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Printed at: 02:55:15 / 20-09-2021

Paediatric Musculoskeletal Stability Group

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Aims

The aims of this group is to give you control over your own back care and to give you the knowledge and understanding of how to support and protect your own spine. The emphasis will be to understand and change daily habits that may be contributing to your pain and to build and improve your stability muscles.

This will be achieved by:
• Training your stabilising muscles around your spine to work effectively, known as your “core stability”.
• Increasing your general fitness.
• Increasing the muscle strength of your legs, back and bottom to help support your spine.
• Build your confidence to return to exercise or hobbies.

Expectations
• Please arrive promptly for each session and register at the physiotherapy reception. The physiotherapist will call you in when ready.
• Wear loose comfortable clothing with trainers.
• Let your physiotherapist know of any conditions that may affect your ability to exercise, e.g. asthma, heart conditions, epilepsy. Please bring any relevant medication.

What is Core Stability?


Core stability is a general term used to describe the way the group of deep muscles that hold and support your spine work to maintain its stability. These muscles are very close to the bones of your
spine, and they form a supportive belt around your spine. These muscles are found at the front (transversus abdominus muscle), back (multifidus muscles), side (obliques) and underneath (pelvic floor muscles) the spine.

Why do I need to train my stability muscles?
Our lifestyles may involve long periods of sitting, standing or walking in a particular way. We are constantly bending, lifting, twisting and turning without any thoughts or awareness of the daily stress we are placing on our spines. These factors combined with repetitive bad lifting techniques, poor posture and lack of fitness can eventually lead to back pain and dysfunction. Our core muscles can become weak due to all of the above and are unable to cope effectively in stabilising and maintaining our spine and posture. It is therefore important to re-train these muscles to enable us to have good support and stability of our spine and allow us to get on with our daily lives.

How do I train my stability muscles?

Pelvic floor muscles (underneath)

The pelvic floor is a hammock of muscles across the lowest part of the pelvis. They are attached from the bottom of your spine known as the coccyx (tail bone) to the bone at the front (pubic bone). It supports the organs of the abdomen and pelvis and forms the bottom part of the core stability muscles.

Exercise: Find a comfortable position and try to squeeze the pelvic floor muscles gently from the front of the pubic bone all the way up the tail bone. Remember these muscles only need a gentle squeeze to get them to work correctly.

Transversus Abdominus (front)
This muscle lies deep within the lower part of your stomach, just above the pubic bone.

Exercise: Find a comfortable position and try to squeeze this muscle gently as if you were squeezing your belly button towards the back of your spine. Be careful not to pull your belly button upwards towards your head but instead towards your spine. Remember to squeeze gently, if you squeeze to hard you will see lots of movements happening from your big tummy muscles.

Multifidus (Back)
This muscle is made up of lots of smaller and deep muscles that run down the back of your spine. These muscles work together to keep your spinal bones (vertebrae) supported and stable, and form the final part of your core stability. To feel this moving, sink your thumbs/fingers on to the fleshy muscle either side of your spine whilst standing. Now try taking a few steps and you will be able to feel the muscle tensing up underneath you finger tips as you take your steps.

Oblique’s (side)
This muscle sits on the lateral anterior part of the abdomen. They perform contralateral rotation of the trunk.

Breath Control
When doing the core stability exercises it is important to breathe correctly and not hold your breath. The correct technique for this is to breathe from your diaphragm. The diaphragm is a dome shaped muscle that sits at the top of your stomach and below your hearts and lungs. When thinking about breathing correctly think about breathing from the lower ribs. Breathe normally and not too deeply or too shallow and try to keep breathing slow and controlled.

Anatomy of the Spine


Our spine is made up of bones, ligaments, joints, discs, muscles and nerves. It is designed to protect our spinal cord and helps maintain our upright posture. The spine has three natural curves known as the cervical, thoracic and lumbar spine. The cervical spine makes up the neck the thoracic spine consists of the mid section and the lumbar spine makes up the lower part of your spine. Below are the sacrum and coccyx which are fused vertebrae

Bones
The bones that make up your spine are called the vertebrae. We have 33 vertebrae in our spine, 24 are free moving and the rest are fused in your sacrum and coccyx. We have 7 in our neck, 12 in our mid spine and 5 in our lower back.

Discs


The discs of our spine act as a shock absorbers in between the vertebrae. They are oval in shape and contain an inner jelly like substance to help with movement and pressures from our daily activities.

Ligaments
These are the elastic bands of our body. There are hundreds around the spine and their job is to hold the bones and all the structures together. They are fairly elastic and can allow stretch as we move about. If you are hypermobile often our ligaments can be extra stretchy, it is therefore important to strength them to gain better control.

Spinal Cord
This is found in the centre of the spinal column surrounded and protected by all the vertebrae bones. This is the link between our brain and body and allows messages to travel up and down the spinal cord to allow for movement and activities.

Nerves
We have many nerves that branch off from the spinal cord. Each nerve leaves the spinal cord and supplies different areas of our body and helps with information to and from the brain.

Joints
The joints in our spine are known as facet joints and are either side of the vertebrae. Each joint allows movement in our spine and allows us to bend forwards, back, sideways and to turn/twist.

Useful hints and tips!
• Once you have completed the group sessions remember to maintain the exercise program that you have learnt.
• Try and take part in regular exercise. Activities such as swimming, cycling and walking help to keep you generally fit and healthy. Start gradually and build up as you feel you can. If you have an acute episode of back pain then remember to start exercising again as soon as you are able.
• Remember to lift correctly—bend your knees and hips into a squat position, keep the object close to your body and straighten your legs to lift.
• Watch your weight.
• Contact your GP or speak to your physio if you need any further advice regarding your back pain.