In my daily practice as a Physical Therapist, I spend considerable time teaching patients “inner core exercises”. In this article, I hope to share this concept with you. If you haven’t read my two prior core articles, it may be helpful to review them before reading this entry. They cover key concepts including the components and function of the inner vs outer core and why it is important to specifically rehabilitate the inner core after a back injury.
Let’s start with the pelvic floor. First, lie comfortably either on your back or side with knees bent. Relax and take a deep breath allowing your stomach to rise and fall. Then try to use one of the following cues to engage your pelvic floor. Try to maintain the gentle contraction or image for 10 seconds while you continue to breath normally and stay relaxed with your outside/external core muscles. Repeat this 5-10 times each session.
Now let’s move onto your multifidus. Repeat the process above but with alternate imagery:
To engage your Transversus Abdominis, try one of the following:
Once you feel more confident with the basic activation exercises above, it’s time to challenge your spine control while you engage your inner core. During the exercises listed below, try to maintain your gentle inner core contraction and do not hold your breath or over tighten your outside core muscles. Be sure your pelvis and spine remains stable throughout. If you are unable to control the movement as described or if you experience any back pain, be sure to stop the exercise. Lie on your back with your knees bent and try the following:
An important component of spine rehabilitation is to begin integrating your inner core activation into normal every day activities. While you are standing, waking, sitting, etc, try to engage your inner core muscles. This helps to retrain the brain to start using the inner core system as you function throughout the day which is its normal pattern.
These exercises are very different than traditional exercises. I frequently need to remind patients that they are activating a coordination and control system, not a power and strength system. The exercises are gentle and very subtle. It often takes time to appreciate the minimal amount of physical effort required and the significant mental focus to perform the program correctly. Hopefully this provides a starting point for you to begin to rehabilitate your inner core. If you feel that you need individual training for your core system, I strongly encourage you to contact a local Physical Therapist for assistance.
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