pelvis is the powerhouse that carries the spine, and with it being weak, everything else is affected by its weakness. By having the client perform the box jump, you will not get true power production potential, and you are placing them at a greater risk of injury.
Due to the condition 3 being the most common condition, and the subsequent potential for injury during explosive power exercises, you should now be asking, "O.K. then, how do I get my clients to perform safe power exercises?" E-cises are the answer.
E-cises are short for Egoscue exercises. The e-cises by themselves are just as effective as the box jump above, which is not effective at all. The benefits of the e-cises occur in the sequence that they are both prescribed and performed. You can take your three clients above through the following e-cises, and you will notice a huge difference. One might think the client has a strength issue, and you may feel getting her stronger will be the key to reducing the stress onto the spine and will equate to a higher jump and greater shock absorption. But as you can see, the e-cises are not strengthening the body in a traditional view.
There are no repetitious exercises for the lower body. What we are working on is altering the position of the pelvis. It is through this position that the body will start to more effectively and safely produce force, reduce force and provide safe shock absorption. Let's evaluate the e-cises so that we can gain an understanding of what is occurring. First, remember that the body is ideally comprised of 90-degree angles, and that is what allows full range of motion as well as resiliency.
The air bench position is at 90 degrees at the hip, knee and ankle. The wall provides for a flat and known plumb level surface, so that both hips are forced to engage equally. The lower back is pressed into the wall, not from rounding the back, but from the force of the thighs which, traditionally when seated, are for the most part inactive. What is created is thoracic extension, through bilateral hip engagement, while stabilizing the pelvis. This will set up the body for the next position (Cats and Dogs). Hold the Airbench for one minute building to two minutes.
Stand against a wall with your feet facing straight ahead. Your hips, upper back and head should be up against the wall. Walk your feet away from the wall approximately two to two and a half feet. Bend your knees and start sliding down the wall. Hold this position and keep the weight in your heels. Your lower back should be flush against the wall.
Cats and Dogs
The Cats and Dogs work to promote flexion and extension of the spine while loading the hips and shoulders. The goal is to increase the condition 3 clients with the ability to extend their spine. However, since the condition 3 clients also have rounded shoulders, the shoulders will be addressed through this position as well. In the dog position, the shoulder blades are to be retracted and depressed. This further extends the thoracic spine and extends the hips. This takes us to the next position (Static Wall). Perform 10 Cats and Dogs in each direction.
Get on your hands and knees. CAT: Pull your hips under, pull your head under and push your upper back to the ceiling. DOG: Roll your hips forward to put the arch in your back, collapse your shoulder blades together and look up. Repeat and remember to drop your shoulder blades together in the dog position.
|Cats and Dogs 1
||Cats and Dogs 2
The Static Wall position works on eliminating the ability of the lower extremities to rotate, while promoting thoracic extension. Again, the floor should be a plumb and level surface. If it is and the head is able to stay in contact to the ground as the lower back is flat, then what we have created is thoracic extension. In addition, the pelvis is equally being pushed flush to the ground, while gravity and the tightening of the thighs works to create the force by which the thoracic extension is achieved. Again, the two targets are the hips and the spine. Two people who both show condition 3 posture can feel the muscular involvement differently. Why? Because the compensation patterns will be different, depending upon the person's activity level and environment, just as someone who breaks a leg or arm will not always show the same signs as an identical twin with the same type of break. One may not see as much loss of strength or lack of range of motion. (This takes us to Static Extension.) Hold the Static Wall for three minutes. Remember to relax your stomach.
Lie on your back with your feet up the wall. As you get more functional, your hips will sit closer to the wall and be flat on the floor at the same time. To start, keep your hips away from the wall and move in as much as you can. When you get your legs up the wall, tighten your thighs and pull your toes back toward your knees and hold. Your feet must be pointed straight behind you for your hips to be doing the work needed to stabilize your spine.
The Static Extension position works to promote lumbar and thoracic extension through bilateral hip demand. The hips are forced into extension through the placement of the hands. This is further increased as the shoulder blades are collapsed down and back, which loads the shoulders and extends the thoracic spine. The demand onto the hips is bilateral as with all the positions due to the placement of the body or the usage of a known plumb and level surface. Hold the static extension for two minutes.
Start on your hands and knees. Move your hands about six inches forward and then move your upper body forward so your shoulders are above your hands. Your hips are now forward of your knees about six inches. Keep your elbows straight and allow your shoulder blades to collapse together while your low back arches. Drop your head. Your low back arches because your hips roll forward to allow this movement to occur. Hold this position.
The order is decided by figuring out the cause of the faulty posture. In this case, the hips were posterior. In addition, since the thigh muscles attach to the pelvis and we are looking to do a lower body power exercise, we need to be able to engage the pelvis through the lower extremity, which includes the big powerful hip flexors. Every position attacked the hips and the thoracic spine because, as the hip flexes, the spine should extend. The muscles involved are involved either from the position or due to the person's compensation. We are not setting out to say, “The hips are posterior, which means the hamstrings are tight, and the shoulders are forward so the pec and lats are tight.” We want to say the hips are in a poor non-facilitated position. What can we do to change that position? The position of a muscle has been shown to be a co-determining factor in isometric muscle contraction. If we stretch something along the way, it is due to the engagement of the opposing muscles and the placement of the body in a position that allows it to be successful. This is what makes the Egoscue Method both a great tool but also a challenge to fully utilize. However, I believe we are all faced with the challenge of dealing with tough clients who do not respond to science-based exercise. This can be due to multiple reasons, which is beyond the scope of this article.
The science backing up the information is discussed in the following paragraphs. The goal is to get you to think of not only how someone is moving the way they do or develops the same injuries over and over, but most importantly, why? With the why in mind, let's take a look at some of the background information about the reasoning for posture as the primary starting point, and what occurs when it is faulty.
Joint position, posture and alignment: these three things need to be at ideal levels in order to facilitate true activation of the core musculature. Optimum posture has been shown in studies to improve the lumbo-pelvic stabilizing musculature, compared to both the sway and slump sitting positions. Moreover, these positions are static in nature. Think of what happens when you now add movement to the equation.
Posture is important for several reasons. First, a muscle can only contract or relax relative to its resting or inactivated state. Second, the nature of the body as a linked system of many joints means that muscles, which do not span other joints, can still provide acceleration about those joints. Third, the production of movement depends on the structural integrity of the kinetic chain; this structural alignment is known as posture. Let's break these three major points down.
A muscle can only contract or relax relative to its resting or inactivated state. The inactivated state is the length tension relationship (LTR). This LTR dictates what muscles the CNS can call on to perform all motor programs. Since no one muscle dominates spinal stability enhancement, and the role of individual muscles continuously changes across tasks, optimum posture allows the body to implement several different muscle strategies to solve any given motor pattern.
The relaxed state is going to dictate the position of the bones and joints of the body, while the nervous system also plays a role in this. Muscles are what make the bones move.
The nature of the body as a linked system of many joints means that muscles, which do not span other joints, can still produce acceleration about those joints. The soleus for example, while not spanning across the knee joint, acts as a knee extensor during gait. By acting on a joint above or below the moving joint, you can accelerate or decelerate force. The muscles activated to support the segments of the spine vary with arm movement, yet the arms are not considered part of the core musculature.
The production of movement depends on the structural integrity of the kinetic chain. This structural alignment is known as posture. Arthrokinetic inhibition, reciprocal inhibition and synergistic dominance all occur secondary to postural dysfunction. A study from Japan showed that altering posture significantly increased TvA and internal oblique activity and timing. With CNS control, timing of muscle activation becomes a major consideration. More than 80% of the population experiences low back pain at some point, and subjects with a prior history of low back pain have both a decreased ability to fire the TvA and an increase in firing time. However, posture significantly increases both activity and timing.
Where to Begin
While some clients will improve with either a draw in or bracing technique, it is difficult to tell whether it is from the activation occurring or is from confidence of the trainer or therapist implementing the program. The psychological aspect is beyond the scope of both the author and this article. However, it is another thing to consider when choosing the best methodology to meet your clients' needs, wants, goals and abilities.
The Egoscue Method definition of the core is, “The core is all the load bearing joints of the body in vertical stacked and in horizontal alignment with its counterpart.” With this simple statement, it encompasses all the information listed above, training the body to perform as an integrated unit, with the sum being greater than its parts. Current core training places too much emphasis on drawing in or bracing or multifidi training. The core musculature is engaged by reflexes in response to your actions and reactions. By training the “chain reaction” of the human body, you will ensure your clients are able to reach their goals and beyond.
What to Do
Train the body to function as it would in optimal alignment. Sounds simple and is simple. By taking the joints through a full range of motion, the natural chain reaction of the musculoskeletal system will activate the right muscles and “loosen up” restrictions. Remember the old school song, “The thigh bones connected to the hip bone, etc.” Train the body as a reactive unit; what occurs in one area affects all others.
- Cook, Gray, Advances in Core Training, online course, www.ptonthenet.com
- Siff, Mel, Transversus Abdominis Revisited, www.ptonthenet.com
- Woodruff, Diane, Movement Patterns: Their Roles in Function and Fitness, www.ptonthenet.com
- Jones, Mike, Medical Exercise Specialist course, American Academy of Health Fitness and Rehab
- Bradley, Brian, Egoscue Method, private correspondence, 2003-2004
- Clark, Mike, Sports Fitness Specialist course, National Academy of Sports Medicine
- Mayoclinic.com, online article, Core Strengthening: More than just a crunch
- O’ Sullivan, Peter, Grahamslaw, Kristy, Spine, The Effect of Different Standing and Sitting Postures on Trunk Muscle Activity in a Pain-Free Population, 27(11):1238-1244, June 1, 2002
- Moseley, G. Hodges, P, Spine, Deep and Superficial Fibers of the Lumbar Multifidus Muscle are on Differentially Active during Voluntary Arm Movements, 27(2):E29-E36, January 15, 2002
- Abe T, Yamada T, Tomita T, Easton PA, J Appl Physiol, Posture Effects on Timing of Abdominal Muscle Activity during Stimulated Ventilation, 86(6):1994-2000, June 1989
- Hodges PW, Richardson, CA, Arch Phys Med Rehabil, Altered Trunk Muscle Recruitment in People with low back pain with upper limb movement at different speeds, 80(9):1005-12, September 1999
- Huub, Maas, GC Guus C Baan, PA Peter A Huijing, Journal of Biomechanics, Vol 37, Issue 1 pages 99-110, January 2004
Pictures reproduced with permission of Brian Bradley of the Egoscue Method.