Core Understanding

I am always extremely excited when I learn information that dramatically influences my practice.  Three years ago I met a PT colleague when she asked me to treat her daughter.   Julie Wiebe (www.interiorfitness.com) introduced me to the emerging adult literature on how the inner Core unit functions and her approach to Core Restoration in adults.  The information had huge applicability for children; those with typical motor skills as well as those with movement challenges.  Julie and I blended our skills and Core Restoration for Kids was born.

I can’t imagine life without my Core understanding.  My 11 year old daughter has a posture that makes her PT mother cringe – you know the one:  knees hyperextended, hips forward and shoulders back.  But with some gentle coaxing, she will engage her inner Core (respiratory diaphragm, transversus abdominis, pelvic floor and multifidus) and occasionally even admits that her back feels better when she uses her body in this way.  And my son is just beginning to use our weight machine.  I am confident that when he activates his Core (rather than stabilizing his spine in an extreme range) he is exercising with good form and targeting the muscles safely.  If we introduced this approach to children in recreational sports and phys. ed. classes, imagine the huge impact we could have on physical fitness levels in children!

In clinical practice the development of Core Restoration for Kids has dramatically influenced my intervention.  Our children with movement challenges have so many different systems involved; neurological, musculoskeletal, motor, and sensory.  And yet, regardless of their diagnosis, one outcome is consistent: when these systems do not function together, the children are not able to prepare for movement in an efficient manner (= anticipatory postural control).   Instead they use breath holding as a way to stabilize their bodies for movement.  This sets up a dynamic that interferes with a host of other functions.  We have identified this clinically for many years and previous research has documented the phenomenon in different ways.  Now the research is beginning to investigate these Core muscles specifically in children with motor challenges.

Much of my previous clinical training in Neuro-Developmental Treatment has focused on the importance of alignment and activity of the trunk muscles to postural control.  Core Restoration for Kids continues to bring the issue of alignment front and center as it specifically targets the four muscles of the inner Core unit and how to activate them for postural control.  The other muscles of the trunk are then set up to work efficiently off this stable center and are ready to be strengthened before and during functional movement.  This specific targeting of the Core musculature sets the stage for all other movement.

As I continue to delve into the research literature and work clinically with my clients, I am discovering links with the Core I never imagined.  Children with low muscle tone display many challenges in activation of their Core and consequently their postural control.  This may be because of a neurophysiological link between the vestibular system and the respiratory diaphragm.  Also, improved control of the Core musculature improves midline control and increases parasympathetic nervous system input.  This may contribute to improved self-regulation in children with sensory modulation disorders.

As we continue to learn more and more about movement, postural control and the Core I’m sure I’ll continue to discover just how much all of these systems are inseparable.  And I will continue to be grateful for my Core understanding.

Shelley Mannell has more than 20 years experience treating babies, children and adolescents with physical challenges and gross motor delays.  Shelley has been a registered Physiotherapist with the College of Physiotherapy of Ontario since graduating from McMaster University.  She is a member of the Canadian Physiotherapy Association, the Neuro-Developmental Treatment Association (C/NDT) and is a book reviewer for  the journal, Physiotherapy Canada. She is also a contributing writer for Cascade DAFO newsletter. You can find out more about her and her services at her web site HeartSpace Physical Therapy for Children.