Monday Medical: For a safer ski season, stabilize your core
November 20, 2017
This winter, while you're pulling out your ski boots or waxing up your board, consider giving some extra attention to your core.
The core includes the muscles between your shoulders and hips, while the deep core consists of the muscles of your midsection. The diaphragm, which is the muscle under your lungs that allows you to breathe, is the roof of your deep core, while your pelvic floor is the basement.
"A stable core helps reduce your potential for injury and optimize performance," said Dave Grinnell, a physical therapist and board certified clinical specialist in orthopaedics with UCHealth SportsMed Clinic.
When talking about the core, Grinnell shies away from the idea of core strength, since much more is involved than simply strength: muscles have to work together to create stability and spinal mobility.
"It's hard to objectify core strength, because it's going to be so different from person to person, and how they stabilize their spine," Grinnell said. "It's all about learning how to control your spine."
A stabilized core is critical to physical health. Fundamentally, it protects your spinal cord, which is the main information highway by which the brain communicates with the rest of the body.
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Instability in the spine can result in back pain, nerve injury, nerve impingement and other injuries. Other parts of the body, such as the hips, will try to make up for any core instability and can then be compromised as well.
And with a stable core, you can do most activities – from skiing and snowboarding, to playing baseball or soccer – more efficiently. "The more stable you are with your spine, the more able you are to transfer energy efficiently to your arm or leg," Grinnell said.
Grinnell points out that it's not just about stability: The spine must also be mobile.
"The spine needs to be stable, but also mobile at the same time; it has to perform on both ends of the spectrum," Grinnell said.
"If you come into PT, one of the first things we're going to work on is your mobility. If you're not mobile, all you're doing with strength work is reinforcing immobility and likely compensatory movement patterns. The core learns to stabilize in positions in which you train in."
Once you've regained mobility and want to improve stability, don't just start with the old-fashioned sit-up, which can rely on hip flexors more than core muscles. Rather, many true core-stabilizing exercises are very subtle.
"For a lot of these simple core activation exercises, you're not going to feel a tremendous muscular burn," Grinnell said. "You're laying the groundwork for motor learning — how to control your spine."
That can lead to some initial frustration for patients. "People don't feel it and will sometimes say, 'I don't know what I'm doing,'" Grinnell said. "You're trying to find that inner core."
It doesn't help that injury and surgery can change and delay how deeper core muscles fire. Through physical therapy, neuromuscular retraining is a must.
Exercises that people can try at home include planks and pushups, if you're able to tolerate them. Pilates and yoga can help, when done correctly. Dynamic stretches such as cat and camel are unloaded spinal mobility exercises. And don't forget a few squats and lunges for leg strength and endurance.
"The core needs to be able to stabilize in all positions, whether you're bending down to tie your shoe, pick up your young child, shovel snow or enjoy our champagne powder," Grinnell said.
And remember, practice is a powerful tool.
"If you do it enough times, you develop that motor memory," Grinnell said. "It's like practicing piano; you get better with repetition."
Susan Cunningham writes for UCHealth Yampa Valley Medical Center. She can be reached at firstname.lastname@example.org.