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After completion of this chapter, the physical therapist should be able to do the following:

  • Describe the functional approach to kinetic chain rehabilitation.

  • Define the concept of the core.

  • Discuss the anatomic relationships between the muscular components of the core.

  • Explain how the core functions to maintain postural alignment and dynamic postural equilibrium during functional activities.

  • Describe procedures for assessing the core.

  • Discuss the rationale for core stabilization training and relate to efficient functional performance of activities.

  • Identify appropriate exercises for core stabilization training and their progressions.

  • Discuss the guidelines for core stabilization training.

A dynamic, core stabilization training program should be a hallmark component of all comprehensive functional rehabilitation programs.10,13,22,23,28,31,55 A core stabilization program improves dynamic postural control, ensures appropriate muscular balance, and affects joint arthrokinematics around the lumbo-pelvic-hip complex. A carefully crafted core stabilization program allows for the expression of dynamic functional strength and improves neuromuscular efficiency throughout the entire kinetic chain.1,11,16,28,29,31,51,61,64-66,88,89

What Is the Core?

The core is defined as the lumbo-pelvic-hip complex.1,28 The core is where our center of gravity is located and where all movement begins.33,34,78,79 There are 29 muscles that have an attachment to the lumbo-pelvic-hip complex.7,8,28,80 An efficient core allows for maintenance of the normal length-tension relationship of functional agonists and antagonists, which allows for the maintenance of the normal force-couple relationships in the lumbo-pelvic-hip complex. Maintaining the normal length-tension relationships and force-couple relationships allows for the maintenance of optimal arthrokinematics in the lumbo-pelvic-hip complex during functional kinetic-chain movements.88,89,96 This provides optimal neuromuscular efficiency in the entire kinetic chain, allowing for optimal acceleration, deceleration, and dynamic stabilization of the entire kinetic chain during functional movements. It also provides proximal stability for efficient lower-extremity and upper-extremity movements.1,28,33,34,43,55,78,79,88,89

The core operates as an integrated functional unit, whereby the entire kinetic chain works synergistically to produce force, reduce force, and dynamically stabilize against abnormal force.1 In an efficient state, each structural component distributes weight, absorbs force, and transfers ground reaction forces.1 This integrated, interdependent system needs to be trained appropriately to allow it to function efficiently during dynamic kinetic chain activities.

Core stabilization exercise programs have been labeled many different terms, some of which include dynamic lumbar stabilization, neutral spine control, muscular fusion, and lumbopelvic stabilization. We use the terms “butt and gut” to educate our patients, colleagues, and health care students. This catchy phrase illustrates the importance of the entire ...

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