When educating patients about their core, I find that most people think the term is synonymous with abdominals. However, several key muscles, not all of which are considered abs, contribute to core stability. We have four primary abdominal muscles, all with different functions. The rectus abdominus is probably the most well known abdominal as it is referred to as the “six pack” muscle. Deep to the rectus abdominus are the internal and external obliques. The rectus abdominus along with the obliques have the primary function of creating movement in the trunk. Conversely, the transversus abdominus is the deepest abdominal muscle and it’s primary action is not to move but to stabilize the lumbar spine, or to “control movement.” Along with the transversus abdominus, the other primary core stabilizer muscles are the multifidus and the pelvic floor muscles. These deep muscles have attachments to the lumbar spine and pelvis and they provide segmental stability to the region. Ideally, when we initiate a movement, for example reaching for an object overhead, our transversus abdominus and multifidus muscles activate prior to the more superficial abdominals. Recent research shows that individuals with low back pain have poor timing in the activation of these muscles, indicating less effective lumbopelvic stability. The importance of these stabilizer muscles is to control the forces we produce with our global muscles in order to reduce the risk of injury.
So if the primary function of the core is to stabilize the spine and lumbopelvic region, how do we effectively train these muscles? The first phase of core training is not strengthening but neuromuscular training to teach appropriate activation and timing of the correct muscles. This can be done under the guidance of a physical therapist. Eventually, progressing core stabilization exercises with movement of global musculature will encourage the core to do it’s job in functional situations such as golfing, skiing, or even getting in and out of the car. During this training period, patients are encouraged to consciously activate their core muscles while maintaining a neutral spine during daily activities until these muscle patterns become more habitual. The ultimate goal of proper core training is decreased risk of injury as well as improved function and physical performance.