Core Stability from the Inside Out

Core Stability

Understanding the Core

You’d have to be living under a rock if you’ve never heard any references to core stability. It’s tied in to upper body strength, back pain, flat abs, and is considered the nirvana of fitness. However, there’s no definitive research that says dedication to your core will actually make a difference. No one can even agree on what the core is and what it does for the human body.

The Story Behind the Core

Take a look back over ten years ago to something known as the abdominal hollowing theory. Exercise gurus were focusing on the Transversus Abdominus, otherwise known as the layer of muscles beneath your six-pack that gives you a defined physique. They were telling people to tuck that belly button in during a workout for optimal results. Experts of today have another take on what works best to hone those abs and tell you to brace your abdomen like you’re getting ready to let someone sock it to you in the gut. Also referred to as abdominal bracing, it does more than strengthen your abs. It helps you to build up your lower back. However, if you really want to get results for your core, you’ve got to start working from the inside out.

What Exactly is the Core?

Take a look in the dictionary to find a definition of the core. The first reference you will find has to do with the center of the planet that we live on. You’ll find terms like the interior of something, the heart, or the middle. The main thing you need to remember is that the core in your body is not something that is hollow. It’s solid muscle that you need to strengthen to reap the greatest rewards.

How Can You Build Up Your Core?

Working at that deep layer of muscle that is in your abdomen takes focus. You’ve got a lot going on in your midsection. There’s the powerful muscle known as the diaphragm, expanding and contracting whenever you breathe. The pelvic floor is in the lower region of your trunk, by your pelvis, and it creates resistance. Your abdominal wall muscle is at work as well, applying pressure to your spine in the front of your body. At the same time, muscles in the lumbar region are hard at work on your back to balance out the effects of your abdominal muscles. Everything hinges on the diaphragm and making sure it is effectively contracting.

What’s the Deal with the Diaphragm?

If your core muscles are going to be at their best, you’ve got to place your energy on your diaphragm. The most important thing you need to remember is contraction of your diaphragm has to be the first step. Contraction of your abdominal wall comes next. You’ve got to make sure your diaphragm pushes down at the right time if you are going to give your spine the stability it needs and avoid issues like back pain at the same time.

Studies Prove the Diaphragm Performs Dual Functions

You might have thought the diaphragm was only important for breathing. Think again. Professor Kolar and his team of researchers discovered that the diaphragm also plays a vital role in establishing proper posture and stabilizing your body. As another interesting point, you can also control your diaphragm, making it do what you want when you want it to. Otherwise, it will perform it’s involuntary functions during breathing as well. You don’t have to think about your diaphragm most of the time. It is when you are working on your core that you need to devote attention to how you are making the best use of your diaphragm. The rest of the time it takes care of itself.

Back Pain and Lack of Diaphragm Control Appear to be Related

Further findings from Kolar’s studies suggest that core stability, diaphragm control, and back pain are connected. Subjects who had difficulty with controlled contraction of the diaphragm were more likely to lack core stability. They suffered for it with pain in the lower back. Interestingly enough, but the study that originally started the ball rolling about core stability did pinpoint the importance of the core. Hodges brought attention to the Transversus Abdominus and the core. For some reason, his mention of the diaphragm was lost in the shuffle.

What’s Going on with Your Diaphragm When You Breathe?

Most of the time, you probably don’t give your diaphragm a second thought. It’s quietly at work, doing what it should when you take a deep breath and let it out, or simply during the act of breathing that we all take for granted. When you inhale, your diaphragm goes through the contraction process, tightening up and pushing its way down. As it heads toward your abdominal cavity, you make room in the thoracic cavity, allowing your lungs to fill up like balloons as you take in the air you need to survive. If your diaphragm is working at optimal levels, it’s going to push down as far as possible into your abdominal cavity. A good way to know if you’re diaphragm is at its best is if you see the ribs in the lower part of your abdomen expanding. Forget about terms like chest breathing or belly breathing.

How Can You Tell if Your Diaphragm is Truly Performing?

If you are going to focus on your core, you need to pay attention to your diaphragm. You can put yourself to the test to see if this important muscle is doing its job properly. You can either lie down or sit up. Have someone place their hands on the lower portion of your ribcage. If your diaphragm is contracting to its full capacity and pushing its way down into your abdomen when you inhale, your ribs and abdominal wall are going to expand, or push out. If anything moves in an upward direction, your diaphragm is not doing what you want it to do. If the person testing your breathing can feel pressure in the lower portion of your abdomen when you inhale, you are on the right track. If you can keep applying pressure to the lower portion of your abdomen during the entire time while you are breathing, you will build up your core stability. It takes concentration and practice.

What Can You Do to Work the Core?

In order to strengthen your core and your diaphragm, you will need to exercise regularly. You can use a resistance band as a starting point. Place it around the lower portion of your ribcage or around your abdomen and keep applying pressure against that band. Move on with exercises that will force you to tighten your diaphragm, including favorites like dead-bugs or variations of the plank. To get results, you’ll have to work for it.

Should You Focus on the Core First or Last?

When it comes to exercising your core, there is no ideal time to focus on the core because it is at the heart of everything you do. As you perform any type of fitness activity, your core will be engaged. Always keep your mind on how effectively you are making use of your diaphragm will performing your workout. Your core is at work to make your spine stable and also takes care of your torso. If your diaphragm is working the way it should, your lower abdomen won’t cave in when you are working out. It will actually round out a bit. If you’ve got that sucked in appearance, you’re not doing it right. Remember that you should have some serious muscle at work in the lowest part of your stomach while you are breathing and pushing yourself during your fitness regimen. If you do, your core will be stable and your body will thank you.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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