Jan. 4, 2006

Shawn Hendi, MS, ATC University of Maryland Sports Medicine

The physical demands that sports place on the body vary depending on the intensity and duration of the activity. Universally, however, sports place a greater demand on high school, collegiate and professional athletes than your average "weekend warrior". That being said, core conditioning can be used by elite level athletes and "weekend warriors" alike in an effort to maximize performance and decrease incidence of injury. There are many approaches to injury prevention in the sports medicine profession today. Core conditioning has gradually been receiving more attention in the past few years. This theory combines the strengthening and flexibility of the core, including but not limited to the back, abdominal and hip muscles.

With elite level swimmers swimming up to 20,000 yards/meters per day in training sessions, overuse injuries frequently occur. This makes for a long season for the athlete, coaches and the sports medicine staff. During our time working with the University of Maryland swimming and diving team, we have seen an increase in the overuse shoulder injuries as the practice and competition demands have hit an all time high. In response to this, we have begun to incorporate flexibility programs, along with core and shoulder stabilization exercises. Core conditioning has been proven to improve muscular power, kinesthetic awareness, flexibility, posture and aid in injury prevention.

The goal of this article is to share some of the techniques we use on our swimmers and divers as well as other teams we cover. Exercises included in this article include scapular stabilization and core strengthening. Hamstring flexibility should be integrated into the rehabilitation program. Hip flexor, quadriceps, iliotibial band, abdominal and low back stretching should not be ignored and would benefit being incorporated into weekly sessions.

Core conditioning and flexibility is but one cog in the wheel of injury prevention, but one that is often overlooked. A full evaluation should be completed before a rehabilitation program includes these exercises. These exercises should be performed with the supervision of an ATC or PT in an otherwise healthy individual with no major medical concerns.

Core 1 (Wall sit-ups)

Starting
Lay with your back on the floor.
Put your buttocks on the wall and put your feet together on the wall (so your body looks like the letter "L").
Place your hands above your head.

Action
Tighten your abdominals and touch the outside of your left foot with both hands.
Go back to the starting position.
Tighten your abdominals and go straight up and touch both feet with both hands.
Go back to the starting position.
Tighten your abdominals and touch the outside of your right foot with both hands.
Go back to the starting position.

Core 2 (Touch and go's)

Starting
Have the person assume the standard sit-up position with their hands above their head on the ground.
Have a partner stand over them holding their legs by squeezing their legs.  They should have a ball (medicine ball, kick ball in their hands).

Action
Have the person in the sit-up position touch where every the ball goes.  Go back down to the ground once they touch the ball.
The partner keeps moving the ball around in the air, hold it in the position.

Core 3
 
Starting
Lie on the floor with your forearms supporting the upper body and feet as if you are in push-up position.

Action
In a sequence, lift the left arm off the mat above the head and hold for a count.  Return the left arm to the mat and raise the right arm.  Return the right arm to the mat and lift the left leg.  Return the left leg and lift the left leg.  Repeat as many times as needed.  In a variation, as this exercise becomes too easy, you may incorporate the superman sequence where you lift the left leg and right arm and then the right leg and left arm. 

Shoulder Stabilization 1 (Pinches)

Starting
Lay on your stomach with your shoulder hanging over the table.

Action
Pinch your scapula back to the spine and hold for 5 seconds then relax.

Shoulder Stabilization 2 (Pinches with movement)

Starting
Lay on your stomach with your shoulder hanging over the table.

Action 1
Pinch your scapula back to the spine and holds, then pointing your thumb inward have the person flex (forward) their shoulder.

Action 2
Pinch your scapula back to the spine and holds, then pointing your thumb outward have the person extend (backwards) their shoulder.

Shoulder Stabilization - Scapular Protraction / Retraction

Starting
Lay with back flat on the table.

Action 1
With a dumbbell weight (or no weight at all), raise arms perpendicular to the floor and gently lift the shoulder blade off the table reaching for the ceiling and hold for 3 seconds.  Return to neutral.

Action 2
With weight (or no weight in hand), gently squeeze the shoulder blades together.  Hold for 3 seconds and return to neutral.

These exercises should be used as a guide and are just a few of several exercises that may help with low back pain. As progression through basic core strengthening and flexibility continues, the program should become tailored to the specific sport. An example of this can be seen when you break down the butterfly swim stroke into three phases. Phase I would involve the "cocking" of the stroke where scapular retraction occurs. Phase II would consist of the scapula returning to a neutral position with concentration of contraction and isolation of the abdominal muscles. Phase III would finish the stroke with the follow through where scapular protraction happens. Core conditioning should aim at strengthening the different phases of the stroke without ignoring a proper stretching protocol. Selecting a phase and having the athlete hold that position while doing a particular exercise is optimal in making the rehabilitation sports specific. Modifications should be made as needed in order for the athlete to be successful during rehabilitation sessions. Core conditioning can range in difficulty depending on sport specific techniques, creativity, previous experience in dealing with different injuries and supplies available.

As you can see, there are variations from very basic to very complex core conditioning exercises, but regardless of the "degree of difficulty" all could be beneficial in the overall conditioning of the athlete. We, at the University of Maryland, have been fortunate enough to recently hire a rehabilitation coordinator who has physical therapist and athletic training credentials who firmly believes in this concept as part of rehabilitation protocols and injury prevention. Working hand in hand under our team physicians protocols have proven to be most successful in returning our athletes in better condition and ready to meet the demands of their respective sports.