Does your daughter do core conditioning? READ THIS…

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Dear Coach….

February 12th 2013

Dear Coach,

We have been sampling gymnastics facilities to look for a program where the coaching staff seemed to understand that 99% of the kids participating would excel and grow through participation, but ultimately would not be Olympians. No coaches barking out orders or “punishing” kids for mistakes along their individual physical learning curves. Overall, I was impressed by your program and it seemed to fit the bill. Your staff seemed to have a good balance between fun, developmentally appropriate challenge, practicing old skills and safely learning new ones. Until it came to “strength training” at the end of their session. **

In addition to wearing my mom hat, I am also a women’s sports medicine physical therapist that specializes in returning women to fitness and sport after injury and pregnancy. This area of focus demands that I understand and keep up with emerging research about the core, how it develops in girls, how to recover it after injury. I have some concerns I wanted to pass on about the messaging the coach communicated to the girls (9-12) about their cores. The coach asked the girls to feel their abdomens and determine if they were “soft, hard, or somewhere in the middle”. He told them it should be hard and he wanted them to have “strong cores”. He then proceeded to ask them to perform a series of planks and high reps of a few variations of crunches.

He is not alone in this widely accepted understanding that strong abs define a “good” or “strong” core. However, this information, while still the standard of training and sport, is rapidly becoming outdated. Please accept this not as a disparagement of him or the program, but an opportunity to share with you and your staff how a decade or so of research is transforming our understanding of how we create a strong sturdy center that anchors all of our movements. Trust me I have done my share of abdominal work with clients, this emerging evidence often makes me wish I could turn back time.

Turns out a strong center does not rely on strengthening any one muscle group alone. Instead, we now understand that central stability, is actually about balancing the pressures inside the abdominal cavity. This is achieved through the teamwork of all the muscles surrounding that cavity from deep to superficial. I think of this pressure system inside the abdomen as an air-filled balloon.

Balanced pressure sytem (IAP)

Balanced pressure sytem (IAP)
Balanced pressure system

Imagine squeezing the balloon in the middle, just like the pressure a sustained abdominal hold would create. The causes the air in the balloon to shift up, out the top, and down, out the bottom.

Abs statically held alters the pressure system

Abs statically held alters the pressure system

This means the diaphragm above and pelvic floor below must alter their function to meet this change in the pressure system. For the diaphragm this results in a change in breathing patterns, including breath holding, to meet stability challenges, and reduced respiratory capacity. These scenarios will create an issue for sustained respiratory support for endurance in athletics. The pelvic floor may not be able to match the excessive pressure from above, which can lead to incontinence. We are growing in our awareness of the magnitude of the issue of leaking during sport among elite (and not so elite) female athletes (read more here). Alternatively, over-recruitment of the pelvic floor to try to match the pressure from above, can lead to pelvic, low back and/or hip pain.

Alternative models are emerging that don’t sacrifice a strong abdominal wall, diaphragm or pelvic floor function. Instead they train the abs along side and in a balanced way with the other muscles that keep our air filled balloons the right shape, not excessively pushed in one direction over another.

In addition, over-reliance and training of one muscle group also changes postural alignment. We are growing in our understanding of which positions optimally recruit the muscles at our center (1,2). Overused abdominals result in bums tucking under and the lower spine flattening, which results in a less than optimal position of recruitment for the pelvic floor, deep abs, and specific spinal muscles. Respiratory pattern changes necessitated by abdominal overuse often results in a high chested position that shifts the ribcage to the back. Both of these alignment shifts will change the shape and position of our balloon. This alters our central stability and forces compensations that will impact quality of movement, balance, muscle recruitment and strength, endurance and vulnerability of injury (3,4).

This information is important for all levels and ages of athlete to understand. However, it is critical that we start our younger athletes in particular off on the right foot. We are shaping their physical future. For the girls my daughters age through their teens we are quite literally “shaping” them as they begin to develop through puberty. We can guide that physical growth and change with the great information at our disposal or hamper it.

Here are some tips and ideas to use this emerging information on central stability to enhance your already great program. First, no more crunches! They encourage an overtraining of the abs, excessive pressure in the middle of our balloons, alter alignment, and additional studies (5) have shown excessively create pressure on low back discs and structures over time. Planks, in good alignment (see pictures below) that keep the bum untucked and ribs not excessively swayed back, are a better trainer of the postural system as a whole.

good plank
Aligned plank

plank tucked
Plank with bum tucked (No!)

Plank belly slouch

Plank belly slouch
Plank with ribs swayed back, abdomen slouching (No! No!)

Having said that we must consider how kids develop best….they were designed to strengthen through play! Isn’t a handstand in good alignment essentially an inverted plank? A cartwheel is just a plank in motion. And really let’s be honest, both are a lot more fun. Maintaining balance on a beam while performing a quick jump with good form demands a lot from that central stability system and trains it in a functional and fun way….no added strengtheing necessary. Balance games in good alignment at the end of the session will do more to strengthen their centers in a meaningful way than 100‘s of crunches or planks.

Good alignment is the common denominator to making these fun tasks a healthy challenge to the central stabilizers. So rather than encouraging a tummy hold during these tasks, asking them to untuck their bums and stack their ribs over their pelvis’ gives their balloons a fighting chance to create deep central stability. This added attention to form increases the challenge, and it trains the postural system in a good alignment that will then be reinforced in their day to day movements. This will encourage some serious inner strength all day, not just during a 5-minute set of crunches. Breathing while performing activities, versus breath holding, will also help them to maintain the appropriate balance of pressures on our balloons. Breath holding as they try to learn a new skill is normal but they should ultimately be able to move beyond that as they master the task. Or the task needs to be modified so they can perform it without the need to hold their breath.

Finally, let’s consider the message we are sending the girls at such a young age about their shape and level of abdominal ‘softness’. They have a lifetime ahead of being self-conscious, culturally bombarded with images of physical perfection and made to feel like they are less beautiful than a stick thin model. Let’s challenge these notions from the get-go with positive talk about strength, health, fitness, and stability over words like soft or hard abs.

Again, please do not read this as an attack on your program, but rather I really do come in peace. My ultimate goal is to combine fun and fitness for my girl and all girls without expecting them to have grown-up programs that expect “hard abs” at 9-12. I understand this is relatively new information and we are all on a steep learning curve how best to apply it and build age appropriate programs around it. Working together we could build a healthy (physically and emotionally) generation of girls. I would be more than happy to answer any question you or your staff may have as you try to assimilate this information.

Let me know if I can be of any further assistance.

Julie Wiebe, PT

**Some detail of our experiences in this pursuit have been modified to generalize the information for the purposes of this blog. However, the statement of the coach is accurate.
1.McDonald D, Moseley GL, Hodges PW. Why do some patients keep hurting their back? Evidence of ongoing back muscle dysfunction during remission from recurrent back pain. Pain. 2009; 142: 183-188.
2.Sapsford RR, Richardson CA, Maher CF, Hodges PW. Pelvic floor muscle activity in different sitting postures in continent and incontinent women. Arch Phys Med Rehabil. 2008;89(9):1741-1747.
3.Hodges PW, Gandevia SC. Changes in intra-abdominal pressure during postural and respiratory activation of the human diaphragm. J Applied Physiol. 2000;89:967-976.
4.Smith MD, Coppieters MW, and Hodges PW. Is balance different in women with and without stress urinary incontinence? Neurouro Urodyn. 2008; 27, no. 1: 71-78.
5.McGill, S. Low Back Disorders, Evidence-Based Prevention and Rehabilitation, 2nd Edition. (p. 44-47) Human Kinetics (2007)

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