Core Strengthening: Beyond the Six-Pack

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Core Strengthening: Beyond the Six-Pack

Everyone has heard of their core, but do we really know what it is? Most people associate their core with having a six-pack of abs. But did you know that the core extends far beyond the abdominal muscles you can see? A strong core is essential not just for aesthetics but for overall function, injury prevention, and optimal performance in daily life and sport.

What Exactly Is the Core If Not Chiseled Abs?
The core is a complex system of muscles that work together to provide stability, balance, and power. These muscles are located in your pelvis, hips, lower back, and abdomen. They can be further broken down into two categories: deep “stabilizers” and superficial “movers”. One of the movers is the Rectus Abdominis, the “six-pack” muscle that helps with forward flexion of the trunk. Although these muscles are important, today’s focus is on the “deep stabilizers”, also known as the “deep core muscles”.

The Deep Core Consists Of:
1. Diaphragm— yes, your breathing muscle! Breathing plays a huge role in stabilizing the core.
2. Pelvic Floor — These muscles support the pelvic organs and contribute to core stability.
3. Transverse Abdominis (TVA) — A deep abdominal muscle that acts like a corset, providing core stability.
4. Multifidus— Small but mighty muscles along the spine that assist with stability.

Why Should We Care About Deep Core Strength?
You may be wondering, why focus on the deep core if it won’t give you a six-pack? The deep core plays a crucial role in treating pain, preventing injury, increasing performance, and making everyday function easier.

Low Back Pain and the Importance of the Deep Core
Trunk strength and endurance tend to decrease in patients with low back pain. In chronic cases—where pain persists for more than three months—the timing of deep core muscle activation can be affected. If these muscles are not turning on or firing at the right time, it can lead to instability and prolonged discomfort. Strengthening the deep core helps retrain these muscles, providing better spinal support and reducing pain. A strong core also distributes forces evenly, reducing strain on the spine and joints.

Injury Prevention
A weak core can lead to poor movement mechanics, increasing the risk of injury in both daily activities and sports. A stable core reduces the likelihood of lower back pain and other injuries by keeping the spine supported.

Performance Improvement
Athletes rely on core strength for power, balance, and efficiency in movement. Whether you are running, lifting, cycling, or playing sports, a strong core enhances performance by improving movement control and force transfer.

Everyday Function
From bending down to pick up something to tying your shoes to carrying groceries or sitting at a desk, your core is engaged in almost every movement you make. A stable core helps maintain good posture, reducing strain and fatigue throughout the day.

Who Can Benefit from Core Strengthening?
The short answer: everyone! Whether you’re an office worker who sits for long hours, a weekend warrior hitting the trails, or a high-performance athlete, a well-conditioned core is essential for movement efficiency and long-term health.

How to Strengthen Your Deep Core
Effective core training involves more than just crunches. A well-rounded program should include stabilizing exercises, anti-rotation, and anti-extension movements. Some examples include:

1. Dead Bugs:

  • Start by lying down on your back on an exercise mat.
  • Lift both legs up into a table top position (knees and hips bent at 90 degrees).
  • Raise your arms so they are both pointing straight towards the ceiling.
  • Maintaining a neutral spine, extend your right leg forwards whilst simultaneously raising your left arm overhead in a controlled manner.
  • Return your arm and leg to the starting position, then switch to repeat the movement on the opposite side.

2. Heel Slides:

  • Start by lying down on your back with both knees bent.
  • Slowly slide one heel out by straightening the knee.
  • Slide your heel back to its starting position with and repeat the movement on the opposite side
  • For an added challenge, do the same exercise starting in a bridge position:

3. Bird Dogs:

  • Start on your hands and knees, with your hands under your shoulders and your knees under your hips.
  • Reach one leg up and out so it’s in line with your back, and reach the opposite arm straight out in front.
  • The arm and leg travel out together, then back to the starting position.
  • Switch sides.

4. Diaphragmatic breathing (breathing deep into your belly):

  • Lie on your back on a flat surface or in bed, with your knees bent.
  • Place one hand on your upper chest and the other just below your rib cage. This will allow you to feel your diaphragm move as you breathe.
  • Breathe in slowly through your nose so that your stomach moves out, causing your hand to rise. The hand on your chest should remain as still as possible.
  • Tighten your stomach muscles, so that your stomach moves in, causing your hand to lower as you exhale through pursed lips

5. Pallof Presses:

  • Set up the cable machine or resistance band so that it sits at chest height.
  • Stand sideways to the machine or band and grip the attachment with both hands at chest height, then take a few steps out to the side and backwards so that the band or cable is providing resistance.
  • With a neutral spine, extend both arms to press the cable or band forwards until the arms are fully extended.
  • Revert the movement by slowly bringing the pulley back towards your chest.

How Do I Know If I Am Activating My Deep Core?
If you’re unsure whether you’re activating your deep core correctly, a physiotherapist can help assess your technique and guide you through proper engagement. With expert guidance, you can gradually build core stability and progress your exercises to help prevent injury and improve movement efficiency.

Written by: Evelina Michniak

Strength Matters: How Diabetes and Muscle Loss Are Linked

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Diabetes, especially type 2 diabetes (T2DM), is a widespread health challenge that affects millions of people around the world. It’s not just about blood sugar levels; it can also lead to a concerning condition called sarcopenia, which is the gradual loss of muscle mass and strength as we age. Let’s explore the connection between diabetes and sarcopenia, why it matters, and what you can do to keep your muscles and health strong.

The Diabetes-Sarcopenia Connection

Sarcopenia isn’t just an unfortunate part of aging; it can also make managing diabetes more difficult. Here’s how it works: T2DM can speed up muscle loss, and weakened muscles can lead to poorer blood sugar control. This creates a vicious cycle where less muscle mass can lead to  less physical activity, which in turn can worsen diabetes management.

Research shows that older adults with T2DM experience muscle loss more rapidly than those without the condition.

Why Muscle Matters

Muscles play a crucial role in how our bodies use glucose, the sugar that fuels us. Healthy muscles help absorb glucose from the blood, which is especially important for people with diabetes. Unfortunately, when muscle function declines, so does the body’s ability to manage blood sugar, leading to higher levels of insulin resistance.

Key Factors Contributing to Sarcopenia

Several factors can contribute to the development of sarcopenia, particularly in people with diabetes:

  1. Aging: Muscle loss typically begins around age 30 and can increase significantly by age 80, especially in those with T2DM.
  2. Energy Intake: As we age, our calorie intake and requirements decrease leading to increased fat accumulation and further muscle loss.
  3. Physical Activity: A sedentary lifestyle greatly contributes to muscle decline. Regular exercise is essential, especially for those with diabetes, to help maintain muscle mass and improve insulin sensitivity.
  4. Diet: Nutritional factors, like vitamin D and protein intake, are vital for muscle health. Vitamin D is essential for proper metabolic function and muscle health, and inadequate protein can accelerate muscle loss.
  5. Hormonal Changes: Hormones such as estrogen and testosterone play important roles in maintaining muscle mass. Changes in these hormone levels can negatively impact muscle health.
  6. Smoking: Smoking can lead to decreased muscle strength and further metabolic issues, making it harder to manage diabetes.

Taking Action: Managing Sarcopenia and Diabetes

Fortunately, there are effective strategies to tackle sarcopenia alongside diabetes. Here are some key approaches:

  1. Dietary Management
  • Focus on a balanced diet rich in protein (aim for 1.0 to 1.5 grams per kilogram of body weight) to help maintain muscle mass.
  • Incorporate foods with anti-inflammatory properties, like those high in omega-3 fatty acids, to support overall health.
  1. Physical Exercise
  • Engage in Progressive Resistance Training (PRT), which is essential for building and maintaining muscle. Aim for at least 150 minutes of moderate aerobic activity each week, combined with 2-3 sessions of strength training.
  • Regular exercise can significantly improve muscle mass and enhance blood sugar control.
  1. Professional Support
  • Physiotherapists can create personalized exercise programs to improve mobility and strength. A physiotherapist will ensure the exercises prescribed are both effective and safe and address any mobility or injury concerns.
  • Kinesiologists focus on developing fitness plans that emphasize resistance training to counteract muscle loss. Kinesiologists are experts in guiding you through proper exercise technique and will help in injury prevention.
  • Dietitians help create meal plans that ensure you’re getting the right nutrients to support muscle and overall health.
  • General Practitioners monitor diabetes progression and manage any necessary medications.
  • Psychologists can assist with mental well-being and motivation to stick to health plans.
  1. Collaborative Care Approach

Working with a team of healthcare professionals ensures all aspects of your health are addressed, from physical fitness to nutritional needs. This holistic approach can empower you to take control of your health and improve your quality of life.

Conclusion

Managing diabetes and preventing sarcopenia is crucial for maintaining health as we age. By focusing on nutrition, regular exercise, and seeking support from healthcare professionals, you can enhance your muscle strength and overall well-being.

If you’re looking for guidance on managing your diabetes or muscle health, don’t hesitate to reach out to us at Treloar Physiotherapy Clinic. Our team is here to support you on your health journey!

Written by Jordan Yum

Fall into Balance: Transform Your Routines with Clinical Pilates!

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September marks the shift from summer to fall. Coinciding with the seasonal change is a tendency to ‘fall’ back into the more regular routines of school, work, sport and exercise.

Come October these new routines tend to be settling into place.

Whether it is the return to the familiar or commencement of the new, it is not uncommon for some aches and pains to accompany these now regular activities.

All activities consist of ‘patterns’ of repetitive postures and movements. The significance on how these influence our complaints often go unnoticed until they impact us negatively. Even then it may not be obvious.

Many of our repetitive postural and movement patterns tend to overload certain areas of the body while at the same time underutilize other regions. This naturally leads to something called an imbalance of function which often plays a significant role in both our inactive and active lifestyle-related complaints.

Correcting these faulty patterns can reduce the risk of chronic overuse type injuries, as well as reduce the risk of acute ones.

This is where Clinical Pilates can be very beneficial. The emphasis on the quality of movement versus the amount of resistance or load is ideal to re-train or reinforce desired patterns.

Some benefits of addressing imbalances and improving our patterns include:

  • improvement of pain/ discomfort
  • injury prevention
  • enhanced performance

We are all humans doing modern human things on a daily basis, many of which include combined bodily movements requiring various direction, speed and control. As a result of ongoing repetition, our body continues to repeat these same movements, thus leading to patterns of imbalance with associated bodily correction (compensation).

But we are also all unique individuals with different presentations and needs. There is no ‘one size fits all’ approach to any type of physical training or rehabilitation, including Clinical Pilates.

An assessment with a Clinical Pilates Physiotherapist can help identify and guide your specific needs, which is especially important if you are managing any discomfort or injury. Some areas they can help you with include:

1. Postural/Movement Analysis

A Clinical Pilates therapist can analyze your lower body mechanics using the reformer to identify issues like overactive hip flexors or weak glutes contributing to knee pain. Targeted Pilates exercises on and off the reformer can strengthen these areas and improve alignment for better function.

2. Exercise/Training Strategies

For runners dealing with knee pain, a Clinical Pilates therapist can evaluate running mechanics on the reformer to identify contributing factors. Specific Pilates exercises can be integrated to strengthen supporting muscles and enhance running performance.

3. Ergonomics/Workstation Set-Up

If you’re experiencing neck and back discomfort from prolonged computer use, a Clinical Pilates therapist can assess your posture and recommend adjustments to your workstation. Utilizing the reformer, they can prescribe Pilates exercises that strengthen postural muscles and improve overall alignment, reducing strain.

In summary, creating positive changes to our day-to-day routines are beneficial. As our ability to move becomes more natural and free of any restrictions and any faulty compensatory patterns, the better we continue to live a pain-free life while engaging in all our daily activities.

Written by Jonathan Poon

The Basics of BPPV: Positional Vertigo

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Summer is here and that brings more outside time and fair weather. Activities like gardening and yard work are frequent, and sports like golf, tennis and swimming encourage us to spend time outside enjoying all that Vancouver has to offer. But have you ever found yourself moving into a position where you are bending over, looking high up or tilting your head to one side and suddenly the outside world appears to be moving?  It can be a very unsettling feeling, even if it doesn’t last long.

 

Vertigo is the sensation of the outside world spinning.  It is a symptom, but not a diagnosis.  The incidence is quite common, as much as 1 in 15 adults will have an episode of vertigo in their life, according to an Ear Nose and Throat Doctor teaching at Columbia University.  One of the causes of vertigo that we see at Treloar Physiotherapy is a condition called Benign Positional Paroxysmal Vertigo (BPPV).  It is important to note that BPPV is not the only cause of vertigo, but it is the most common.  Here is some basic information about BPPV:

What is it?

  • BPPV is a problem that occurs in the vestibular system that causes a sensation of spinning for short periods of time when the head is moved into certain positions.
  • The crystals that are located in sacs within the inner ear break free, moving into one of the semi-circular canals of the inner ear.
  • When your head moves, the crystals float through the canal and continue to move even after you stop moving. This creates a temporary spinning sensation (vertigo) that comes on with specific head movements.

What causes it?

  • In most cases, we do not know what causes the crystals to break free and move into the semi-circular canals.
  • Very few cases occur because of a physical blow to the head (ie something that ‘knocks’ the crystals loose).

What movements trigger the vertigo symptoms?

  • Big movements that involve bending over and looking down – emptying the dishwasher, weeding the garden, bending low to pick up something under the bed, tying shoes, putting the golf ball on the tee (!).
  • Looking up at something high – getting ready to prune the tree, changing a light bulb (we don’t do this as often anymore thanks to LEDs!), a high tennis serve toss, looking up/leaning head back while washing your hair.
  • Changes of position – moving from lying down to sitting up or vice versa (ie in/out of bed, getting up/down off an exercise mat) or turning your head/rolling to one side while lying down.

How long does the vertigo last?

  • With BPPV, the vertigo sensation itself typically lasts less than 1 minute, and not more than 2 minutes (it can often feel much longer in the moment!). The symptoms will recur as the head and body move into the provoking positions.
  • There can also be a sensation of imbalance while moving/walking or mild nausea when someone is suffering with BPPV and this can occur more frequently.

How do you treat BPPV?

  • BPPV can be treated very effectively with a re-positioning maneuver – essentially using gravity and the position of your head to move the crystals out of the affected canal and back to their normal resting position. When this happens, and the crystals are ‘back in their home’ the vertigo symptoms go away.

Many people use the internet to look up home treatment for BPPV and often read about the ‘Epley Technique’.  This is the most commonly performed re-positioning maneuver for BPPV; but it does not treat all types of BPPV.  The Epley is only effective for one type of BPPV. The key to effective treatment involves: figuring out which ear has the problem (it is usually only one ear), determining what canal the crystals are stuck in, and effectively applying the correct treatment technique.  If the wrong technique is used, or done incorrectly you will not likely cause damage, but you can make yourself feel pretty rotten and it will not solve the problem.

 

A physiotherapist who has studied vestibular rehabilitation will take you through an assessment that will involve the following:

  • A thorough history of your symptoms and current challenges.
  • A safety screen to rule out more serious causes of vertigo.
  • A physical assessment to determine if BPPV is the cause of the vertigo and how to best treat it.

 

Often treatment can be done in the same session.  Assessment and treatment for BPPV does involve reproducing the symptoms of vertigo – but it’s worth it when the vertigo is gone.  Don’t let vertigo get in the way of enjoying the activities that you enjoy, especially in the summer season!

Call one of our clinics or book online (www.treloarphysio.com) to make an appointment with one of our physiotherapists trained in vestibular rehabilitation.

Written by Stacy Benmore (Physiotherapist, Treloar Physiotherapy Kerrisdale). 

Dance Pain-Free: Physiotherapy Tips to Conquer Snapping Hip Syndrome

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What is Dance Physiotherapy?

Dance Physiotherapy combines manual therapy & clinical pilates techniques to help artistic athletes – dancers, gymnasts, skaters (and more!) reach their goals. Dance physio is ideal for artistic athletes of any level who are recovering from injury, preparing for pointe work, looking to prevent injury, improve mobility or overall performance.

Dance physiotherapy can help with a variety of conditions including:

  • Knee injuries – for example jumper’s knee & bursitis
  • Back injuries – including spondylolisthesis
  • Foot injuries – for example plantar fasciitis, bunions and achilles tendinopathy
  • Hip pain & injuries – including snapping hip syndrome
  • Chronic or acute ankle sprains
  • Overuse injuries
  • Joint Hypermobility

In this blog post we will be discussing snapping hip syndrome which unfortunately, is very common in dancers, particularly when extending the leg or coming into a grand battement.

What is the snapping or clicking sound? One of the most common sounds is a deep “clunk” when extending the leg. The most likely cause of this is spinal instability and/or over-recruitment and chronic thickening of your psoas muscle (your hip flexor) 

How do I get rid of the noise/ snapping sensation? By working on mobility, stability and then gradually loading the hip. Below are some great exercises to start with!

1. Aikido or “Frog” Mobilization

Come into Aikido or frog stretch position – knees wide on the mat, bottoms of the feet together, arms or forearms resting on the mat. 

Rest in this position for 10-15 seconds, allowing for a gentle stretch in the inner thighs and opening of the front of the hip. 

From here, bring your pelvis into a forward tilt (think about rotating the top of your hip bones towards the mat), and hold for a further 10-15 seconds. Engage your deep core in this position to get an even deeper stretch through the front of the hip! 

Alternate between these positions 4-5 times.

Note: There should not be any discomfort or pain in the hips during this mobilization. If you are feeling any pinching or discomfort decrease how far apart your knees are or consult your physiotherapist before continuing. 

One of the common contributors to snapping hip syndrome is when the outer, or lateral glute muscles have increased tension in them – this can occur when glute med grips to maintain turnout in standing – rather than the deep external rotators. 

 

  2. External Rotation in Table Top

Equipment needed: pillow or small ball 

Lie on the mat, back flat and deep core engaged. Slowly bring both legs up to tabletop position (knees bent at 90 degrees) with the small pillow or ball between your thighs. 

Maintaining inner thigh activation by squeezing the pillow or ball, slowly extend one knee in parallel. Then, from the deep hip socket, externally rotate your extended leg (coming into turn-out). Hold for 2-3 seconds and then come back to parallel and then back to your tabletop position. Continue to maintain the squeeze of the pillow/ball during this entire process. 

Repeat this up to 10 times on each side.

Tip: to ensure the core & deep external rotators are working, check that hip flexors are relaxed throughout this entire exercise.

 

3. Plié Variation targeting deep external rotators

Begin standing tall, in first position. Start with a demi plié and then, maintaining your turn-out (external rotation), slide one leg along the floor (in fondu – one side continues to be in plié, the other knee extends). The foot on the extended leg should come onto the ground. Then, while maintaining your weight over your standing leg (in plié), bend your extended leg while you slide it back to first position. 

During this movement you should be able to feel your inner thighs (extended leg) and deep external rotators (standing leg).

Tip: Place one hand over the outer glutes on your standing leg – these muscles shouldn’t be gripping or over-activating as the turnout should be coming from your deep external rotators.

Note: This exercise can be completed in centre or standing at the bar (or at a counter at home!)

 

Thanks for reading! Consult your physiotherapist if you experience pain or are interested in a personalized targeted program to address your specific goals!

 

Written by Talia Berson (Physiotherapist, Clinic Pilates Instructor).

 

“If you’ve seen one concussion, you’ve seen one concussion”.

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Just Keep Swimming – Six Reasons Swimming is Fantastic for Your Health

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Just Keep Swimming – Six Reasons Swimming is Fantastic for Your Health

Amidst these scorching summer days here in BC, there’s nothing like a refreshing swim, but swimming has many health benefits besides being a fantastic way to cool off.

One significant aspect of water-based exercises is the hydrostatic effect of water, which has fantastic therapeutic benefits. The pressure can alleviate pain by reducing swelling and calming our sympathetic nervous system. As a result, pool-based exercises and swimming can benefit those in post-recovery (like ankle sprains, knee replacements, etc.) and facilitate a faster recovery.

But the benefits don’t stop there! Other great aspects include:

1. Low-impact exercise:

Unlike many other forms of exercise, swimming is low-impact, which puts less stress on joints. Being low-impact makes swimming an ideal activity for people of all ages, including those with joint pain/sprains, arthritis, or other mobility concerns.

2. Flexibility and balance:

Swimming enhances stability and coordination and helps those who fear falling to practice safe balance drills in waist-height water. It also improves joint flexibility through various strokes and positions.

3. Improved posture:

Swimming helps strengthen the muscles that support the spine, leading to better posture and reduced risk of developing back problems or aches.

4. Cardiovascular health:

Swimming elevates the heart rate, improves blood circulation, and reduces the risk of heart disease and high blood pressure.

5. Full-body workout:

Swimming engages multiple muscle groups simultaneously, providing comprehensive exercise for the entire body. It strengthens the arms, shoulders, back, core, and legs, improving muscle tone and overall strength.

6. Weight management:

Swimming is a calorie-burning activity that can aid in weight management and loss. It helps burn many calories while providing a fun and refreshing workout.

Conclusion

Before taking a dip or starting any exercise program (like hydrotherapy/pool-based rehab), consult your doctor and physiotherapist, especially if you have any underlying health concerns. Stay safe, and just keep swimming!

Physiotherapist Ania Stojek wrote this article.