What is the core and how do you know if you’re using yours properly?
When you think of the “core,” what exactly comes to mind? a 6 pack? Weakness? Crunches? Internal organs?
The biggest confusion we see as Physical Therapists with “the core” and how to strengthen it, is that we usually only talk about this group of muscles as ONE thing; when in fact, there are TWO important groups. There is actually an inner AND an outer core. Who knew?
There are 2 “cores”: the INNER, and the OUTER, and they need to work TOGETHER. Inner = stability. Outer = mobility.
The inner core is the deepest, so you can’t actually see it. This is the “STABILIZER” group and consists of your diaphragm on the top, transversus abdominis (wrapping like a corset), pelvic floor on the bottom, and multifidus (deep spinal muscles) in the back. They all should work together to create stability for our trunk and regulate pressure. Pressure is created and changed in a variety of ways: breath, muscle contraction, posture, tension, etc. Poorly regulated pressure can lead to leaks, pain, prolapse, even hernia or DRA.
The outer core, is what we generally think of with exercise, it is what we can see, and most commonly talked about. This is our “MOVER” group because it literally moves the spine, pelvis and ribs. Many influencers and exercise “specialists” only mention the outer and how it needs to constantly ENGAGE, ENGAGE, ENGAGE. Anyone who encourages only more, hard, constant contractions does NOT understand how these muscles work (regardless of how they look).
Advice from a Pelvic Physical Therapist:
No part of the body is designed to constantly contract/clench. Yes, there is a difference between “contracting” and “clenching”. Stop “sucking in” your stomach trying to make it stronger or flatter, regardless of who told you to do this. You are only messing with your pressures and not allowing the full range of motion that the muscles NEED to have full and true strength.
“Sucking in your stomach all day will not make your abs any stronger than squeezing your hand in a fist all day gives you a stronger hand. It actually makes you WEAKER, stiff/painful, and you can’t use it properly. Please stop it, even if it makes the belly feels soft, it’s supposed to, just like the rest of the body.” – Dr. Schwalbe, DPT
Combining BOTH inner and outer cores in a coordinated way manages of our pressures.
It is important to support the spine, pelvic organs, maintain proper posture, and move well through the spine and ribs. Whether you’ve never learned how, had an injury or a baby, skilled Pelvic Physical Therapy can teach you how to coordinate and balance these groups to work effectively together. While there are 2 parts, they always work together, having different jobs.
How to get started?
The easiest and most effective way to engage your core is by activating and coordinating it with the breath. When you inhale, your diaphragm drops as your lungs expand. So does the belly, and the pelvic floor is supposed to move. If you try to contract, or tighten the other muscles on inhale, they’re going to be fighting against the downward pressure. Conversely, when you exhale, the diaphragm lifts up as the lungs empty, giving the other core muscles more space to engage. If you’re not sure if you know how to do that, come see us! This coordination is foundational when it comes to core strengthening and, just as importantly, relaxation.
Inhale – relax and lengthen
Exhale – recoil or draw in (contract)
On exhale, the amount of contraction can vary from simply gently recoiling from the lengthening, to fully and intentionally engaging to stabilize spine and increase activation of the outer core. The amount depends on what you are doing and how much support and stability you need. Not sure what you need? Again, that’s what we can show you!
Imbalances, such as incoordination, too much contraction, too much relaxation, can lead to problems. These include pain, leaks, abdominal separation, pelvic organ prolapse, decreased spinal motion, and overall core weakness.
Pee your pants, have prolapse, diastasis recti?. Those are all pressure problems.
Maybe you’re not really WEAK?
Many people blame weakness alone, thinking “if I just get stronger”, only to never really feel stronger because the critical parts of coordination and motion are not addressed.
Reasons you may feel weak abs:
- Muscles have been lengthened (after a baby) and need time to heal
- lack of coordination – poor timing and activation patterns
- improper posturing
- lack of range of motion (especially the spine)
- too tight (you can’t contract what’s already contracted)
- other muscles are overly dominant
- you’ve never been taught or felt what an inner core is supposed to feel like
The core has contents
The core is not empty; it is filled with internal organs, which can affect its ability to function. The internal organs are surrounded by connective tissue called fascia. Fascia around organs specifically, is called viscera. This fascia is contractile, meaning it can tighten and loosen similar to muscles. So if that visceral or regular fascia is too tight, it can inappropriately pull on any part of the core or other organs, limiting its range of motion (or cause pain) and therefore limit function. As pelvic floor Physical Therapists, we have extensive specialized training on how to mobilize the visceral fascia, which can significantly influence your core. If you’ve had surgery, inflammatory conditions like endometriosis or PCOS, had a baby, or others, you may be having issues related to your fascia.
“What if I do pee my pants (or have the other things you mentioned)?”
No big deal right?
NO. Even a little bit is a big deal because it can signal a much deeper problem. Since the core is the foundation for almost every movement, in addition to supporting out organs, even small symptoms can indicate something isn’t working well at our very foundation. Don’t wait until it gets worse, or affects quality of life. Even worse, please don’t assume it’s normal or “just how you are”.
When you’re doing most exercises, your core should be engaged in some amount. This gives your trunk the stabilization it needs in order to do the movement safely. The pelvic floor muscles, one of the muscle groups of the core, surround the opening of the urethra, so they contract to prevent urination when it’s not the appropriate time. So if you’re leaking during an exercise, a key muscle group in the core is not engaging properly. Leaking can happen because the muscles are too weak or coordination is lacking so they may not be engaging properly at all, essentially pressure from above is greater than the force of the contraction of the pelvic floor from below. Either way, leaking is a sign that your core is not ready for that particular exercise. The rest of your body may be, but your pelvic floor is not. This doesn’t mean you can never do that exercise ever again, it just means we need to figure out why. If you’re leaking with exercise, feel pain or heaviness/pressure or have doming or tenting of the abdominal wall, please come in and see us so we can figure out what the cause is and take care of it!
What’s the best way to strengthen your core?
This is one of our most-asked questions.
Answer: It depends!
The best way is the way that is best for YOU! What can YOUR body control, coordinate, support? Where are YOU lacking strength and/or motion? We are all different. We have different bodies that each have a lifetime of unique experiences, activities, postures, and goals. Come to physical therapy and we can show you exactly what YOU need! We can assess the whole body to make sure the muscles of your core are able to contract properly. With that, your program is then designed specifically for you, your lifestyle, and your goals.