What Exactly is a Healthy Core?


The core I am referring to is the DEEP CORE muscles. These four muscles act in synergy, or together, in order to provide a specific function. When these muscles do not work together or one of them is not working, compensations develop that can lead to pain and dysfunction.

I like to compare the four deep core muscles to a horse carriage being pulled by four horses. If one horse becomes unable to carry the load, the other three have to work harder. And since the horse (or muscle) is not strong enough to pull the load, other horses (or muscles) are required to help pull the load. The other horses are the muscles that contribute to the most problems, becoming tight and hypertonic and include the hamstrings, iliopsoas, piriformis, hip adductors (inner thigh/groin), obturator internus, rectus abdominus, pelvic floor, paraspinals and quadratus lumborum. Sound familiar? Most of us struggle with tightness in these muscles for the same reason: our core needs help!

In the presence of inflammation or dysfunction, muscle function is disrupted and compensations occur. This inhibition of motor control does not automatically improve once the pain or dysfunction has resolved. In order to retrain these muscles, it is crucial to first gain timing and sequencing of the deep core muscles, which is the foundation of all subsequent core strengthening exercises, including Pilates and more advanced core exercises. The deep core muscles include the transverse abdominus (deepest of the four abdominal muscles), diaphragm, pelvic floor and multifidus (small segmental back muscles). These muscles must be working optimally and be retrained first and folks, I am not talking about sit-ups or crunches (more in a later blog).

Many of us start with higher level exercises and never gain results since the basic core contraction is never learned and often a strength training program only reinforces a non-optimal pattern of muscle activation. For example, you cannot jump into an exercise class with seasoned and experienced individuals doing advanced exercises before you gain the proper core contraction. You cannot start running as your only exercise after having a baby or surgery. You cannot put the cart before the horse and skip the essential steps at regaining core control first.

Why are the deep CORE muscles so important? What is the FUNCTION of the CORE?

  • Stabilizes or holds together the pelvic organs, joints and spine including stabilization of the spine during movements of the upper and lower extremities (think Pilates).

  • Provides postural support to maintain normal spinal curvatures, much like the basement or foundation of a house.

  • Allows for proper lung expansion to help with endurance and sports performance.

  • Assists with good balance, along with the inner ear (vestibular system) and ligamentous support system within the ankle.

  • Promotes normal elimination of urine and stool - the pelvic floor has to be relaxed to assist with the reflexive contraction of the bowel and bladder.

  • Provides sphincteric action to keep in urine and stool.

  • Supports the internal pelvic organs and provides atmospheric pressure to retain the positions of the organs from the ill effects of gravity.

  • Promotes normal sexual function as the muscles have to be relaxed and supple for penetration and strong enough to keep blood flow in the clitoris for orgasm.

  • Promotes a piston action between the pelvic diaphragm (pelvic floor muscles) and respiratory diaphragm, as both diaphragms move up together and down together with each breath.

There are many problems related to weakness or motor control deficits of the deep core. Many of our patients come in with a diagnosis of one of these issues and find out they have quite a few others. Core motor control deficits can result in the following common conditions:

  • Back pain​

  • Sciatica (radiating pain down one leg)

  • Pelvic pain

  • Piriformis Syndrome

  • Sacroiliac (SI) dysfunction

  • Pelvic organ prolapse (POP): bladder, vagina, urethra or rectum

  • Urinary incontinence (involuntary loss of urine)

  • Fecal incontinence (involuntary loss of stool)

  • Urinary frequency, urgency or nighttime voiding (nocturia)

  • Constipation or difficulty eliminating stool

  • Hip pain or tightness

  • Knee pain

  • Menstrual or abdominal cramps

  • Abnormal breathing patterns

  • Poor posture

  • Painful penetration (dyspareunia)

  • Inability to achieve orgasm (anorgasmia)

  • Pelvic floor cramps or spasms

  • Pain with sitting

  • Pain with lying or sleeping

  • Inability to exercise

As a physical therapist, it makes sense to talk about the physical aspect of the CORE. However, I cannot speak about the CORE without referring to its translated Latin meaning, "HEART." The heart is the driving force behind all living beings. We cannot survive without it. It is essentially our soul and source of love and life. I also believe every woman is the core of her family. If a woman is happy, everyone around her is happy. If she is having problems, everyone around her potentially suffers. She is literally the pulse of the family. What this means is she has to be functioning on all four cylinders with all four horses (deep core muscles) working optimally and be healthy in mind, body and soul.

We have witnessed the transformation of so many individuals who initially walk in the door in so much pain and dysfunction, they have lost desire to do anything they enjoy. When the physical dimension comes into balance, it is like a light switch turns on and a person is able to find or live out their purpose. They return to exercise or social activities with confidence. They become the "best version of themselves". It is really a privilege to partner with each individual in this discovery of true health potential and authentic femininity.

I want to help you have a HEALTHY CORE as your therapist, coach and biggest cheerleader. Together we can accomplish so much!

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