// Nailing the core

by Lisa Champion and Anna-Louise Bouvier

A PERFECT PRACTICE™ ARTICLE

We think it’s a fair call to say that ‘core stability’ has myriad definitions and interpretations in the worldwide fitness industry. Not only do personal trainers have many different concepts and ideas about what constitutes core stability, but there is a wide range of research into the topic, some of it with quite conflicting results.

In the PERFECT PRACTICE™ Training System: core control, we define it as: ‘The ability to maintain balanced alignment as you move’. This can also be called ‘optimal dynamic control’. Notice that the word ‘stability’ is not used at all. One reason for this is that trainers often think that to increase ‘stability’ clients require more ‘rigidity’. This is not necessarily true, nor is it functionally ideal (see the Autumn 2008 Network magazine for a full article on this topic).

In 2006, we developed the CIRCLE OF CONTROL™ model for better understanding core control (the Circle of Control Chart can be downloaded in pdf format from the Member’s Gymbag section of the Network web site). In this model we attempt to include the range of research by defining three levels of core control (see Table A).



So, given these levels of core control, the $64,000,000 question is: can you, as a trainer, assess your client at each of these levels and, if their core control is lacking, do you have the skill to retrain them at the required levels? Also, do you understand how a lack of core control, at any level, is affecting your client’s performance and injury risk?

THE 1-2-3-4 CORE ASSESSMENT*

A great first step in your client evaluation is to determine the likelihood of poor core control based on verbal assessment. Anna-Louise developed the 1-2-3-4 Core Assessment model in 2005 for use in her Physiocise program. This brilliant system provides a real advancement in the understanding of what can influence core control. The premise of the system is that if any one part of the core unit is compromised, the entire unit is more likely to undergo a core ‘crash’, causing a loss of form and a higher potential for injury. The core unit is made up of four parts; a lid, a front wall, a back wall and a floor. Table B shows the things that can cause each part of the core to be compromised.

WHAT DOES THE 1-2-3-4 CORE ASSESSMENT TELL YOU?


For each part of the core unit that is compromised, give your client one point. The higher their score out of four, the stronger the likelihood that they will have difficulty ‘switching their core on’ (you will generally find your clients who suffer from back pain will always have a score higher than 1). If this is the case, you will have to incorporate some low-level core retraining to establish a better brain connection to their LMS, and then carefully assess their ability to maintain optimal dynamic control as levels of work progress to medium and high.

Educating your client as to what can cause a core crash is a vital part of getting them to start thinking independently about their form and function. As they begin to understand what elements influence their core control, they will start to take more personal responsibility for their breathing, posture, daily habits, and overall body awareness.

Notice that some of the elements are long-term problems, deeply rooted in your client’s medical history, while others are acute conditions like having a high stress level, a gastric bug, or menstruating. With this in mind, it’s important to know your client’s medical history but also to keep checking in with their status on a session-by-session basis.

* You are encouraged to incorporate the 1-2-3-4 Core Assessment questions in your client evaluations. The concept and term 1-2-3-4 Core Assessment, however, is Anna-Louise’s intellectual property and must be attributed to the PERFECT PRACTICE™ Training System.

LIGAMENT LAXITY ASSESSMENT
 
A second valuable assessment tool is understanding your client’s genetic ligament laxity. Some people are born with looser collagen than others, making their ligaments more lax. Anna-Louise calls these people ‘Floppies’. People who are higher on the Floppy scale (also called hypermobile) have more difficulty controlling their optimal alignment. Think of them as having ‘cooked spaghetti syndrome’ – that is, an inability to hold themselves up against the forces of gravity. To determine whether your client is a Floppy, include these questions in your initial client assessment:

• Were you considered quite flexible as a child?
• Could you do the splits as a child?
• Could you do back bends?
• Have you ever been told you were double jointed?
• Do you tend to fidget a lot?
• Do your joints click a lot?

If your client answers yes to several of these questions, chances are they are a Floppy. You can also do a quick physical assessment by asking your client to touch their toes. Floppy clients (without pain issues) can generally fold themselves in half and quite comfortably place their palms on the ground. So, what do you learn from this and how is it relevant to core control?



Firstly, it’s important to understand that Floppies will always need a heavy emphasis on core control. They need to understand that it is their genetic predisposition that makes it difficult to maintain optimal alignment, and hence they need a strong brain/body connection. They need to be taught how to establish this connection through their breathing and their postural awareness which, in time, becomes the foundation of all their movement patterns.

Floppies get into trouble when they compensate for their laxity through stiffening and tightening their global, or outer, muscles. As these muscles are not designed to work all the time, when overused they eventually become fatigued and begin to spasm, leading to back and neck pain. Floppies who have this compensation pattern will tell you that they are always tight and feel the need to stretch – a sure sign that the balance between their LMS and GMS has gone askew. When exercising, Floppies will tend to use their GMS as a ‘first line of defence’, stiffening and tightening to achieve optimal alignment at all levels of challenge, rather than being able to differentiate the body’s requirements for a task.

It is important to understand that Floppy clients should only be stretched strategically, in the areas that have become chronically tight. Over-stretching your Floppy clients can actually destabilise them. In contrast, clients who are genetically more stiff will need more stretching to help them find better range and hence, better performance.

So, there you have two VERBAL ways of assessing your clients that will give you excellent benchmarks as to their need to work on core control. In a future article, we will look at the PHYSICAL ways of assessing and retraining low, medium and high level core control.

Lisa Champion, MSc and Anna-Louise Bouvier, BAppSc (Physio)
Lisa is an exercise therapist who specialises in helping clients maximise their movement potential and minimise their risk through innovative training. Anna-Louise is a physiotherapist whose practice, Physiocise, teaches over 750 clients a week how to fix their backs through exercise and posture education. Together they are the co-creators of the PERFECT PRACTICE™ training system.


NETWORK • SPRING 2008 • PP52-54