4/1/2019

Introduction Trunk Integration

Balanced Body Movement Principles Module 2: Key Principles

Balanced Body Movement Principles Mobility Whole

and Body Breathing
Restoration Movement

How the Body Works and How to Train It Inner unit - core work
Module 2: Trunk Integration • Diaphragm, Transverse Abdominis, Multifidi, Pelvic Floor

Upper Body Trunk Outer unit - lumbopelvic stability

Training Integration
• Deep Longitudinal System, Anterior Oblique Sling, Posterior Oblique
Sling, Lateral System

Lower Body
Training
Spinal mobility
• Flexion, Extension, Lateral Flexion, Rotation

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Trunk Integration Trunk Integration - Breathing Trunk Integration - Breathing

The Evolution of Core Training The Importance of Breath Anatomy
Core Training The Anatomy of Breathing
Panjabi, Richardson, Jull, Hodges et al The Purpose of
Breathing • The diaphragm is the primary
muscle of respiration BUT!
Functional Movement • Any muscle that moves the rib
Gray, Chek, Cook et al • Respiration cage can influence breathing.
• Enhancing the mind • Additional respiratory muscles
Myofascial Slings “Anatomy Trains” body connection. include: intercostals, scalenes,
Myers, Schleip, Lee, Vleeming et al serratus posterior inferior and
• Creating a rhythm superior, levator costarum,
for movement. quadratus lumborum and
Trunk Integration more.

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Diaphragm Trunk Integration - Breathing Trunk Integration - Breathing

How Breathing Works How Breathing Works

On the Inhale On the Exhale

• The diaphragm contracts. • The diaphragm relaxes.
• The dome moves down. • The dome moves up.
• The volume of the lungs • The volume of the lungs
increases and draws air in. decreases and air flows
• Abdominal pressure out.
increases. • Abdominal pressure
• Pelvic floor responds. decreases.
• Transversus abdominis
contracts.
• Pelvic floor responds.
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Trunk Integration - Breathing Trunk Integration Trunk Integration

Breathing Exercises Supine Exercise Sequence All Fours Exercise Sequence
Diaphragmatic Breathing
• Belly expands, relaxing, calming
breath
Posterolateral Breathing
All Fours Abdominals Opposite Arm and Leg Reach
• Expands lung capacity, allows Pelvic Clock
breathing with abdominal stability
One Lung Breathing
• Improves lateral flexion, corrects TA activation Marching and Toe Taps Diagonal Press Dead Bug
imbalances
Sniffing Breath (PPT Extra) Cat/Cow Cat/Cow Tail Wag

• Stimulating, rhythmic breath

Abdominal Curl Oblique Abdominal Bridging – Flat or round
back Bridging with Marching
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Trunk Integration Trunk Integration – The Inner Unit Trunk Integration – Lumbopelvic Stability
Prone Exercise Sequence Inner Unit, Core or Powerhouse Lumbopelvic Placement - Neutral Position

The core, powerhouse or inner unit provides The placement of the pelvis is
support to the lower spine during dynamic neutral when the anterior superior
movement. iliac spines and the pubic bone are
Swimming
in a plane perpendicular to the
The elements of the core include: ground in standing and parallel to
the ground when supine.
• Diaphragm
Rockets
• Transversus abdominis
• Multifidi According to current research in
• Pelvic floor biomechanics, the core or “inner
Mini Swan The core stabilizes the spine through a unit” works best as a spinal
complex series of interconnections between stabilizer when the pelvis is in a
the fascia, the muscles and the bones. neutral position.

Swan
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Trunk Integration – Lumbopelvic Stability Trunk Integration – Lumbopelvic Stability Trunk Integration – Lumbopelvic Stability
Lumbopelvic Placement – In Standing Lumbopelvic Placement in Supine Lumbopelvic Placement – In Supine
When standing or sitting with a neutral lumbopelvic
position, the action of gravity on the core
Find a neutral position in supine by balancing the
Neutral placement
musculature leads to a balanced engagement of the muscle engagement on the front and back of the
muscles on the front and back of the spine. body while maintaining a bony position that is as
close to neutral as possible.
Imprinted spine
This decreases the stress on the spine and helps to • When lying supine, the pressure of the ground on the back of the
prevent low back pain and injury. flexed lumbar spine with
a posterior pelvic tilt pelvis can tilt the pelvis slightly posterior so use muscle
engagement rather than just the bony position to optimize the
position.
A neutral position should be used in any exercise Exaggerated lumbar
designed to train clients for upright, functional curve
movement.
with an anterior pelvic tilt
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Trunk Integration – Lumbopelvic Stability Trunk Integration – Lumbopelvic Stability Trunk Integration – Lumbopelvic Stability
Lumbopelvic Placement – Supported Neutral Lumbopelvic Placement – Imprinted Spine Lumbopelvic Placement – Exceptions to neutral

Supported neutral The following conditions MAY prefer an imprinted spine

Use a rolled up sticky mat or For clients that need to and a slightly posteriorly tilted pelvis:
towel to support the lower use a slightly imprinted
back in neutral for: • Spondylolisthesis (anterolisthesis only)
position for comfort: • Spinal stenosis
Beginners • Spinal arthritis
• Who need both support and increased proprioception to learn where
• Clients can maintain the
• Some sacroiliac joint dysfunctions
neutral is. position themselves by
posteriorly tilting the pelvis. • Some disc injuries
Clients with unstable lumbar spines
• Clients can use a sticky mat, An imprinted spine should only be used to allow clients to
• To keep the back neutral during challenging exercises.
towel or small wedge under perform exercises comfortably and should be discontinued
Clients with an increased or decreased lumbar lordosis the sacrum to passively tilt when the client can comfortably maintain a neutral spine
• To support and help relax the low back muscles. the pelvis posteriorly. position.
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Trunk Integration – Lumbopelvic Stability Trunk Integration – The Inner Unit Trunk Integration – The Inner Unit
Lumbopelvic Placement Exercises Transversus Abdominis Transversus Abdominis
• Interior surfaces and
Pelvic Clock The first link in the chain, the
transversus abdominis acts like a Origin:
costal cartilage of ribs 7-
12, linea alba,
corset to draw in the abdominal thoracodorsal fascia
• Move the pelvis muscles and decrease the
from 12 to 6 diameter of the waist.

• From 3 to 9 • Interior surface of iliac

Insertion: crest, lateral third of
• Then in circles inguinal ligament

• The goal is to feel The fibers of the transversus

abdominis wrap horizontally
the center point around the abdomen creating • Compresses the contents
where the pelvis the deepest abdominal layer. Action:
of the abdomen,
stabilizes the lumbar
is balanced spine

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Trunk Integration – The Inner Unit Trunk Integration – The Inner Unit Trunk Integration – The Inner Unit
Inner Unit Activation Exercises - TA The Multifidi and Erector Spinae Rotatores and Multifidi
Supine Fingertip • Sacrum and transverse
The next link in the chain is the processes of lumbar through
Abdominals multifidi.
Origin:
cervical vertebrae. Rotatores,
thoracic vertebrae only*.
• Place the fingers just inside
the ASIS
• Draw the abdominals toward The multifidi connect the • Spinous processes of lumbar
They can be felt as the
transverse processes of each
the spine. relatively thin and taut band of
vertebra to the spinous through 2nd cervical vertebrae.
muscle just on either side of Insertion:
process of the vertebra 3 to 4 Rotatores span 1 – 2, multifidi
the midline of the spine.
levels above. span 2 – 4.
All Fours Abdominals
The multifidi and the rotatores
• Lift the abdominals up toward fill in the space between the • Torso extension, contralateral
the spine while maintaining a spinous processes and the Action: torso rotation, spinal segmental
transverse processes. stabilization
neutral lumbopelvic position.
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Trunk Integration – The Inner Unit Trunk Integration – The Inner Unit Trunk Integration – The Inner Unit
Thoracolumbar Fascia Thoracolumbar Fascia Transverse Abdominis & Thoracolumbar Fascia

When the transversus Rectus abdominis As the TA contracts and tightens the
abdominis contracts, it thoracolumbar fascia, the multifidi
expand into the fascia creating a
creates tension on the External oblique
abdominal stabilizing support around the lumbar
thoracolumbar fascia which vertebrae.
Psoas major
surrounds the following
muscles: Internal oblique
Quadratus The fascia acts like a corset around
abdominal
lumborum
the multifidi forcing the muscles to
• Multifidi elongate vertically as it contracts.
• Erector spinae Transverse
Fascial connections
abdominis
• Psoas Latissimus dorsi Multifidi
This creates axial elongation or
• Quadratus lumborum Body of L3
decompression of the vertebrae.
Erector spinae

Cross section of the torso at L3

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Muscles of the Spine and Thorax

Trunk Integration – The Inner Unit Trunk Integration – The Inner Unit
Inner Unit Activation Exercises - Multifidi Inner Unit Activation Exercises - Multifidi

Standing Multifidi
Neutral Back Engagement
Bridging • Do both sides of the spinal
muscles fire at the same
time?
• Keep the spine
relatively neutral Lunge with Weight
as the hips rise Shift
to activate the • The muscles on the back
leg side should (maybe) fire
multifidi. more easily.
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Trunk Integration – The Inner Unit Trunk Integration – The Inner Unit Trunk Integration – The Inner Unit
Pelvic Floor The Pelvic Floor Pelvic Floor Awareness Exercises
The pelvic floor acts in conjunction with the Standing Anterior and
diaphragm to create the top and bottom of the Posterior Pelvic Floor
cylinder formed by the transversus abdominis, Engagement
the spine and the spinal muscles.
• Notice how the pelvic floor
engages when the pelvis is in
The purpose of the pelvic floor is to: an anterior or posterior
position.
• Support the contents of the abdomen against the force of
gravity. Supine Engagement
• Control urination and defecation.
• Assist with sexual function. • Add a ball between the knees
• Facilitate childbirth. to increase the activation

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Trunk Integration – The Inner Unit Trunk Integration – The Inner Unit Trunk Integration – The Inner Unit
Inner Unit Activation Exercises – Pelvic Floor Inner Unit Activation in Standing Core Activation
Transversus
There are currently many abdominis and
conflicting ideas about pelvic Squats multifidi co-
contract to
floor training. • Use the inner unit to support a support the spine.
neutral lumbopelvic position
• Using verbal cues
• Using movements that naturally Sumo Squat
activate the pelvic floor All 4 elements
• Wide, turned out legs, hip work together
Movements of the hips and hinge, low back neutral until to create
stability of the
legs such as walking, squats, bottom of squat lumbar spine
lunges, bridging, side leg lifts Diaphragm Pelvic floor
and clam shells may be more Upright Squat/Plie stabilizes the pelvis
organizes the by drawing the
effective than verbally cueing • Use the inner unit to support a ribcage over bones together
activation. neutral lumbopelvic position the pelvis. from the inside.

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Trunk Integration – The Inner Unit Trunk Integration – The Inner Unit Trunk Integration – The Inner Unit
Quadratus lumborum and Psoas major Psoas Major Quadratus Lumborum
In addition to the inner unit muscles, the
• Bodies, transverse processes • 12th rib, transverse
psoas major and quadratus lumborum
play an accessory role in stabilizing or Origin: and intervertebral discs of Origin: processes of lumbar
vertebrae
destabilizing the lumbar spine. vertebrae T12 and L1-4.

The psoas major runs along the front of

the spine and has many different • With the iliacus tendon
functions depending on the structure of
Insertion: on the lesser trochanter Insertion: • Posterior iliac crest
the individual and the movement being
of the femur.
performed.

The quadratus lumborum connects the • Hip flexion, adduction and • Spinal lateral flexion,
ribs, spine and iliac crest and is critical in external rotation. extension, stabilization
• Lumbar extension (maybe flexion) Action:
maintaining the balance of the torso in
walking and running.
Action: lateral torso flexion, stabilization
of the pelvis, ribcage
and spine.
of the lumbar vertebrae (select
fibers)
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Trunk Integration – Lumbopelvic Stability Trunk Integration – Lumbopelvic Stability

Lumbopelvic Stability Lumbopelvic Stability The 4 Outer Units
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The 4 Outer Units

Lumbopelvic stability is the Good core activation
ability of the neuromuscular combined with the action of
All four muscular systems
system to maintain balance the 4 “outer units” is work together to create Deep
between the rib cage, required for lumbopelvic Lateral
harmonious movement of Longitudinal
lumbar spine and pelvis. stabilization. System
the torso, pelvis and legs. System

Maintaining balance and

strength in the four outer This model is based loosely Anterior Posterior
Deep Longitudinal System Anterior and Posterior Sling Lateral System
units is essential for on the work of Diane Lee, Oblique Oblique •Erector Spinae, Quadratus Lumborum, •Anterior = Anterior serratus, External oblique, •Hip abductors and adductors
preventing low back pain PT, FCAMT, CGIMS. and Sling Sling Thoracolumbar Fascia, Sacrotuberous Ligament
and the Biceps Femoris, Gastrocnemius, Plantar
Contralateral internal oblique and adductors
•Posterior = Latissimus dorsi and Contralateral
•Quadratus Lumborum
Fascia and Toe Flexors Function
and for creating efficient and Andry Vleeming, PhD, PT Function
glutes

Function •Keeps the pelvis balanced over the femurs

graceful movement patterns. •This system holds us upright against gravity and when walking, running or balancing on one
creates spinal extension. •Together stabilize the torso and in opposition leg.
create flexion, lateral flexion and rotation of the •Imbalances lead to an un-level pelvis when
torso standing on both legs.
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Trunk Integration Trunk Integration – Lumbopelvic Stability Trunk Integration – Lumbopelvic Stability
Deep Longitudinal System in Action Anterior Oblique Sling in Action Posterior Oblique Sling in Action

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Trunk Integration – Lumbopelvic Stability Trunk Integration – Lumbopelvic Stability Trunk Integration – Lumbopelvic Stability
Anterior and Posterior Oblique Sling in Action Anterior & Posterior Oblique Slings in Action Lateral System in Action

Anterior oblique sling Posterior oblique sling

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Trunk Integration – Lumbopelvic Stability Trunk Integration – Lumbopelvic Stability Trunk Integration – Lumbopelvic Stability
Lumbopelvic Stability Exercises Lumbopelvic Stability Exercises Lumbopelvic Stability Exercises
Marching Diagonal Press Bridging
• Place the hands under • Hand to opposite inner
thigh for Anterior Oblique • Focus on articulating the
the sides of the hips to spine
Sling
see if the pelvis stays
• Press hand and foot into • Keep the pelvis level
level
the floor for Posterior • Spine can be flexed or
Toe Taps Oblique Sling neutral
• Marching and Toe Taps Dead Bug Bridge with Marching
Introduce the idea of • Teaches coordination of the
lumbopelvic stability upper and lower body in
• The goal is to keep the
stability contralateral patterns pelvis level
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Trunk Integration – Lumbopelvic Stability Trunk Integration – Lumbopelvic Stability Trunk Integration – Lumbopelvic Stability
Lumbopelvic Stability Exercises Lumbopelvic Stability Exercises Lumbopelvic Stability Exercises
Opposite Arm and Leg Plank Swimming
Reach • Provides a quick
• Provides a quick assessment assessment of all 4 outer • One arm
of all 4 outer units. units.
• Deep longitudinal system – • Deep longitudinal system • Alternating arms
Line from head to tail – Line from head to tail • One leg
• Anterior and posterior • Anterior and posterior
oblique slings – stability of oblique slings – stability of • Alternating legs
shoulders and pelvis shoulders and pelvis
• Lateral system – note
• Opposite arm and
• Lateral system – note lateral
sway of hips lateral sway of hips leg
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Trunk Integration – Lumbopelvic Stability Trunk Integration – Lumbopelvic Stability Trunk Integration – Spinal Mobility
Lumbopelvic Stability Exercises Lumbopelvic Stability Exercises The Purpose of the Spine
Standing Diagonal Walking
Press • Keep the pelvis
level. • Creating efficient force
• Keep the pelvis level. Takes transfer between the ground,
the supine work into a • Observe the counter The lower body and upper body.
functional position. rotation of the torso purpose • Protecting and organizing the
and pelvis. spinal cord and nerve roots
of the • Maintaining good posture.
Standing Marching Running spine • Creating spinal mobility for
efficient, effective and
• Observe what graceful movement patterns
• Keep the pelvis level. Takes happens with speed
the supine work into a
functional position
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Trunk Integration – Spinal Mobility Trunk Integration – Spinal Mobility Trunk Integration – Spinal Mobility
Movements of the Spine Spinal Anatomy Anatomy of a Vertebra
The spine is composed of 5 interconnected segments Spinous process

Cervical 7 small vertebrae connecting the head to Inferior Lamina

Spine the spine facet Superior facet
Flexion Extension
Thoracic 12 vertebrae attached through the ribs to
Spine the sternum to form the rib cage Transverse process
Spinal
Mobility Lumbar 5 larger vertebrae to support the weight of Vertebral foramen Pedicle
Spine the body
Lateral Sacrum 5 fused vertebrae to connect the spine and
Rotation Vertebral body
Flexion the pelvis
Coccyx or 3 or 4 fused vertebrae that used to be a tail
tailbone

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Trunk Integration – Spinal Mobility Trunk Integration – Spinal Mobility Trunk Integration – Spinal Mobility
Anatomy of an Intervertebral Disc Muscles of the Spine Muscles that Move the Spine
In addition to the spinal muscles, all of the following muscles are attached to
The disc acts as a cushion and Deep spinal muscles Spinalis the spine and integrate its motion with other areas of the body.
allows movement between the
vertebrae. • Rotatores Diaphragm Latissimus dorsi
• Multifidi • Connects spine to the inside of the • Connects humerus, scapula, spine and
ribcage. pelvis
It is a common source of injury Erector spinae Iliocostalis
Abdominals Trapezius
in lower back problems. • Spinalis
Longissimus • Connect rib cage, spine (through fascial • Connects head, spine, scapula and clavicle
connections of TA and Internal Oblique)
• Longissimus and pelvis

• Iliocostalis Psoas major

• Connects spine to femurs

Quadratus lumborum
• Connects rib cage, spine and pelvis
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Trunk Integration – Spinal Mobility Trunk Integration – Lumbopelvic Stability Trunk Integration – Lumbopelvic Stability
Muscles that Move the Pelvis and affect the Spine Abdominal Strengthening Internal oblique
Hip Extensors Abdominal strength is important for: • Cartilage of ribs
Origin: 10-12, linea alba,
• Creating a strong, stable and balanced lumbodorsal fascia
Hip Flexors torso.
• Generating power in athletic activities
such as golf, tennis, swimming and
Hip Abductors dancing. • Iliac crest, lateral
Insertion: third of inguinal
Abdominal strength starts with the core or
Hip Adductors inner unit but the inner unit does not
ligament
move the torso. In order to create
movement the remaining abdominals must
Hip Lateral Rotators be engaged. These are: • Torso flexion,
• Internal oblique abdominal Action: ipsilateral torso
• External oblique abdominal rotation
• Rectus abdominis
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Trunk Integration – Lumbopelvic Stability Trunk Integration – Lumbopelvic Stability Trunk Integration – Spinal Mobility
External oblique Rectus abdominis Spinal Mobility Exercises
• Outer ribs 5-12 • External surfaces All Fours Cat/Cow
interdigitating with
Origin: Serratus anterior, linea Origin: of ribs 5-7, xiphoid • Observe thoracic flexion
alba process, linea alba • Lumbar extension
• Integration of pelvis and lumbar
• Integration of the head and cervical
spine
• Iliac crest, lateral third • Superior surface
Insertion: of inguinal ligament Insertion: Tail Wag
of pubic symphysis
• Observe lateral flexion
• Integration of spine, pelvis and hips
in lateral flexion
• Torso flexion, • Integration of the head and cervical
Action: contralateral torso Action: • Trunk flexion spine
rotation • Range of motion of the hips in
rotation.

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Trunk Integration – Lumbopelvic Stability Trunk Integration – Spinal Mobility Trunk Integration – Spinal Mobility
Spinal Mobility Exercises Spinal Mobility Exercises Spinal Mobility Exercises
Thoracic Extension (Rockets) Standing Roll Down
Abdominal Curls
• Focus on the upper back
• Lift the head from the • Maintain abdominal support • Segmental articulation of
torso. the spine
Thoracic Extension (Mini Swan)
• Observe the difference • Bend the knees if
between keeping the pelvis • Focus on the upper back. necessary
neutral and allowing a • Lift the chest, press into the pinky side
posterior tilt. of the hand and slide the shoulder
blades down the back.
Standing Flexion
Oblique Abdominal
Curls Back Extension/Swan • Where does the flexion
come from?
• Focus on rotation around • Spread the extension out over the
the midline rather than whole spine. • Does the pelvis
lateral flexion. • Observe mobility in all segments. participate
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Trunk Integration – Spinal Mobility Trunk Integration Trunk Integration

Spinal Mobility Exercises Standing Exercise Sequence Standing Spinal Mobility Sequence

Standing Extension

Standing Lateral
Flexion
Standing Multifidi Multifidi – One Sided Standing Diagonal Reach Standing Marching

Standing Standing

Standing Rotation Standing Roll Down

Extension Rotation

Standing
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Flexion
Squats Knee Bends

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Trunk Integration
Module 2: Key Principles Balanced Body Movement Principles Balanced Body Movement Principles

Whole Body Movement (√)

Breathing
Trunk Integration (√)
Core work
• Transverse Abdominis, Multifidi, Pelvic Floor, Diaphragm
Moving on to Lower Body
Lower Body Training
Outer unit or lumbopelvic stability Training!
• Anterior Oblique Sling, Posterior Oblique Sling, Deep Longitudinal
System, Lateral System Upper Body Training
Spinal mobility
• Spinal rotation, lateral flexion, flexion and extension
Mobility and Restoration
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Trunk Integration – Lumbopelvic Stability Trunk Integration – Lumbopelvic Stability Trunk Integration – Lumbopelvic Stability
Deep Longitudinal System Anterior Oblique Sling Posterior Oblique Sling
• Includes the serratus anterior, • The posterior oblique
• The deep longitudinal system external oblique abdominal, sling includes, along one
includes the erector spinae, Anatomy: opposite internal oblique
line, the latissimus dorsi,
quadratus lumborum, thoracodorsal abdominal and opposite Anatomy: opposite gluteus
fascia, sacrotuberous ligament and
Anatomy: the biceps femoris. In the Anatomy
adductor muscles.
maximus and opposite
Trains system, it also includes the external hip rotators.
medial hamstrings, gastrocnemius,
plantar fascia and toe flexors.
• Creates torso flexion and torso
Function: rotation as in the Crisscross
• The posterior oblique
exercise.
sling creates torso
extension and rotation
Function: as well as pelvic stability
• This system creates spinal extension
Function: and holds us upright against gravity.
Instrumental in creating pelvic as in the many Swan
exercises.
stability in exercises like walking.
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Trunk Integration – Lumbopelvic Stability Trunk Integration – Lumbopelvic Stability Trunk Integration – Lumbopelvic Stability
Lateral System Adductors Abductors
• The Lateral System • Superior pubic ramus,
includes the hip Origin: inferior pubic and
Anatomy: abductors, hip adductors
Origin: • Ilium and sacrum
and the quadratus ischial ramus.
lumborum.

• Linea aspera on the • Greater trochanter,

• Responsible for keeping
the pelvis balanced over
Insertion: posterior thigh, medial Insertion: posterior thigh and ITB
tibia (gracilis only) (gluteus maximus only)
Function: the femurs when walking,
running or balancing on
one leg.
• Hip abduction,
• Hip adduction, flexion,
Imbalances lead to an unlevel Action: extension, rotation.
Action: extension, flexion
rotation.
pelvis when standing on both legs.
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Trunk Integration – Lumbopelvic Stability Bony Landmarks

Lumbar Vertebra
Lateral System Imbalances Primary actions: Flexion, lateral flexion, extension.
Rotation is extremely limited.

High hip Low hip

(pelvic upslip) (pelvic downslip)
• Abductor is long • Abductor is
• Adductor is short
short • Adductor is long
• Quadratus • Quadratus
lumborum is lumborum is
short
long
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Cervical Vertebra Axis (C-2)

Thoracic Vertebra
Primary actions: Flexion, extension, lateral flexion, Primary action: Rotation!
Primary actions: Flexion, lateral flexion,
rotation. Extension is somewhat limited. rotation

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Atlas (C-1) Trunk Integration – Spinal Mobility

The atlas is the first cervical vertebra. In classical Greek
mythology Atlas held up the world. In our spine the Atlas
holds up our head! Sort of the same thing, really.
Ranges of Motion in the Spine
Primary action: Flexion, extension, slight lateral flexion

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