alicia canzanese, dpm, atc important is core... · 2018-08-03 · “core stability is the ability...
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Alicia Canzanese, DPM, ATC
The National-Washington DC-2018
Track 2-Biomechanics
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Short answer: Yes, it is quite important
Functional anatomy
Kinetic chain
Injury specific applications
Treatment and prevention
Evaluation tools and techniques
Evidence Based Medicine
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(Kibler, Press
and Sciascia
2006)
Hip Stability
Abd and Adductors
Glutes
Hip Flexors
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“The ability to control the position and motion of the trunk over the pelvis and leg to allow optimum production, transfer and control of force and motion to the terminal segment in integrated kinetic chain activities.” –Wilkerson, et al.
“Core Stability is the ability of the lumbopelvic-hip complex to prevent buckling and to return to equilibrium after perturbation”–Wilson et al.
Purpose: maintain integrity of the spinal column, alignment of the pelvis, and to provide a stable base for movement of the extremities
Primarily maintained by dynamic muscle function
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Important in any sport/activity that involves walking/running
Internal Corkscrew
Rotational or translations abnormalities in any segment effect the entire chain
Bottom can effect the top
Top Can effect the bottom
“Impaired proximal function increased the likelihood of uncontrolled joint displacements or unsolicited accessory movements throughout the lower kinetic chain” – Ridder et al
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EMG studies show us that the core and hip muscles activation is coordinated with lower extremity muscle activation
Multisegmental coordination
Bobbert et al evaluated jumping activities and showed that knee extension and ankle plantar flexion were strongly related to the rise time of the gluteus medius
The multifidus and transverse abdominus muscles have been shown to be activated before any lower extremity movements occur -Hodges et al
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ITB “runners knee”
PFPS
ACL Injures
Medial Tibial Stress syndrome (MTSS)
Chronic Ankle Instability (CAI)
Acute ankle injuries
Tendinopathy Peroneal
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Ipsilateral hip abductors weakness after inversion ankle Sprain
Friel et al. Journal of Athletic Training. 2006
Following Chronic Ankle Sprains
Ipsilateral Hip Ext and Hip ABD weakness
Initially after acute injuries altered hip muscle recruitment
McGuine et al. reported that high school basketball players who sustained acute ankle instability events, demonstrated considerably greater postural sway
Doherty et al in 2016 showed that those who developed CAI had impaired proximal hip function to those who recovered from their ankle injury
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Hamstra-Wright et al. BJSM- 2015
Meta-analysis of risk factors for MTSS
Of the 100+ risk factors noted only 9 were included in the study
Those which showed strong correlation
BMI
Navicular Drop
Ankle PF ROM
Hip External Rotation ROM
Study investigating male military recruits
Decreased hip IR was a risk factor for MTSS
Excessive ER of hip had increased incidence of tibial stress fractures
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Very clinically relevant for overuse knee injuries
Clin J Sport Med in 2004/2005
Runners with Lower extremity injures demonstrated significantly weaker hip ABD and ER
Novice runners
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Stance Exam
Hip Level
Lumbar Lordosis
Trendelenburg sign
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Hip Excursion/Pelvic Level
Arm Swing
Cross Over
N=3-6cm from midline
Causes
Poor Core stability
Weak Hip ABD
STJ Pron leading to pelvic tilt
LLD
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Natural Excursion during gait
Look for excess or asymmetry
Increased movement with increased running speeds
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“Injury-induced neural inhibition of muscle function can produce subtle and persistent performance deficiencies”-Wilkerson et al
Core and Hip Stability should be included in their rehab program
Especially in Ankle sprain
Knowing your Physical therapist/Athletic Trainer
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“A growing body of scientific evidence suggests that clinical tests of core strength and stability can help predict risk of lower extremity injury in athletes”
Debate over what those factors are specifically
EBM: Wilkerson et al, Journal of Athletic Training 2015 3 year prospective study of Division I football players
Preseason screening and injury occurrence
Strong predictors of core and lower extremity
sprains and strains
High exposure to game conditions
Low back dysfunction (even if mild)
Poor endurance of core musculature
Trunk flexion hold
Wall sit
DeRidder et al. AJSM 2017 3 year prospective youth soccer players
Hip extension muscle strength as an
independent and modifiable risk factor for ankle
sprains
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YES! Core Stability is Important
Core Stability involves more than just the 6-pack Muscle of the entire abdomen, back, pelvis, gluts, hips
Proper Core and Hip Function is important to the entire kinetic chain
Proximal instability/weakness/poor neuromuscular control is in important factor in the prevention, treatment, and rehabilitation of lower extremity injuries More research is needed in terms of Cause and Effect
Core/Hip intervention should be included in your treatment protocol for ankle sprains, Chronic ankle instability, and MTSS Make sure you PTs and ATCs are addressing
There is a growing body of evidence in the sports medicine literature to support the importance of core stability in lower extremity function and really all gross motor activity
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Slide 3: http://advantagestrength.com/what-is-core-stability/
Slide 4: https://www.sixpackfactory.com/six-pack-abs-shortcuts/ https://www.physio-
pedia.com/The_effectiveness_of_core_stability_exercise_with_regards_to_general_exercise_in_the_management_of_chronic_non_specific_low_back_pain
https://cor-kinetic.com/core-stability-does-it-work-for-lbp-a-look-at-the-evidence/
https://en.wikipedia.org/wiki/Muscles_of_the_hip
https://www.lyzabethlopez.com/glute-activation-exercises/
Slide 6: http://athleticlab.com/importance-lumbopelvic-hip-complex-1/kinetic-chain/
Slide 7: https://www.rchsd.org/documents/2014/02/rehabilitation-for-hip-pathologies.pdf
Slide 8: http://www.suseagulls.com/sports/mlax/2007-08/news/seasonpreview
Slide 9: https://www.youcoach.it/en-au/articolo/ankle-sprains
Slide 10: https://www.myfootdr.com.au/2017/06/dont-let-shin-splints-cut-your-netball-season-short/
Slide 11: https://www.youtube.com/watch?v=-6Ksus4QfE4 https://www.bebeautiful.in/lifestyle/health-and-fitness/5-exercises-to-help-tone-your-butt
Slide 12: http://epomedicine.com/clinical-medicine/trendelenburg-test-or-sign/ http://www.joannasoh.com/fitness/knowledge/workout-to-improve-bad-posture
Slide 13, 14: Ray Feehery, DPM
Slide 15: http://www.graychiropractic.ca/testing-you-core-part-3/ http://thorsenchiropractic.com/health-rx/exercise-rx/low-back-exercises/strength---stability-for-low-back.html
http://docsportsmed.com/exercises/low-back/lumbar-extensor-strengthening/
https://www.outsideonline.com/2176286/15-minute-bodyweight-workout-every-outdoor-athlete-needs-their-training-routine
Slide 17: https://www.youtube.com/watch?v=dKYXfbBQfLE
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Wilkerson, et al. A refined prediction model for care and lower extremity sprains and strains among collegiate football players. Journal of Athletic Training. 2015;50(6):643-650.
Snyder et at. Core stability and lower extremity injury risk. http://lermagazine.com/article/core-stability-and-lower-extremity-injury-risk. Sept 2013.
Hamstra-Wright et al. “Risk factors for medial tibial stress syndrome in Physically active individuals such as runners and military personnel: a systematic review and meta-analysis.” British Journal of Sports Medicine. 2015;49:362-369.
DeRidder et al. “Hip strength as an intrinsic risk factor for lateral ankle sprains in youth sports.” American Journal of Sports Medicine. 2017;45(2):410-416.
Schmitz et al. “Do novice runers have weak hips and bad running form?” Gait Posture. 2014;40(1):82-86.
Blaiser et al. “Is core stability a risk factor for lower extremity injuries in an athletic population? A systematic review.” Physical Therapy in Sport. 2018;30:48-56
Leetum et al. “Core stability measures as risk factors for lower extremity injury in athletes” Med Sci Sports Exerc. 2004 Jun;36(6):926-34..
Mucha et al. Hip abductor strength and lower extremity running related injury in distance runners: A systematic review. J Sci Med Sport. 2017 Apr;20(4):349-355. Epub 2016 Sep 20.
Garnock et al. Predicting individual risk for medial tibial stress syndrome in navy recruits. J Sci Med Sport. 2018 Jun;21(6):586-590. doi: 10.1016/j.jsams.2017.10.020. Epub 2017 Oct 23.
Steinberg et al. The relationship of hip muscle performance to leg, ankle and foot injuries: a systematic review. Phys Sportsmed. 2017 Feb;45(1):49-63.