Muscles of the Core-Lumbo-Pelvic-Hip Complex

1. Muscles of the Core-Lumbo-Pelvic-Hip Complex

2. Core Muscles • The term core refers to the Lumbo-Pelvic-Hip Complex (LPH) • It is the center of the body and the beginning point for movement • Comprised of about 29 muscles that attach to the spine and/or pelvis • Involves structures of the lumbar, thoracic, and cervical spine, the pelvic girdle and the hip joint.

3. Lumbo-Pelvic-Hip Complex • The lumbo-pelvic-hip complex (core) functions primarily to maintain dynamic postural control by keeping the center of gravity over our base of support during dynamic movements

4. Core Muscles • Abdominals (Deep to Superficial) • Transverse Abdominis • Internal and External Oblique • Rectus Abdominis • Spinal Muscles (Deep to Superficial) • Rotatores • Semispinalis • Mulitifidus • QuadratusLumborum • Erector Spinae • LatissimusDorsi

5. Core Muscles • Hip Extensors: Gluteus Maximus, Hamstrings • Hip Abductors: Gluteus Medius, Gluteus Minimus, Tensor Fascia Lata, Iliopsoas, and Sartorius • Hip flexors: Iliopsoas, Rectus Femoris, Tensor Fascia Lata and Pectineus • Hip Adductors: Gracilis, Adductor Magnus, Adductor Longus, Adductor Brevis, and Pectineus

7. Transverse Abdominis • The most important abdominal muscle • Contracted first before any other muscle

8. Transverse Abdominis • The deepest layer of abdominal muscles • It wraps around the trunk from front to back and from the ribs to the pelvis • The muscle fibers run horizontally, similar to a corset or a weight belt • It does not move the spine or pelvis O: Thoracolumbar Fascia, Iliac Crest, Costal Cartilages of Ribs #7-12 I: Linea Alba, Pubic Crest A: Facilitates forceful expiration of air from the lungs • Stabilizes the spine • Compression of abdominal contents

9. Integrated Function of Transverse Abdominis • Works synergistically with the internal oblique, multifidus, and erector spinae to stabilize the lumbo-pelvic-hip complex

10. Transverse Abdominis Exercises • Draw In (supine, quadruped, prone, seated, kneeling or standing) • Attempt to pull the bellybutton through the spine • Or imagine trying to zip up the world’s tightest pair of pants • Attempt each position for five reps held for five to 10 seconds

11. Internal and External Abdominal Oblique Muscles

12. Internal Abdominal Oblique • Deep to external oblique and lies just above transverse abdominis O: Inguinal Ligament, Iliac Crest, and ThoracolumbarAponeurosis I: Last three ribs (10-12), Pubic Crest, Linea Alba A: Flexion of Trunk • Lateral Flexion of Trunk • Contralateral Rotation of the Trunk • Compression of Abdominal Contents

13. Integrated Function of Internal Oblique • Assists in eccentric deceleration of trunk extension • Assists in eccentric deceleration of trunk rotation • Works synergistically with the transverse abdominis, multifidus, and erector spinae to stabilize the lumbo-pelvic-hip complex

14. External Abdominal Oblique • Located externally in the abdomen with diagonal fibers • Lateral to the rectus abdominis • “Pocket Muscles” (put your hand into a coat pocket and your fingers would be pointing along the direction of the fibers) • It’s fibers meet latissimus dorsi at ribs # 10-12

15. External Oblique O: Lower 8 ribs (# 5-12) I: Anterior Iliac Crest of Pelvis and Abdominal Aponeurosis A: Flexion of the Trunk • Lateral Flexion of the Trunk • Contralateral Rotation of the Trunk • Compression of Abdominal Contents

16. Integrated Function of External Obliques • Assists in eccentric deceleration of trunk extension • Assists in eccentric deceleration of trunk rotation • Assists in dynamic stabilization of the lumbo-pelvic-hip complex

17. External and Internal Obliques • Force Couple: • Two separate muscle groups on opposing sides of the body work together to achieve the same movement goal. • One movement will have two agonists on opposite sides of the body.

18. How Obliques Cause Trunk Movement Trunk Flexion • Right and Left sides of Internal and External Obliques Lateral Trunk Flexion • Lateral flexion right : Right External Oblique and Right Internal Oblique • Lateral flexion left: Left External Oblique and Left Internal Oblique

19. How Obliques Cause Trunk Movement Trunk Rotation • Rotation Right : Left External Oblique and Right Internal Oblique • Rotation left : Right External Oblique and Left Internal Oblique

20. Rectus Abdominis-Anatomy • The Rectus Abdominis is a superficial muscle bisected by tendinous inscriptions that is covered by the rectus sheath which is formed by aponeurosis.

21. The Rectus Abdominis is a superficial muscle bisected by tendinous inscriptions that is covered by the rectus sheath which is made up of aponeurosis • Tendinous Inscriptions • Three fibrous bands that transect and divide the rectus abdominis.

22. The Rectus Abdominis is a superficial muscle bisected by tendinous inscriptions that is covered by the rectus sheath which is made up of aponeurosis • Rectus Sheath • Sheath (protective covering) • Anterior and posterior sections • Lays under and over RA

23. The Rectus Abdominis is a superficial muscle bisected by tendinous inscriptions that is covered by the rectus sheath which is made up of aponeurosis • Aponeurosis • Flattened tendons with a shiny, whitish-silvery color. • Sparingly supplied with blood vessels and nerves. • When dissected, are papery, and peel off by sections.

24. Rectus Abdominis • The two rectus sheaths (left and right) meet in the midline of the abdomen and form the linea alba • Linea Alba: The tendinous band along the midline of the rectus abdominis muscle.

25. Rectus Abdominis • Rectus means straight O: Pubic crest I: Xiphoid process of sternum and costal cartilages of 5th, 6th and 7th ribs A: Trunk Flexion • Compression of Abdominal Contents (expiration, vomiting, expulsion of feces from the intestines and urine from the bladder) • Posterior Tilt of the Pelvis

26. Integrated Function of Rectus Abdominis • Assists in eccentric deceleration of trunk extension • Assists in eccentric deceleration of anterior pelvic tilt • Assists in dynamic stabilization of the lumbo-pelvic-hip complex

27. Rectus Abdominis Exercises Common Mistakes Made: • Pulling the head with the hands (risking injury to the cervical vertebrae) • Not pressing back to the floor • Flexing the torso to a fully seated position • When straight leg raises or full sit-ups are done, the movement is not trunk flexion but hip flexion.

28. Multifidus • A deep muscle located along the back of the spine very close to the midline. • The deep fibers are short and span single vertebral segments. • Functions together with transverse abdominis & pelvic floor muscles to stabilize the low back and pelvis BEFORE movement of the arms and/or legs occurs

29. Multifidus • Important stabilizer of the back • Studies have shown people who had low-back pain also had wasting of the multifidus muscle on the side of the back that matched the painful side. The studies also showed that over time back pain did improve.

30. Multifidus O: Sacrum, lumbar, and cervical transverse processes I: Spinous Processes of all Vertebrae A: Extension of Trunk and Neck • Lateral Flexion of Trunk and Neck • Contralateral Rotation of Trunk and Neck

31. Integrated Function of Multifidus • Assists in eccentric deceleration of trunk flexion • Assists in eccentric deceleration of trunk rotation • Assists in dynamic stabilization of the lumbar spine • Provides proprioception (awareness or sense of where the body is in space-up, down, left, right…) during dynamic movements which enhance neuromuscular efficiency

32. Multifidus • There are lots of exercises that strengthen the multifidus as well as the other back extensor muscles. The only problem is all the extensor muscles will contract with traditional back exercises • The multifidus must first be isolated and re-activated through specific isometric exercises then followed up with functional exercises to further strengthen the muscles of the lower-back.

33. Multifidus Exercises Prone Trunk Extension with Rotation • Begin in a prone position • Rest your forehead on your hands • Retract your scapula • Extend the lumbar spine and rotate the upper torso • Keep scapula retracted

34. Quadratus Lumborum • This muscle is shaped like a square located in the back • Anterior to quadratuslumborum are the colon, kidney, and diaphragm O: Posterior Iliac Crest I: 12th Rib and Transverse Process of L1-L4 A: Elevation of Pelvis • Lateral Trunk Flexion • Extension of Trunk • Depression of 12th Rib

35. Integrated Function of Quadratus Lumborum • Assists in eccentric deceleration of lateral trunk flexion • Works synergistically with the hip abductors and adductors as the primary frontal plane stabilizers

36. Quadratus Lumborum • The quadratus lumborum can elevate the pelvis sometimes called “hip hiking”. • Do not confuse this with flexing the femur • To feel how the pelvis moves using the quadratus lumborum stand with feet apart and weight equal on both feet. Shift your weight from side to side while lifting up your toe on the side that you are shifting away from.

37. Quadratus Lumborum • Pulls 12th rib inferiorly causing thoracic cavity to expand which creates more space for the lungs to expand

38. Quadratus Lumborum Exercises • Horizontal isometric side bridge which can be done from a knee supporting position on the floor or a more challenging version which utilizes a feet supported version.

39. Erecter Spinae • Makes the spine erect • Divided into three longitudinal columns • From lateral to medial they are: • Iliocostalis • Longissimus • Spinalis

40. Erector Spinae Iliocostalis: O: Sacrum, Iliac Crest, and Ribs 3-12 I: Ribs 1-12 and Transverse Process of C4-C7

41. Erector Spinae Longissimus O:Sacrum, Iliac Crest and Transverse Process of T1-T5 I: Ribs 4-12, Transverse Process of T1-T12 and Mastoid Process of Temporal Bone in Skull (behind ear)

42. Erector Spinae Spinalis O: Spinous Process of T11-L2 and C7 I: Spinous Process of T5-T12 and C2

43. Erector Spinae Actions: • Extension of Trunk, Neck and Head • Lateral Flexion of Trunk, Neck and Head • Rotation of Trunk, Neck and Head • Anterior Tilt of Pelvis

44. Integrated Function of Erector Spinae • Assists in eccentric deceleration of trunk flexion • Assists in eccentric deceleration of trunk rotation • Assists in eccentric deceleration of lateral trunk flexion • Assists in dynamic stabilization of the lumbar spine during dynamic movements

45. Exercises for Trunk Extensors • Isometric Trunk Extensions on Floor • Trunk Extensions on a SB • Trunk Extensions on a Bench

46. Exercises Trunk Extensions • Muscles Worked: Erector Spinae, Multifidus, and Semispinalis • Common Mistakes Made: “hyperextending” the back past a horizontal position, flexing the spine, and performing the reps too fast.

47. Exercises Trunk Extensions • Possible Risks: • By flexing (rounding your back) and hyperextending your spine during this exercise you allow your vertebrae to separate from each other. Through repeated repetition, there is a large possibility of slipping a disk through the vertebrae. • To Perform Correctly • Slowly bend forward at the waist as far as you can while keeping your back neutral. Do not round your back. Slowly raise your torso until your legs and upper body are in a straight line again. Do NOT arch your back past a straight line!

48. Belts and Wraps • Using Belts (knee and/or ankle wraps) For Every Exercise: • Common Mistakes Made: Dependence of the weight belt for every exercise. • Negative Effect: Weak abdominals and lower back muscles • Solution: Avoid wearing the belt and lower your weight so the muscles you weakened due to belt use can recover. Most people use belts only for squats and power exercises. Even this is excessive, unless you are doing maximal weight loads

49. Belts and Wraps • Knee and elbow wraps should generally not be used. If you have an injury you should not be lifting, or should reduce the load. • Belts can be important at certain times, such as when you are lifting heavy loads with which you can only do a few reps, and when you are learning form on power exercises.