The core... time to demystify

Thanks to Taryn Watson, one of Southcare’s Continence and Women’s Health Physiotherapists, we thought it was time to demystify the “CORE”. We hope you enjoy this blog on all things abdominal.

With the recent popularity of pilates, the term ‘the core’ has become wide spread. When taken in the true sense of the term, it should involve activation of the pelvic floor muscles (PFM) and the deep abdominal muscles such as the transverse abdominus (TA).

Despite popular belief, your six pack muscle (more correctly termed the Rectus Abdominis or RA) is not your core. Neither are the two layers of obliques underneath this. They are ‘power’ muscles, and help to move your trunk, and while very important, they do not have a supportive function like the PF and TA. In fact, while the PF and TA muscles have an upward, inward motion when contracting correctly, the RA and obliques create a downward and often outward force in the abdomen.

Why is the ‘core’ so important?

The upward and inward action of the ‘core’ is very important in gynaecological and urological health. We know from research that this action of the PF, which is assisted by the TA, prevents the pelvic organs from descending (known as pelvic organ prolapse), prevents our bladder and bowel from leaking (called incontinence) and helps to support the lower part of the spine and the pelvis.

Recent research on women has shown that it is possible to manage (or even better to prevent) incontinence and prolapse by exercising the ‘core’ muscles regularly, if done under the guidance of a Women’s Health and Continence Physiotherapist (Hagen et al 2014, Neumann et al 2005).

How do you exercise your ‘core’?

The main way to exercise these muscles is to do regular pelvic floor exercises (or ‘Kegels’), which involves a squeeze and a lift around the back passage, front passage and the vagina. This should not be visible from the outside, except for maybe a subtle indraw of the lower abdomen as the TA muscles come in to assist the PF. Ideally you should be doing a few sets of these a day, but there is no ‘recipe’. A Women’s Health & Continence Physiotherapist can give you an individualised program depending on what you can do after they check with an abdominal ultrasound, or in some cases a vaginal or rectal examination.

These exercises can be done in any position – standing, sitting, lying down – and the physiotherapist can show you how to incorporate this into your other workouts. Pilates-type exercises can complement the basic PF exercises, and this is where ‘Core training’ comes into play.

In reality, unfortunately, what is advertised as ‘core training’ exercises in many gym programs are double straight leg raises and heavy medicine ball work that actually cause an over-recruitment of the superficial ‘power’ abdominal muscles and completely override the more subtle, deeper muscles. When a Women’s Health & Continence Physiotherapist assesses the pelvic floor, the bearing down and bulging into the pelvic floor during these exercises is often evident. Externally this can also be obvious, with abdominal doming and breath holding occurring. Sit ups, double leg raises and planks may eventually have their place in a safe work out – but they are definitely NOT the starting point for Core Training.

What can go wrong if ‘core training’ is done incorrectly?

People often only realize that these exercises have been inappropriate when something goes wrong. This may be in the form of a musculoskeletal issue such as a lumbar disc injury, in the form of an abdominal issue such as an umbilical hernia, or in the form of a urological/gynaecological issue such as a vaginal prolapse or urinary incontinence. All of these are essentially caused by the same issue – repetitive high intra-abdominal pressure that exceeds what can be matched by the deep supporting muscles such as the pelvic floor.

So in summary – question what you are told in a gym class is a ‘Core’ exercise. Is it really, or are you just recruiting your upper abdominal muscles and pushing everything outwards? Do you want abdominal muscles that draw inwards and are flat, or abdominal muscles that push outwards? And more importantly, do you want your insides to be pushed downwards into your pelvic floor during a work out (like the chicken in the picture)? Probably not.

Seek help from a Women’s Health and Continence Physiotherapist if you wish to learn more about how to correctly exercise your core.

Hagen et al (2014), Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY): a multicenter randomized controlled trial, The Lancet, 383 (796-806).

Neumann PG, K. Grant, R. Gill, V (2005) Physiotherapy for female stress urinary incontinence: a multicentre observational study. Australian and New Zealand Journal of Obstetrics and Gynaecology;45(226-232)