Raphael Brandon introduces a three-part trunk strengthening regime that sustains challenge and beats boredom.
Therapists prescribe core stability exercises to patients suffering from a variety of injuries, especially those involving the back, groin, hamstrings and knee. But within the repertoire of ‘core stability’ there is a large range of exercises, the suitability of which will vary according to the injury and therapeutic needs of each individual client. There are three major groups:
- those focusing on the recruitment of the small deep-lying stabilising muscles, transversus abdominis and multifidus, often taken from clinical Pilates
- static bodyweight exercises focusing on developing stability and/or strength endurance in certain postures, and requiring co-contraction of the small stabiliser and larger mobiliser muscles, such as the popular ‘plank’ exercise
- traditional dynamic strength exercises for the prime movers of the trunk, often performed on the floor or Swiss ball.
Different therapists will make their exercise prescription choices in line with their clinical preferences, but commonly patients will start with the recruitment orientated exercises and progress to strength work once stability has been achieved and symptoms are progressing.
Sports medics, physiotherapists and strength and conditioning coaches also recommend that athletes perform regular core stability or trunk strength exercises to prevent injury. The rationale for prophylactic training is that increased recruitment of the stabiliser muscles and increased strength of the prime movers will carry over into better posture and more control, both in daily life and in sporting movements. Athletes tend to have a list of three to five ‘core stability’ exercises targeting various muscles or positions that they are required to perform regularly each week.
Whilst this prehabilative strategy is well intentioned, it has two limitations. The first is behavioural. Core stability exercises can quite quickly become ‘bore stability’! It takes self-discipline to do 20-30 minutes of the same exercises three or more times a week over a long period. As a consequence, adherence to the preventive programme can be an issue. The second limitation is physiological. The principles of specificity and progression apply to core work in the same way as they do to any other body training. In my experience it is quite common for an athlete to perform the same core routine over a long period and get very good at four or five movements or ‘holds’. But teach the same athlete a new core exercise and they will find it difficult, simply because it’s a new stimulus. The message is that progression and variety are key to optimising benefits of a strengthening programme.
The scheme of ‘core training menus’, presented below and in forthcoming issues of Sports Injury Bulletin, aims to overcome the problems of non-compliance and lack of challenge, and provide a system where an athlete can follow a prophylactic or rehabilitative core stability and strengthening programme using a wide variety of movements to maximise adaptations and muscle groups trained.
It is designed for athletes who have developed basic transversus recruitment skills and are familiar with a number of core exercises. The scheme offers a challenging programme, which covers all the trunk and pelvic muscles and runs from basic recruitment to very advanced strength movements.
The training system contains 10 exercise menus, each menu using a single piece of training apparatus. A menu contains four to eight exercises, which between them target most trunk and pelvic muscles. Some of the exercises involve resistance, some bodyweight, some are simply about recruitment.
Within the menu, the difficulty of exercises varies, and some menus are very advanced (and therefore not within the competence of all athletes). Coaches, therapists and athletes should set the number of sets and repetitions for each exercise according to the usual principles.
The therapist or coach should select the most relevant menus, which the athlete should use in rotation. Thus, if the athlete is using eight menus and doing four units of core training per week, over the course of a fortnight they will perform each menu once. This will ensure that the athlete works all the muscles in a variety of ways, using different pieces of equipment.
Menu 1: Floor, static
The aim of this menu is to develop a basic level of lumbar and pelvic stability working front, rear and side muscles of the trunk. It can also be used as a maintenance dose of training for intermediate to advanced level athletes
Overview A common exercise that requires good abdominal strength and co-contraction of the abdominal wall musculature to hold the lumbar spine and pelvis in correct alignment
Abdominal wall (TvA/internal obliques)
Technique Hold a straight body position, supported on elbows and toes. Brace the abs, and set the low back in the neutral position, once you are up. Sometimes this requires a pelvic tilt to find the right position. The aim is to hold this position, keeping the upper spine extended, for an increasing length of time up to a maximum of 60 secs. Perform two to three sets. Keep shoulders back and chest out, while maintaining the neutral lumbar position. This makes the exercise considerably more challenging
Progression Lift one leg just off the floor; hold the position without tilting at the pelvis
The side plank
Overview Recommended by McGill (1) as a safe and effective exercise for the obliques and quadratus lumborum (a key lumbar stabilising muscle). Recent research from Behm et al (2) also shows this to be an excellent exercise for the lower abdominal muscles
Obliques (internal and external)
Technique Lie on one side, ensuring the top hip is ‘stacked’ above the bottom hip. Push up until there is a straight bodyline through feet, hips and head. Hold the position, increasing the length of hold up to a maximum of 60 secs. Perform two to three sets. Keep the elbow under the shoulder to avoid upper body strain. Lower under control and repeat on opposite side
Progression Raise the top leg in the air and hold it in the abducted position
The side plank
The gluteal bridge
Overview Research from Konrad et al (3) suggests this is more a low back than gluteal exercise. However, it is a good way to teach athletes to recruit the gluteals in the ‘inner range’ position
Technique Lie on the floor with your knees bent. Squeeze your gluteals and then push your hips up until there is a straight line through knee and hip to upper body. Shoulders remain on the floor. Beware of raising too high or of flaring the ribs, which pushes the back into hyperextension. Hold the position. Start with five sets of 10 secs progressing to two to three sets of 60 secs
Progression Extend one leg carefully ahead of you and hold the position without dropping or tilting the pelvis
The gluteal bridge
‘Birddog’ or ‘Superman’
Overview Also recommended by McGill as a safe and effective exercise for the lumbar and thoracic portions of the erector spinae muscle. This exercise also requires co-contraction of the abdominal wall muscles to stabilise the pelvis
Thoracic and lumbar portions of erector spinae
Technique Start with hands below shoulders and knees below hips. Set your low back into neutral and brace your abs slightly. Slowly slide back one leg and slide forward the opposite arm. Ensure that the back does not slip into extension, and that the shoulders and pelvis do not tilt sideways. Hold, increasing the duration up to a maximum of 20 secs. Slowly bring your leg and arm back and swap sides. Perform sets of 5-10, alternating sides after each hold
‘Birddog’ or ‘Superman’
Menu 2: Floor, dynamic
To develop a good level of strength endurance in the major trunk muscles. Overall the level of these exercises is intermediate to advanced
Active straight-leg raise
Overview Requires a strong static contraction of the abdominals to stabilise the lumbar spine against the load of the legs. It also requires good active range of motion of the hamstrings
Technique Lie on your back with knees bent. Set your lumbar spine in neutral and brace the abs. Lift one leg up straight in the air, ensure your back does not move. Lift the other leg up, again keeping your back in place. (If the back cannot be stabilised during this movement, the exercise is too advanced and more static transversus stability control work will be needed first.)
Keeping one leg in the air, slowly lower the other down to the floor. Only go as far as you can until you feel the lumbar spine start to move. Placing your fingers under your back will help you to gauge when this happens. Keep bracing the abs and then lift the leg slowly back up. Repeat with the other leg. Perform sets of 5-10 reps, alternating legs
Progression Lower and raise both legs together
Overview A good exercise for both the obliques and the abdominals
Technique Lie on your back with right ankle resting on left knee. Right arm is placed on the floor out to the side. Keeping the right shoulder down, curl the left shoulder up to the right knee. Crunch at the top and return slowly, under control. Perform sets of 15-30 reps on each side in turn. Avoid ‘head nodding’ during the movement: keep head off the floor and look forward throughout
Progression Hold a dumbbell in the hand by your head. Keep arm still so you are forced to raise the dumbbell using your abs and not your arm
Side-lying hip abduction
Overview This is an isolation exercise for gluteus medius. Strength in this muscle group has been shown to be useful in preventing lower-limb injuries in female athletes (Leetun et al (4))
Technique Lie on your side and set pelvis so your top hip is stacked above lower hip. Roll shoulders forward a little and brace the abs to control pelvic position. Lift the top leg slowly up and down, without hitching at the hip. Perform sets of 20-30 reps, each side in turn
Progression Weight the top leg with an ankle weight or tie a resistance band between your ankles and pull the band apart as you lift the leg
Side-lying hip abduction
Lying windscreen wipers
Overview An advanced active mobility exercise working the obliques and trunk rotation
Technique Lie on your back with arms out to the sides. Lift legs straight up in the air until the hip is at 90 degrees. Set the lumbar spine in neutral and aim to keep it set throughout. Keeping legs straight and maintaining hip angle, move the legs to one side, controlling any movement in the trunk. Go as far as you can in control, keeping your upper back and shoulders on the floor. Bring the legs to a halt, pull them back up to the start position and then over to the other side, under control. The slow side-to-side movement is like a ‘windscreen wiper’ arc
In parts 2 and 3:
Menu 3: Swiss ball, static
Menu 4: Swiss ball, dynamic
Menu 5: Pulley machine, kneeling
Menus 6: Pulley machine, standing.
Raphael Brandon MSc is a sports conditioning and fitness specialist, working as the London region strength and conditioning coach for the English Institute of Sport
Illustrations by Viv Mullett
- McGill S (2002) Low Back Disorders. Human Kinetics
- Behm DG et al (2005) Journal of Strength and Conditioning Research 19(1):193-201
- Konrad P et al (2001) Journal of Athletic Training 36(2):109-118
- Leetun DT et al (2004) Medicine and Science in Sport and Exercise 36(6):926-934