'The core': understanding it, and retraining its dysfunction.

"Core stability training" is popular in both the therapeutic and fitness industries but what is actually meant and understood by this concept? And does everyone need the same training approach? This paper examines the landscape of 'the core' and its control from both a clinical and research perspective. It attempts a comprehensive review of its healthy functional role and how this is commonly changed in people with spinal and pelvic girdle pain syndromes. The common clinically observable and palpable patterns of functional and structural change associated with 'problems with the core' have been relatively little described. This paper endeavors to do so, introducing a variant paradigm aimed at promoting the understanding and management of these altered patterns of 'core control'. Clinically, two basic subgroups emerge. In light of these, the predictable difficulties that each group finds in establishing the important fundamental elements of spino-pelvic 'core control' and how to best retrain these, are highlighted. The integrated model presented is applicable for practitioners re-educating movement in physiotherapy, rehabilitation, Pilates, Yoga or injury prevention within the fitness industry in general.

The pelvic crossed syndromes: a reflection of imbalanced function in the myofascial envelope; a further exploration of Janda's work.

Structurally, the sacrum-coccyx provides the dual roles of serving as the base of the spinal column while also forming part of the pelvic ring. Physiological movement control of the pelvis and the spine are functionally interdependent. In particular, intra-pelvic control, (that between the ilia and sacrum/coccyx in support and control of the forces and small movements within the pelvic ring) is fundamental to controlling its spatial organization as a whole and its control on the femoral heads, all of which directly influence spinal alignment and control mechanisms. This involves coordinated activity in the related neuro-myofascial systems in providing mechanisms of both intrinsic and extrinsic support and control.

A model of movement dysfunction provides a classification system guiding diagnosis and therapeutic care in spinal pain and related musculoskeletal syndromes: a paradigm shift-Part 1.

An integrative functional model largely based upon clinical observation and analysis of the more common features of neuromusculoskeletal-dysfunction encountered in clinical practice is presented as a working hypothesis in Part 1. This endeavours to incorporate contemporary knowledge and practice. The enlightened work of Professor Vladimir Janda has undoubtedly been seminal in the development of this model; however a further evolution of his work is elaborated on in this paper. Thinkers from the human potential movement as well as the scientific community have provided further valuable insights to assist our understanding of function. A related simple classification system of two main clinical subgroups with back pain and related disorders is offered in Part 2. These are based upon the most usual dysfunctional postural and movement strategies. Further distillation provides a number of dysfunction syndromes which will have predictable consequences. This is not a mathematical, computer generated or theoretical biomechanical model. This model describes 'what it is' that we see in our patients, and endeavours to be an overview of the movement related causes of back pain. It provides a clinically useful and practical framework to assist the practitioner in diagnosis and to better understand the development and perpetuation of most spinal pain and related disorders. In so doing, more rational, functional and effective manual and exercise therapy interventions can ensue.

A model of movement dysfunction provides a classification system guiding diagnosis and therapeutic care in spinal pain and related musculoskeletal syndromes: a paradigm shift-Part 2.

An integrative functional model largely based upon the observation and analysis of the more common features of neuromusculoskeletal dysfunction encountered in clinical practice was presented as a working hypothesis in Part 1. The functional inter relationships between these regional and general features and their contribution to the development and perpetuation of local and or referred spinal pain syndromes was explored. Here we look more closely at clinical patterns of presentation. A simple classification system of clinical subgroups with back pain and related disorders is offered. These more commonly observed dysfunctional postural and movement strategies have been distilled into a number of dysfunction syndromes which will have predictable consequences. In beginning to provide a map of the tendencies towards, or actual, changed postural and movement responses seen in people with spinal pain and related disorders, this model provides a valuable reference for those working in the body work and movement therapies realm. It is a practical and useful clinical tool to assist diagnosis and help better understand the development and perpetuation of most spinal pain and related disorders. In so doing, more rational, functional and effective therapeutic and research interventions can ensue.