If the glutei's are inhibited or weak

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• If the glutei's are inhibited or weak
• Lateral pelvic stability reduced
• Femur adducts
• 29 muscles connected to each side of pelvisWork
  synergistically with entire kinetic
  chainMaintain center of gravity over base of
  support during dynamic movements
• gait cycle - loss of balance

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Muscle Fatigue

• Decreased ability to maintain dynamic muscle
  force
• Fatigue running
• Unable to stabilize core
• Shear forces and compressive forces in lumbar
  spine
• Hamstring strains

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Assessment of the Core

• Posture, ROM, control
• Alignment
• Single knee bend
• Forward flexion
• Seated knee extension
• Thomas test
• Prone knee bend
• Post glut medius

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Assessment of the Core

• Muscle imbalances
• Arthrokinematic deficits
• Core
• Strength
• Endurance
• Neuromuscular control
• Power
• Overall function of lower extremity kinetic chain

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Straight-Leg Lowering Test for Core Strength

• Supine w/ knees in extension
• BP cuff placed under lumbar spine (L4-L5)
  raised to 40 mmHg
• With knees extended, ? hips to 90
• Performs drawing in maneuver (belly button to
  spine) then flattens back maximally into the
  table BP cuff
• Lower legs to table while maintaining flat back
• Hip angle is measured with goniometer

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Abdominal Neuromuscular Control Test

• Supine w/ knees hips in 90 ?
• BP cuff placed under lumbar spine (L4-L5)
  raised to 40 mmHg
• Performs drawing in maneuver (belly button to
  spine)
• Lower legs until pressure decreases
• Assesses lumbar spine moving into extension
  (ability of lower abs wall to preferentially
  stabilize the lumbo-pelvic-hip complex)
• Hip flexors begin to work as stabilizers
• Increases anterior shear forces compressive
  forces at L4-L5
• Inhibits transversus abdominis, internal oblique
  multifidus

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Core Muscular Endurance Power

• Endurance
• Erector spinae performance
• Prone with hands behind head spine extended 30º
• Measure ability to sustain position with
  goniometer
• Utilize axilla and table for frame of reference
• Hold maintain as long as they can
• Power
• Backwards, overhead medicine ball jump throw
• Assessment of total body power production

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• Lower extremity functional profiles
• Isokinetic tests
• Balance tests
• Jump tests
• Power tests
• Sports specific functional tests
• Kinetic chain assessment must assess all areas of
  potential deficiency

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Guidelines for Core Stabilization Training

• Perform comprehensive evaluation
• Muscles imbalances, myokinematic deficits,
  arthrokinematic deficits, core strength/
  neuromuscular control/power, overall kinetic
  chain function
• Muscle imbalances arthrokinematic deficits must
  be corrected prior to initiating aggressive
  training
• Program Requirements
• Systematic
• Progressive
• Functional

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Specific Guidelines Exercise Selection

• Proprioceptively rich program
• Safe
• Challenging
• Stress multiple planes
• Incorporate multi-sensory environment
• Activity specific
• Progressive functional continuum
• Slow to fast
• Simple to complex
• Known to unknown
• Low force to high force
• Eyes open to eyes closed
• Static to dynamic

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Rules of Stability Training

• Differentiate hypermobility, instability,
  normal movement and hypomobility
• Safe
• Must be challenging/multisensory
• Progressive several stages
• Offer variety
• All planes of motion
• Integration into functional activity
• Make it fun not bore stability!

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• Emphasize muscle contraction spectrum
• Concentric (force production)
• Eccentric (force reduction)
• Isometric (dynamic stabilization)
• Begin program in most challenging environment
  that can be controlled
• Must be challenging with progression through
  function continuum
• Program Variation
• Plane of motion
• Range of motion
• Loading (physioball, med. ball, body blade,
  weight vest, tubing)
• Body position
• Amount of control speed
• Feedback
• Duration and frequency (sets, reps, time under
  tension)

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• Goal of program - develop optimal levels of
  functional strength stabilization
• Focus on neural adaptations instead of absolute
  strength gains
• Increase proprioceptive demands
• Quality not quantity
• Poor technique and neuromuscular control results
  in poor motor patterns stabilization
• Focus on function

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Questions to Ask Yourself

• Is it dynamic?
• Is it multiplanar?
• Is it multidimensional?
• Is it proprioceptively enriched?
• Is it systematic?
• Is it progressive?
• Is it activity-specific?
• Is it based on functional anatomy science?

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Progression and Variety

• Floor work Static
• Floor work Dynamic

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• Swiss ball Static
• Swiss ball Dynamic

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• Cables
• Medicine Balls, dumbells
• Open and closed chain, speed
• Standing, kneeling, lying, one leg etc

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Progression of training

• progress from slow to fast
• simple to complex
• known to unknown
• low force to high force
• static to dynamic

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Breathing

• Correct inspiration underrated and critical for
  stability
• Allows the diaphragm help stabilise trunk
• Increased intra-abdo pressure
• Helps to activate Trans Abs (modulates with
  respn)
• Inhibits use of external obliques
• Helps maintain thorax posture
• Increases breathing efficiency and performance

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Core Stabilization Training Program

• Level I Stabilization

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Level II Stabilization and Strength
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Level II Stabilization and Strength
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Level III Integrated Stabilization Strength
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Level IV Explosive Stabilization
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De-stabilising the training environmentChallen
ges the neuro muscular systemImproves
proprioceptionimproves equilibrium /
co-ordinationImproves functional
skillGreater sporting performance.
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Swiss Ball

• Optimal dynamic stabilisation at right joint,
  right time, right plane of movement
• With any movement all three planes are working
  together concurrently
• Producing force in one plane whilst stabilising
  or controlling in other 2 planes eccentrically

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Benefits

• Proprioception
• Postural re-education
• Improves balance / co-ordination
• Challenges the CNS - improve joint stability and
  sports performance