Industry Insider: Movement at the Core

From Mobilize Pro

Industry Insider: Movement at the Core

“Core” certainly is the buzz word for the past 10 years. I particularly enjoy the many interpretations of core injury diagnosis and treatment that are presented by the self imposed “experts” that seem to be on every corner. 

I am very grateful for the research that we as therapists have access to and believe that we are much more able to create a best practice plan of attack in the diagnosis, treatment and prevention of core injuries. In general I think therapists understand the WHAT of the injury very well but it is the clinical reasoning behind the WHY that is still a challenge.

Very few Core injuries are a result of a single mechanism trauma – we can always ask “why’” and then we need to reverse engineer the entire mechanics to determine where the fault is. There is often more than one movement fault that will contribute to a breakdown either at or away from the site of dysfunction.

“We tend to treat the victim but more importantly we need to find the criminal”

Basic Assessment Process

1) Lumbar scan – rule out serious pathology (you do not know it if you did not test it)

2) Standing Kinetic Chain scan – static & dynamic

3) Posture/Position assessment – static & dynamic – stand, sit and functional

3) Specific joint assessment – foot, ankle, knee, hip, pelvis, lumbar and thoracic spine

4) Specific Core assessment – form & force closure mechanisms

                                              – local and global system integrity

This may seem like a long assessment but many of these areas overlap. The key is to figure out what the pieces of the puzzle are and then how they fit into creating the picture. Even though there are common patterns, every presentation may have different pieces that create a different picture. I never know until my complete assessment is done what the picture looks like and then the key is to figure out where to start and where to go.

Rehabilitation/Retraining Process

1) Ensure form & force closure integrity

2) Train local & global systems

3) Functionally re-train the systems

4) Specific functional re-training

I am grateful to Diane Lee for providing this great logical summary for assessment and treatment of Core Injuries.

Lee D G 2004 The Pelvic Girdle, 3rd edition. Churchill Livingstone, Edinburgh

Low back, abdominal, pelvic, hip and groin injuries are very rewarding to treat when you can figure why they occur.

I enjoy every day at work because I get to problem solve injuries and not just treat them. I thrive on the ability to provide an accurate diagnosis – what the injury is and WHY it is - and then successfully ‘sell’ my recovery plan. This will then allow a greater buy in from the client for the treatment process and provide clear expectations for recovery and prevention.

So put on your Sherlock Holmes hat and find solutions to the problems through education, assessment, and innovation. You will enjoy your work and importantly your clients will become a better owner of their injury and recovery process.

Oh – and when you can’t “fix” them create a pair of shorts that can!

Greg Bay PT, FCAMT

Dip Sports PT