The transversus abdominis, pelvic floor, deep lumbar multifidi, and diaphragm muscles form our deep muscle system, known by many as the inner core. For more information on these muscles, please refer to my blog post, “The Deep Muscle System (“Inner Core”). The transversus abdominis, pelvic floor, and deep lumbar multifidi muscles have been found in research studies to stabilize our spine before movement of the legs and arms occur. However, their activation is often delayed or absent and the muscles may contract too much or too little. They may also fail to work together as they should. If these co-contraction patterns aren’t corrected, they may lead to degeneration of the underlying joints due to loss of stability and control of motion. The activation patterns of these muscles generally won’t change without guidance from a trained professional such as a physical therapist.
Pain, fear of pain, trauma, surgery, childbirth, and poor awareness of our deep muscle system may disrupt our ability to optimally contract these muscles at the appropriate time or with the proper amount of force (“amplitude”) needed for movement. This is known as “motor control” and involves the connection between our brain and muscles. If muscles aren’t receiving the correct messages from our brain, then their activation patterns and ability to strengthen will most likely be compromised.
Before strengthening inner core muscles that demonstrate poor motor control, they need to be trained to turn on at the proper time during movement. Diane Lee and Linda Joy (LJ) Lee, prominent Canadian physiotherapists and international educators on lumbopelvic-hip dysfunction and inner core muscle performance, advocate a three-step process in restoring optimal recruitment and timing of these muscles. Step one involves training muscles to contract in isolation, often through the use of imagery, since a muscle that is inhibited or not optimally activated can’t be properly strengthened. Being able to isolate each of the inner core muscles allows us to be able to co-activate that muscle along with the other inner core muscles at rest and with breathing, which is the goal of step two. Diane and LJ’s final step is to learn to contract the inner core muscles together at the right time and with the appropriate amplitude so that they can provide stability of the lumbopelvic and hip regions with progressive strengthening exercises and functional activities.
Having incorporated Diane and LJ's inner core training program into my patient care for years, I've observed many patients with impaired ability to recruit these muscles respond very favorably to training and move on to the final two steps. For further information on the specifics of their program, I recommend you read the training material on Diane's website. She describes their training program by individual muscle, offering several different cues to help patients activate the muscles in isolation and then together with the other inner core muscles.
Before commencing this type of training program for the deep muscle system, please consult your physical therapist to ensure that it is appropriate for you.
References:
Lee D 2011 "The Pelvic Girdle, An Integration of Clinical Expertise and Research," Churchill Livingstone, Elsevier, Edinburgh
Course Notes: "The Thorax: Connect the Whole Body & Optimize Performance with ConnectTherapy and The Thoracic Ring Approach." LJ Lee, PT.
Course Notes: "The Sports Pelvis & Hip: Recurrent Groin and Hamstring Problems – Find the Driver & Treat the Whole Person with ConnectTherapy." LJ Lee, PT.
