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Core Stability for Kids with Special Needs


One of my favourite children’s books is “If You Give a Mouse a Cookie” – I love how the beginning of the story is also the end of the story.  As a Physical Therapist I understand that success in motor skills begins and ends with core stability; the core supports every skill from eating to printing to walking to basketball.  And I think it’s outstanding that so many people are now talking about the importance of core stability for kids.

However, I think we need to bring some clarity to our core conversations.  Specifically, there are inner core muscles and outer core muscles.  The four inner core muscles stabilize our spine and pelvis before every movement that we make.  (FYI these are: the respiratory diaphragm, the pelvic floor, the transversus abdominis and the multifidus.) And our research has shown that there is a key to building core stability – we need to have neutral alignment of your rib cage and pelvis and we need to be able to breathe into the front, back and especially the sides of our rib cage (we call this “umbrella breathing”).  This is the way we efficiently stabilize our body in preparation for movement.

There’s another bonus to teaching children to engage their core.  As children get that all important alignment and learn to breathe fully with their diaphragm, they impact the calming nervous system.   It turns out that when we belly breathe or when we breathe with our upper chest, we don’t impact those nerves; we calm only when we breathe by fully expanding our diaphragm.

For many reasons, children with special needs have difficulty activating their inner core. They actually do the opposite; they hold their breath in order to create stability. Sometimes they begin this almost as soon as they are born.  And difficulties with muscle tone (both low tone and high tone) make neutral alignment difficult, which interferes with inner core activation even further.  A nervous system stuck in the “fright or flight” response interferes with core activation too.  All this contributes to poor movement quantity and quality.  It sounds like an insurmountable problem but thankfully it’s not.   We are teaching therapists about inner/outer core relationships, their impact on motor skills and how best to address them in treatment, activities of daily living and recreation (

So when children with special needs activate neutral alignment and umbrella breathing, every activity becomes a core activity.  And if you give a kid their core, you are preparing them for a lifetime of successful movement.

photo credits


Shelley Mannell,  PT, HeartSpace Physical Therapy for Children

@heartspacept on Twitter or HeartSpacePT on Facebook

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