Functional Therapeutic and Core Strengthening

  • Gerard A. MalangaEmail author
  • Steve M. Aydin
  • Eric K. Holder
  • Ziva Petrin


The “Core” is a generalized term used to describe the complex three-dimensional matrix of bones, ligaments, fascia, and muscles that provides stability to the spine, allows for motion in multiple planes, and enables the generation and transference of energy during movement. In fact, a strong, balanced, and controlled core is essential to providing stability and proper alignment of not only the thoracolumbar spine, but also the hip, pelvis, sacrum as well as distal limb structures. Core stability is an integral component of the concept of the kinetic chain, which describes the efficient interconnection of musculoskeletal motion, energy, and transference of force from the limbs to the trunk. It has been postulated that optimal sports performance is intimately related to the athlete’s core strength, endurance, coordination, flexibility, balance and is an ongoing area of further investigation. The medical literature supports the importance of a strong, balanced core in the prevention of injury. Thus, targeted exercises to promote neuromuscular re-education in athletes with evidence of core dysfunction are crucial to preventing and treating injury, optimizing functionality, and promoting athletic longevity.


Core strength Core musculature Core exercises Core dysfunction Kinetic chain Core stabilization Core neuromuscular control 


  1. 1.
    Nadler SF. Visual vignette: injury in a throwing athlete: understanding the kinetic chain. Am J Phys Med Rehabil. 2004;83(1):79.CrossRefPubMedGoogle Scholar
  2. 2.
    Schuenke M, et al. Thieme atlas of anatomy, general anatomy and musculoskeletal system. New York: Thieme; 2006.Google Scholar
  3. 3.
    Netter FH. Atlas of human anatomy. 2nd ed. Canada: Icon Learning Systems LLC; 2001.Google Scholar
  4. 4.
    Akuthota V, Nadler SF. Core strengthening. Arch Phys Med Rehabil. 2004;85:S86–92.CrossRefPubMedGoogle Scholar
  5. 5.
    Norris CM. Abdominal muscle training in sport. Br J Sports Med. 1993;27(1):19–27.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Callaghan JP, Patla AE, McGill SM. Low back three-dimensional joint forces, kinematics, and kinetics during walking. Clin Biomech (Bristol, Avon). 1999;14:203–16.CrossRefGoogle Scholar
  7. 7.
    Barr KP, Griggs M, Cadby T. Lumbar stabilization: core concepts and current literature, part 1. Am J Phys Med Rehabil. 2005;84:473–80.CrossRefPubMedGoogle Scholar
  8. 8.
    Barr KP, Griggs M, Cadby T. Lumbar stabilization: a review of core concepts and current literature, part 2. Am J Phys Med Rehabil. 2007;86:72–80.CrossRefPubMedGoogle Scholar
  9. 9.
    Nadler SF, Malanga GA, DePrince M, et al. The relationship between lower extremity injury, low back pain, and hip muscle strength in male and female college athletes. Clin J Sport Med. 2000;80:89–97.CrossRefGoogle Scholar
  10. 10.
    Nadler SF, Malanga GA, Feinberg JH, et al. Relationship between hip muscle imbalance and occurrence of low back pain in collegiate athletes: a prospective study. Am J Phys Med Rehabil. 2001;80:572–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Nadler SF, Malanga GA, Bartoli LA, et al. Hip muscle imbalance and low back pain in athletes: influence of core strengthening. Med Sci Sports Exerc. 2002;34:9–16.CrossRefPubMedGoogle Scholar
  12. 12.
    Bliss LS, Teeple P. Core stability: the centerpiece of any training program. Curr Sports Med Rep. 2005;4:179–83.CrossRefPubMedGoogle Scholar
  13. 13.
    Keankaampaa M, Taimela S, Laaksonen D, et al. Back and hip extensor fatigability in chronic low back pain patients and controls. Arch Phys Med Rehabil. 1998;79:412–7.CrossRefGoogle Scholar
  14. 14.
    Beckman SM, Buchanan TS. Ankle inversion injury and hypermobility: effect on hip and ankle muscle electromyography onset latency. Arch Phys Med Rehabil. 1995;76:1138–43.CrossRefPubMedGoogle Scholar
  15. 15.
    DeVita P, Hunter PB, Skelly WA. Effects of a functional knee brace on the biomechanics of running. Med Sci Sports Exerc. 1992;24:797–806.PubMedGoogle Scholar
  16. 16.
    Panjabi M. The stabilizing system of the spine: I. function, dysfunction, adaptation and enhancement. J Spinal Disord. 1992;5:383–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Vleeming A, Pool-Goudzwaad AL, Stoeckart R, et al. The posterior layer of the thoracolumbar fascia: its function in load transfer from spine to legs. Spine. 1995;20:753–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Solomonow M, Zhou B, Harris M, et al. The ligamento-muscular stabilizing system of the spine. Spine. 1998;23:2552–62.CrossRefPubMedGoogle Scholar
  19. 19.
    Juker D, McGill S, Kropf P, Steffen T. Quantitative intramuscular myoelectric activity of lumbar portions of psoas and the abdominal wall during a wide variety of tasks. Med Sci Sports Exerc. 1998;30:301–10.CrossRefPubMedGoogle Scholar
  20. 20.
    Hodges PW, Richardson CA. Delayed postural contraction of transversus abdominis in low back pain associated with movement of the lower limb. J Spinal Disord. 1998;11:46–56.CrossRefPubMedGoogle Scholar
  21. 21.
    Youdas JW, Boor MM, Darfler AL, Koenig MK, Mills KM, Hollman JH. Surface electromyographic analysis of core trunk and hip muscles during selected rehabilitation exercises in the side-bridge to neutral spine position. Sports Health. 2014;6(5):416–21.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Huxel Bliven KC, Anderson BE. Core stability training for injury prevention. Sports Health. 2013;5(6):514–22.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Ambegaonkar JP, Mettinger LM, Caswell SV, Burtt A, Cortes N. Relationships between core endurance, hip strength, and balance in collegiate female athletes. Int J Sports Phys Ther. 2014;9(5):604–16.PubMedPubMedCentralGoogle Scholar
  24. 24.
    Gordon AT, Ambegaonkar JP, Caswell SV. Relationships between core strength, hip external rotator muscle strength, and star excursion balance test performance in female lacrosse players. Int J Sports Phys Ther. 2013;8(2):97–104.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Filipa A, Byrnes R, Paterno MV, Myer GD, Hewett TE. Neuromuscular training improves performance on the star excursion balance test in young female athletes. J Orthop Sports Phys Ther. 2010;40(9):551–8.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Zazulak BT, Hewett TE, Reeves NP, Goldberg B, Cholewicki J. Deficits in neuromuscular control of the trunk predict knee injury risk: a prospective biomechanical-epidemiologic study. Am J Sports Med. 2007;35(7):1123–30.CrossRefPubMedGoogle Scholar
  27. 27.
    Saal JA. Dynamic muscular stabilization in the nonoperative treatment of lumbar pain syndromes. Orthop Rev. 1990;19(8):691–700.PubMedGoogle Scholar
  28. 28.
    Hicks GE, Fritz JM, Delitto A, McGill SM. Preliminary development of a clinical prediction rule for determining which patients with low back pain will respond to a stabilization exercise program. Arch Phys Med Rehabil. 2005;86(9):1753–62.CrossRefPubMedGoogle Scholar
  29. 29.
    Wang XQ, Zheng JJ, Yu ZW, Bi X, Lou SJ, Liu J, Cai B, Hua YH, Wu M, Wei ML, Shen HM, Chen Y, Pan YJ, Xu GH, Chen PJ. A meta-analysis of core stability exercise versus general exercise for chronic low back pain. PLoS One. 2012;7(12), e52082.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Stuber KJ, Bruno P, Sajko S, Hayden JA. Core stability exercises for low back pain in athletes: a systematic review of the literature. Clin J Sport Med. 2014;24(6):448–56.CrossRefPubMedGoogle Scholar
  31. 31.
    Waldhelm A, Li L. Endurance tests are the most reliable core stability related measurements. J Sport Health Sci. 2012;1(2):121–8.CrossRefGoogle Scholar
  32. 32.
    Shinkle J, Nesser TW, Demchak TJ, McManus DM. Effect of core strength on the measure of power in the extremities. J Strength Cond Res. 2012;26(2):373–80.CrossRefPubMedGoogle Scholar
  33. 33.
    Fredericson M. A systematic approach to core strengthening for improved athletic improvement. Lecture handout, 2007.Google Scholar
  34. 34.
    Gilchrist RV, Frey ME, Nadler SF. Muscular control of the lumbar spine. Pain Physician. 2003;6:361–8.PubMedGoogle Scholar
  35. 35.
    McGill SM, Childs A, Liebenson C. Endurance times for low back stabilization exercises: clinical targets and training from a normal database. Arch Phys Med Rehabil. 1999;941–44.Google Scholar
  36. 36.
    Okada T, Huxel KC, Nesser TW. Relationship between core stability functional movement and performance. J Strength Cond Res. 2011;25(1):252–61.CrossRefPubMedGoogle Scholar
  37. 37.
    Mills JD, Taunton JE, Mills WA. The effect of a 10 week training regimen on lumbo-pelvic stability and athletic performance in female athletes: a randomized controlled trial. Phys Ther Sport. 2005;6:60–6.CrossRefGoogle Scholar
  38. 38.
    Cook G. Baseline sports-fitness testing. In: Foran B, editor. High performance sports conditioning. Champaign: Human Kinetics; 2001. p. 19–47.Google Scholar
  39. 39.
    Cook G. Weak links: screening an athlete’s movement patterns for weak links can boost your rehab and training effects. Train Cond. 2002;12:29–37.Google Scholar
  40. 40.
    Reed CA, Ford KR, Myer GD, Hewett TE. The effects of isolated and integrated ‘core stability’ training on athletic performance measures: a systematic review. Sports Med. 2012;42(8):697–706.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Hill J, Leiszler M. Review and role of plyometrics and core rehabilitation in competitive sport. Curr Sports Med Rep. 2011;10(6):345–51.CrossRefPubMedGoogle Scholar
  42. 42.
    Prieske O, Muehlbauer T, Borde R, Gube M, Bruhn S, Behm DG, Granacher U. Neuromuscular and athletic performance following core strength training in elite youth soccer: Role of instability. Scand J Med Sci Sports. 2015;6.Google Scholar
  43. 43.
    Hibbs AE, Thompson KG, French DN, Hodgson D, Spears IR. Peak and average rectified EMG measures: which method of data reduction should be used for assessing core training exercises? J Electromyogr Kinesiol. 2011;21:102–11.CrossRefPubMedGoogle Scholar
  44. 44.
    Martuscello JM, Nuzzo JL, Ashley CD, Campbell BI, Orriola JJ, Mayer JM. Systematic review of core muscle activity during physical fitness exercises. J Strength Cond Res. 2013;27(6):1684–98.CrossRefPubMedGoogle Scholar
  45. 45.
    Yun K, Lee S, Park J. Effects of closed chain exercises for the lumbar region performed with local vibration applied to an unstable support surface on the thickness and length of the transverse abdominis. J Phys Ther Sci. 2015;27(1):101–3.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Bolgla L, Cook N, Hogarth K, Scott J, West C. Trunk and hip electromyographic activity during single leg squat exercises do sex differences exist? Int J Sports Phys Ther. 2014;9(6):756–64.PubMedPubMedCentralGoogle Scholar
  47. 47.
    Calatayud J, Borreani S, Martin J, Martin F, Flandez J, Colado JC. Core muscle activity in a series of balance exercises with different stability conditions. Gait Posture. 2015;42(2):186–92.CrossRefPubMedGoogle Scholar
  48. 48.
    Granacher U, Schellbach J, Klein K, Prieske O, Baeyens JP, Muehlbauer T. Effects of core strength training using stable versus unstable surfaces on physical fitness in adolescents: a randomized controlled trial. BMC Sports Sci Med Rehabil. 2014;6(1):40.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Akuthota V, Ferreiro A, Moore T, Fredrickson M. Core stability exercise principles. Curr Sports Med Rep. 2008;7(1):39–44.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Gerard A. Malanga
    • 1
    Email author
  • Steve M. Aydin
    • 2
  • Eric K. Holder
    • 3
  • Ziva Petrin
    • 3
  1. 1.New Jersey Sports MedicineLLC, Rutger’s School of MedicineCedar KnollsUSA
  2. 2.Department of Physical Medicine and RehabilitationMusculoskeletal Medicine at Manhattan Spine and Pain Medicine, Northwell Health – Hofstra School of MedicineNew YorkUSA
  3. 3.Department of Physical Medicine and RehabilitationThomas Jefferson University HospitalPhiladelphiaUSA

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